Iberogast (STW-5)
Best-in-class: Iberogast
A fixed liquid combination of nine herbal extracts — bitter candytuft, angelica root, milk thistle fruit, celandine, caraway, liquorice, peppermint, lemon balm and chamomile. It is one of the very few botanicals in this catalog with a placebo-controlled meta-analysis behind it rather than tradition alone.
Iberogast (STW-5) quick facts
| Suggested dose | 20 drops three times daily, with meals. |
| How often | three times daily |
| Who it's for | Functional dyspepsia — early fullness, upper-abdominal pain, bloating after normal-sized meals. The best-evidenced botanical here for that specific picture. |
This is one of a very small number of herbal products in this category with a real meta-analysis behind it rather than a tradition and a good story. That alone puts it ahead of most of the shelf. The honest caveat is celandine: rare but real reports of liver injury led European regulators to review celandine-containing products, so this is not one to take casually or indefinitely, and not at all with existing liver disease. Used as a defined course rather than a daily habit, it earns its place.
How Iberogast (STW-5) actually works
Nine herbs, and the interesting part is that they do not all pull in the same direction. STW-5 relaxes the fundus — the part of the stomach that should expand to accept a meal — while increasing motility further down in the antrum. That combination is why it helps both the person who feels full after four bites and the person whose meal sits there for hours, which most single-herb products cannot do. The same region-specific effect is the basis for using it between meals to support the migrating motor complex, the sweeping wave that keeps the small intestine clear — though that application is an extrapolation from the dyspepsia trials, not something tested directly.
Where to get Iberogast (STW-5)
Find Iberogast (STW-5) on iHerb →The evidence for Iberogast (STW-5)
Graded by what exists behind each claim.
✅ Clinically validated
- A 2004 meta-analysis pooling three randomized placebo-controlled trials (173 patients) found it more effective than placebo for functional dyspepsia, with the benefit clearest where reflux symptoms or epigastric pain predominated. Melzer J, Aliment Pharmacol Ther 2004 — PMID 15606389 (https://pubmed.ncbi.nlm.nih.gov/15606389/).
- A reference-controlled trial against cisapride — a prokinetic drug — found no significant difference in efficacy or tolerability.
📊 Correlative data
- Decades of routine use in Germany for functional dyspepsia, where it is sold as a licensed medicine rather than a supplement.
🧪 Theoretical / extrapolated benefits
- The proposed mechanism is region-specific rather than global: relaxing the gastric fundus so the stomach accommodates a meal, while stimulating antral motility so it empties. That would explain why it helps fullness and early satiety specifically, rather than acting as a general antispasmodic.
- The trial evidence is for functional dyspepsia. Extending it to SIBO or IBS is extrapolation from an overlapping symptom set, not a demonstrated effect.
How to read these tiers: they say how much human evidence exists, not how well something works — and ✗ flags harm, never a disappointing trial. How the evidence tiers work →
What Iberogast (STW-5) actually does
This is a fixed combination, and the interesting thing about it is that the nine extracts are proposed to act on different parts of one organ at the same time. The mechanism review of STW 5-II describes a region-specific action rather than a single global one: relaxation of the gastric fundus so the stomach accommodates a meal, alongside stimulation of antral motility so it empties Annahazi 2025. Those are opposite effects on smooth muscle a few centimeters apart.
That regional split is what makes the symptom targeting specific. Impaired fundic accommodation is the physiology behind early satiety and postprandial fullness; delayed antral emptying is the physiology behind postprandial heaviness. A preparation that relaxes one compartment and drives the next is aimed at those two symptoms and not at reflux, not at pain of another origin, and not at the colon Lambiase 2025.
The clock is in the dosing instruction and nobody explains why. Twenty drops three times daily with meals is not an arbitrary convenience. Gastric accommodation is a reflex that happens during a meal, over minutes, and a preparation intended to modify it has to be present in the stomach while the meal is arriving. This is the rare supplement whose schedule is the mechanism, and a dose taken between meals is a dose taken outside the event it is meant to modify.
A newer formulation makes the composition question live. STW 5-II is a reduced-herb version of the original combination, and it has its own trial record Andresen 2024 Aguilar 2025. Whichever bottle a reader has, the mechanism argument belongs to a specific mixture rather than to any of its nine plants individually.
Cell, rodent, human — and where it stops
The unusual feature of this entry is that the human evidence is the strong part and the plant list is the weak part.
What has been measured in people. A patient data-based meta-analysis of STW 5-II in functional dyspepsia pooled individual participant data rather than published summaries Andresen 2024. A controlled study examined the effect of STW 5-II on tolerance to gastric gas in patients with functional dyspepsia Aguilar 2025. A general-practice study reported effectiveness, safety and tolerability in children with functional gastrointestinal disorders Michael 2022. For a botanical, that is an unusually orderly record.
The specific obstacle is that the trials are in functional dyspepsia and the shelf sells it for everything upstream and downstream. The narrative review of this phytomedicine is explicit that the indication is a disorder of gut-brain interaction with defined diagnostic criteria Lambiase 2025 Annahazi 2025. Extending it to small intestinal bacterial overgrowth or to irritable bowel syndrome is an extrapolation across an overlapping symptom set, not a demonstrated effect.
The second obstacle is that the formulation moved under the evidence. The older combination and STW 5-II are not the same mixture, and the newer trials belong to the newer mixture Andresen 2024 Aguilar 2025. A reader holding a bottle has to check which one they have before deciding which literature applies to it.
What would close the gap. Report which formulation, and report symptom subgroups rather than a global score, because the mechanism predicts fullness and early satiety should move more than anything else Annahazi 2025. The review literature on herbal medicines in functional dyspepsia already frames the opportunity and the risk together Gwee 2021.
Iberogast (STW-5) — which form, and does it matter
The form question on this page is which herbs are in the bottle, and the answer changed in 2020. The original nine-herb liquid contained celandine, Chelidonium majus. A reformulated version without it exists, and the trial program that carries the STW 5-II name belongs to the reduced mixture Andresen 2024 Aguilar 2025. Two products, similar names, different composition, and the difference is the herb with the safety record.
Celandine is the constituent with the liver signal. A review of the alkaloids of Chelidonium majus covers its phytochemistry, pharmacology and toxicology together Li 2024, and a systematic review with meta-analysis of herb-induced liver injury places this genus in the wider pattern of idiosyncratic hepatotoxicity from botanicals Ballotin 2021.
A liquid extract is also a dosing form with a dosing problem. Drops are counted by a person, at a bottle angle, three times a day. Compared with a tablet, that is a wider dose distribution before anything pharmacological has happened -- which matters more, not less, when a component carries an idiosyncratic risk.
What this page does not claim. No filed panel for this product has been read into supplements_data.BLENDS, so nothing here asserts the contents of a specific bottle. The composition question above is the question a reader should answer from the carton in their own hand.
What would have to be true, and how you would know it was not
1. The symptom-specificity prediction, at 4 weeks. Score postprandial fullness, early satiety, epigastric pain and reflux separately at baseline and 4 weeks. Predict fullness and early satiety move most, because those map onto fundic accommodation Annahazi 2025. If reflux is the only thing that improves, the mechanism on this page is not the one operating.
2. The timing prediction. Two weeks taking it with meals, two weeks taking the same daily total between meals. Predict the with-meals block wins, because accommodation is a mealtime reflex. This is the cleanest test of the clock argument here and nobody has published it.
3. The liver prediction, and it is a monitoring schedule rather than a threshold. Alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase and bilirubin before starting and again at 8 weeks if use continues. Predict no change in the great majority, and understand that a normal 8-week panel does not license month six, because the injury pattern in this class is idiosyncratic rather than dose-dependent Ballotin 2021 Li 2024.
4. The formulation prediction. If both versions can be obtained, run each for 4 weeks against the same symptom diary. Predict no loss of benefit from the celandine-free mixture, because the newer trial record is built on it Andresen 2024. A loss of benefit would be genuinely important and nobody has looked.
5. The gas-tolerance prediction. Predict improved tolerance of a gas load rather than less gas produced, which is the distinction the controlled gastric-gas study was designed to make Aguilar 2025.
What nobody has tested yet
Nobody has run the with-meals versus between-meals comparison. The dosing instruction has been the same for decades and rests on the accommodation mechanism Annahazi 2025 rather than on a randomized schedule.
Nobody has published a head-to-head of the two formulations. The reduced mixture has its own evidence Andresen 2024 and the original has its own history, and no trial has compared them directly.
Nobody knows which of the herbs carries the effect. The preparation is trialed and licensed as a fixed combination Lambiase 2025, and no dismantling study has removed one component at a time.
And nobody can predict the idiosyncratic liver reaction. No genotype, no baseline test and no dose threshold identifies who will have it Ballotin 2021, which is exactly why the review literature pairs the opportunity with the risk in one sentence Gwee 2021.
Iberogast (STW-5) — its own safety story, not its category's
The risk that belongs to this preparation rather than to its category is idiosyncratic hepatocellular injury, and its clock is one to six months. That is the part a symptom list leaves out. The injury pattern described for this class of botanical is not dose-dependent Ballotin 2021 Li 2024, so a small dose is not protection and an uneventful first month is not clearance.
The single most useful decision is which formulation to buy. The celandine-free version exists and carries the newer trial record Andresen 2024 Aguilar 2025. Choosing it removes the component that carries the liver signal without giving up the evidence.
The symptoms to stop for are specific. Dark urine, pale stools, right upper quadrant pain, unusual fatigue, or any yellowing of skin or eyes -- stop and get liver enzymes checked. Anyone with existing liver disease should not start, and anyone continuing beyond a few weeks is a candidate for a baseline and a follow-up panel Ballotin 2021.
Two component-level cautions that are not about the liver. The classic mixture contains licorice, which with sustained use can raise blood pressure and lower potassium, and peppermint, which can worsen reflux by relaxing the lower esophageal sphincter -- the same relaxation that helps the stomach below it Annahazi 2025. Pediatric use has been described in general practice Michael 2022, and that is a description of practice rather than a recommendation. Nothing here is medical advice or a diagnosis, and none of these statements has been evaluated by the Food and Drug Administration.
Sources read for this page
- Aguilar A. Effect of STW 5-II (Iberogast-N) on Tolerance to Gastric Gas in Patients With Functional Dyspepsia. The IBO-2 Study. Neurogastroenterol Motil 2025 · PMID 40684457
- Andresen V. Efficacy and Safety of STW 5-II for Functional Dyspepsia Treatment: A Patient Data-Based Meta-Analysis. Digestion 2024 · PMID 38246134
- Lambiase C. Iberogast in functional dyspepsia: yesterday, today, and tomorrow - a narrative review of a multitarget phytomedicine. Expert Opin Pharmacother 2025 · PMID 41319263
- Annahazi A. A Review of the Mechanisms of Action of the Herbal Medicine, STW 5-II, Underlying Its Efficacy in Disorders of Gut-Brain Interaction. Neurogastroenterol Motil 2025 · PMID 40275491
- Gwee KA. Herbal medicines in functional dyspepsia: Untapped opportunities not without risks. Neurogastroenterol Motil 2021 · PMID 33258198
- Michael R. Functional gastrointestinal disorders in children: Effectivity, safety, and tolerability of the herbal preparation STW-5 (Iberogast) in general practice. Complement Ther Med 2022 · PMID 35998755
- Li XL. Alkaloids in Chelidonium majus L: a review of its phytochemistry, pharmacology and toxicology. Front Pharmacol 2024 · PMID 39239653
- Ballotin VR. Herb-induced liver injury: Systematic review and meta-analysis. World J Clin Cases 2021 · PMID 34307603
How you would know if it worked
There is no blood test for this one. That is not a criticism — it is a fact about the effect, and it changes how you should judge it.
- What to watch: Early fullness and upper-abdominal pain after normal-sized meals — the functional dyspepsia picture the pooled trials measured, and specifically the fullness end of it, because the proposed action is relaxing the gastric fundus so the stomach accommodates a meal while antral motility keeps emptying it. Lower-abdominal bloating sits outside what was measured.
- How long before it means anything: Two to four weeks of three-times-daily dosing with meals. If the accommodation mechanism is real for you, tolerance of a normal meal volume is where it shows first.
- What will fool you: The liver risk runs on a longer clock than the benefit. Celandine-associated hepatocellular injury typically appears one to six months in and is idiosyncratic rather than dose-dependent, so a comfortable first month is not a safety result. Use the celandine-free Advance formulation, and treat dark urine, pale stools or right-upper-quadrant pain as a stop signal rather than a footnote.
Run it one variable at a time. Starting three things in one week means a result you cannot attribute, which is the same as no result.
Iberogast (STW-5) — safety & side effects
- Liver injury is the one that matters, and it is not dose-dependent. Of the nine herbs, only celandine (Chelidonium majus) has been associated with hepatotoxicity — over a dozen European reports of acute hepatocellular injury, typically appearing one to six months in, and idiosyncratic rather than dose-related, so running a small dose is not protection.
- Prefer the celandine-free formulation. Germany's BfArM asked Bayer to warn consumers in 2008 and was refused; warnings were only forced in 2018, after a patient died of liver failure. Bayer launched Iberogast Advance in October 2020 without celandine, angelica root or milk thistle.
- Stop immediately and get liver enzymes checked for dark urine, pale stools, right-upper-quadrant pain, unusual fatigue or any yellowing of skin or eyes. Not for anyone with existing liver disease, and worth a baseline and follow-up liver panel if you stay on it beyond a few weeks.
- Contains liquorice, which can raise blood pressure and lower potassium with sustained use, and peppermint, which can worsen reflux by relaxing the lower esophageal sphincter — the same relaxation that helps the stomach above it.
Not medical advice. If you take prescription medication or have a diagnosed condition, check this against it with a pharmacist or doctor — pharmacists are underused and free.
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Unlock in Skool — $10/mo →Bloodwork to run alongside Iberogast (STW-5)
Baseline first, then again at 8–12 weeks.
| Marker | What it’s watching for |
|---|---|
| Complete Blood Count (CBC) with Differential | Anemia is the commonest sign of a gut absorbing badly |
| Ferritin | Iron is the first thing malabsorption takes |
| Vitamin B12 | The second thing, and the one with permanent consequences |
| hs-CRP (High-Sensitivity C-Reactive Protein) | Separates inflammatory bowel disease from IBS |
The Gut Health & Absorption panel covers these in one order — 11 markers, $208.80 with the discount applied.
Check results you already have → · All 103 markers A–Z
Iberogast (STW-5) — frequently asked questions
What is Iberogast (STW-5)?
A fixed liquid combination of nine herbal extracts — bitter candytuft, angelica root, milk thistle fruit, celandine, caraway, liquorice, peppermint, lemon balm and chamomile. It is one of the very few botanicals in this catalog with a placebo-controlled meta-analysis behind it rather than tradition alone.
What is the suggested dose of Iberogast (STW-5)?
20 drops three times daily, with meals. This is a general reference for education only — statements have not been evaluated by the FDA and this is not medical advice.
Where can I find Iberogast (STW-5) dosing and the full breakdown?
The suggested dose and the full evidence — clinical, correlative and theoretical — are on this page. What's inside Skool is when to take it, which form actually absorbs, the brand worth buying and Coach Cam's stacks.
Where can I buy Iberogast (STW-5)?
Coach Cam sources Iberogast (STW-5) from vetted, top-rated brands on iHerb — use the buy link on this page.
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