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PubMed2001

[The safety of herbal medicines in the psychiatric practice].

The use of alternative medicines is increasing world-wide and in Israel. These drugs, considered by the Ministry of Health as food supplements, are to be obtained at pharmacies and health stores and are being sold freely, without any professional advice. Many of the herbs are used by patients to treat psychiatric disorders. These herbs have a pharmacological activity, adverse effects and interactions with conventional drugs, which can produce changes in mood, cognition, and behavior. We present the most commonly used herbal drugs, and discuss their safety and efficacy in psychiatric practice. Hypericum--used as an antidepressant and as an antiviral medicine, was reported in 23 randomized clinical trials reviewed from the MEDLINE. It was found to be significantly more effective than placebo and had a similar level of effectiveness as standard antidepressants. Recent studies almost clearly prove that this herb, like most of the conventional antidepressants, can induce mania. Valerian--is used as an anti-anxiety drug, and reported to have sedative as well as antidepressant properties. In contrast to the significant improvement in sleep that was found with the use of valerian, compared to placebo, there are several reports on the valerian root toxicity. This includes nephrotoxicity, headaches, chest tightness, mydriasis, abdominal pain, and tremor of the hands and feet. Ginseng--another plant that is widely used as an aphrodisiac and a stimulant. It has been associated with the occurrence of vaginal bleeding, mastalgia, mental status changes and Stevens-Johnson syndrome after it's chronic administration. It has interactions with digoxin, phenelzine and warfarin. Ginkgo--in clinical trials the ginkgo extract has shown a significant improvement in symptoms such as memory loss, difficulties in concentration, fatigue, anxiety, and depressed mood. Long-term use has been associated with increased bleeding time and spontaneous hemorrhage. Ginkgo should be used cautiously in patients receiving aspirin, NSAIDs, anticoagulants or other platelet inhibitors. Health care professionals can no longer ignore the widespread use of alternative medicines and cannot continue with the "don't ask, don't tell" policy. Clinicians should ask the patients about their use of herbs in a non-judgmental way, and should document the patient's use of these drugs. Finally, we must be more aware of the side effects and the potential drug interactions of these herbs, and advise our patients to avoid long term use of these drugs due to lack of information regarding the safety of these medicines.

Ginkgo biloba↗
PubMed2005

Management of insomnia: a place for traditional herbal remedies.

(1) Insomnia should be treated first with non drug measures; this has traditionally involved the use of herbal remedies. (2) About 20 plants are approved in France in the production of medications 'traditionally used' for minor sleep disturbances. Virtually nothing is known of their efficacy or potential dangers. (3) Most of these plants are suspected of toxicity and should therefore be avoided, especially in view of their unproven efficacy. (4) Littleleaf linden, vervain, melissa and orange flower have no demonstrated efficacy but are safe and can therefore be used. Similarly, there are no scientific grounds for rejecting preparations based on hawthorn or passiflora. (5) Available data suggest that valerian extracts have a modest impact on subjective sleep quality; they are nevertheless more effective than a placebo. Valerian products that do not contain valepotriates have no apparent adverse effects. It is best to avoid high-titre alcoholic extracts and powdered valerian root, and to select aqueous extracts and low-titre hydro-alcoholic preparations.

Anemone↗
PubMed1984

[Studies on the effect of Harmonicum Much on sleep using polygraphic EEG recordings].

The effects of 60 and 120 mg valerian (1 resp. 2 capsules Harmonicum Much) have been investigated by computer analysis of sleep stages (sleep profiles) and psychometric methods ( questionnaires ). EOG, EMG of cervical muscles, ECG and EEG (two-sided: centro-occipital and fronto-central - have been recorded from 6 male and 5 (3) female healthy volunteers. Amplified signals have been analysed on-line (power spectral analysis) and the sleep profiles have been calculated accordingly. After one night for adaptation, each subject took orally placebo, 60 and 120 mg valerian (1 resp. 2 capsules Harmonicum Much) according to a randomized double-blind repeated measures-design. The sleep investigations have been carried out by distance of a week for each condition (dosage per subject). In the morning following this night, the subjects completed a mood scale. Both dosages showed a decrease of sleep stage 4 and a slight reduction of REM-sleep. Contrary, a slight increase of sleep stage awake, 1 and 2 could be observed. A further increase of sleep stage 3 could be identified. After application of 120 mg valerian , the frequency of REM-phases (in %) declined during the first half of the night, whereas during the second part of the night, a surplus appeared. Changes or the Beta-intensity of the EEG during REM-sleep show a stronger hypnotic effect for the 120 mg dosage than for 60 mg. Maximum effect was observed between 2 and 3 hours post medicationem . Results of the mood scale are indifferent between the experimental conditions, which indicate no negative (side-) effects neither by drug nor by testing methods.

Adult↗
PubMed1996

[Vigilance-decreasing effects of 2 plant-derived sedatives].

Previous studies on the efficacy of valerian extracts have given occasional hints of possible side effects involving impaired vigilance. Because of the currently insufficient knowledge about potential impairment of vigilance by plant-based sedatives, we have conducted a controlled study to assess the effects of two plant-based sleep remedies in comparison with flunitrazepam and placebo after single oral administration. Aim of the study was to derive recommendations concerning potential hazards in driving or operating machinery. Residual sedative effects (hangover) were examined in four groups of 20 healthy volunteers, receiving either tablets containing valerian and hops or syrup containing valerian only or flunitrazepam or placebo; furthermore, immediate sedative effects of the two plant preparations have been examined in comparison with placebo (three groups of twelve healthy volunteers). The tests included objective measurements of cognitive psychomotor performance as well as subjective questionnaires on well-being. Tolerability was assessed from spontaneous reports of side effects and a verbal inquiry at the end of the tests. We found that objectively measurable impairment of performance on the morning after medication occurred only in the flunitrazepam group, a finding which was even more pronounced in the subjective questionnaires. In addition, 50% of the volunteers in the flunitrazepam group reported mild side effects in the inquiry at the end of the tests, compared with only 10% from the other groups. The subjective perception of sleep quality was improved in all three medication groups, when compared to placebo. Examination of acute effects of the plant remedies 1 to 2 hours after administration revealed no changes in the more important lead variables; however, a very slight impairment of vigilance after taking syrup was statistically significant as well as a retardation in the processing of complex information for the tablets. The subjective perception of effects was more pronounced (shaky legs, feeling less active). In conclusion, the residual sedative effects (hangover) observed in some earlier studies cannot be confirmed for the recommended doses of the two plant-based sleep remedies which we have examined with respect to vigilance and cognitive performance. On the contrary: our findings show improved subjective self-assessment (more alert, more active, feeling better). Hangover effects on the following morning need not be a cause for concern, which is of particular interest to car drivers; however, a slight impairment of performance during the first few hours after ingestion should be anticipated. Impairment of vigilance on the morning after ingestion of benzodiazepines, frequently reported and confirmed by our results, constitutes a potential hazard. In this situation, plant remedies such as those examined in this study should be considered as viable alternatives.

Adult↗
PubMed2000

Anterior electroencephalographic asymmetry changes in elderly women in response to a pleasant and an unpleasant odor.

Greater left than right frontal EEG activation has been associated with increased positive and/or decreased negative affect, whereas greater right than left frontal activation has been associated with the opposite pattern. Substantial research has documented the trait properties of asymmetry, as well as responses to pleasant and unpleasant stimuli. The present study examined changes in anterior alpha asymmetries in response to pleasant (vanilla), unpleasant (valerian), and neutral (water) odors. As predicted, vanilla produced relative left frontal activation compared to valerian and water. Frontal asymmetry did not differ in response to valerian compared to water. The results are consistent with the hypothesis that the left frontal region of the brain is involved in positive/approach-related emotion, and extend previous results into the olfactory realm.

Affect↗
PubMed1978

Serum FSH, LH and oestrone levels in postmenopausal patients on oestrogen therapy.

Serum FSH, LH and oestrone levels were determined in postmenopausal women before and at 1, 3 and 6 months after the onset of cyclical treatment with 0.05 mg of ethinyl oestradiol (n = 19) or 2 mg of oestradiol valerianate (n = 20). Most samples from the women taking oestradiol valerianate were also analyzed for oestradiol. Vaginal smears were obtained from all patients. Although all women were relieved of vasomotor symptoms, the FSH levels usually exceeded the fertile range. Ethinyl oestradiol reduced FSH by 70 to 75 per cent and LH by 30 to 40 per cent while oestrone was increased by 20 to 40 per cent. In the women taking oestradiol valerianate, FSH and LH levels were both reduced by 20 to 25 per cent wheras serum oestradiol increased by 200 to 300 per cent and oestrone increased by 600 to 700 per cent. The mean vaginal maturation value rose equally in the two groups but 40 per cent of the patients in both groups showed no change in the value. There was no correlation between the appearance of vaginal endocrine smears and hormone levels.

Estradiol↗
PubMed1999

Concentration of volatile fatty acids in digesta samples obtained from healthy cows and cows with cecal dilatation or dislocation.

OBJECTIVE: To compare concentrations of acetic, propionic, butyric, and i- and n-valerianic acids in digesta samples obtained from the rumen, cecum, proximal loop of the ascending colon (PLAC), and rectum of healthy cows and cows with cecal dilatation or dislocation (CDD). ANIMALS: 20 cows with CDD and 20 healthy cows. PROCEDURE: Samples were collected from all sites during surgical correction of CDD and also from the rectum 1, 2, and 3 days after surgery (group CDD). Samples from healthy (control) cows, matched on the basis of diet and milk yield, were obtained at a slaughterhouse. Concentrations of volatile fatty acids (VFA) were analyzed by use of gas chromatography. Absolute concentration of each VFA was additionally corrected for pH to allow calculation of the concentration of undissociated VFA. RESULTS: Absolute concentration and concentration of the undissociated form of all analyzed VFA were significantly increased in samples collected from the cecum and PLAC of cows in group CDD, compared with concentrations for control cows. Within 3 days after surgery, significant decreases of the absolute concentration of butyric, i- and n-valerianic acids, and undissociated i- and n-valerianic acids were evident in samples obtained from the rectum of group-CDD cows. Concentrations of VFA in samples obtained from the rectum during surgery correlated with corresponding VFA concentrations in samples obtained from the PLAC. CONCLUSIONS: Concentrations of VFA are increased in the cecum and PLAC of cows with CDD. However, the role of increased concentrations of VFA in the etiopathogenesis of CDD is unknown.

Animals↗
PubMed2001

Herbal medicines and perioperative care.

CONTEXT: Widespread use of herbal medications among the presurgical population may have a negative impact on perioperative patient care. OBJECTIVES: To review the literature on commonly used herbal medications in the context of the perioperative period and provide rational strategies for managing their preoperative use. DATA SOURCES: The MEDLINE and Cochrane Collaboration databases were searched for articles published between January 1966 and December 2000 using the search terms herbal medicine, phytotherapy, and alternative medicine and the names of the 16 most commonly used herbal medications. Additional data sources were obtained from manual searches of recent journal articles and textbooks. STUDY SELECTION: We selected studies, case reports, and reviews addressing the safety and pharmacology of 8 commonly used herbal medications for which safety information pertinent to the perioperative period was available. DATA EXTRACTION: We extracted safety, pharmacodynamic, and pharmacokinetic information from the selected literature and reached consensus about any discrepancies. DATA SYNTHESIS: Echinacea, ephedra, garlic, ginkgo, ginseng, kava, St John's wort, and valerian are commonly used herbal medications that may pose a concern during the perioperative period. Complications can arise from these herbs' direct and pharmacodynamic or pharmacokinetic effects. Direct effects include bleeding from garlic, ginkgo, and ginseng; cardiovascular instability from ephedra; and hypoglycemia from ginseng. Pharmacodynamic herb-drug interactions include potentiation of the sedative effect of anesthetics by kava and valerian. Pharmacokinetic herb-drug interactions include increased metabolism of many drugs used in the perioperative period by St John's wort. CONCLUSIONS: During the preoperative evaluation, physicians should explicitly elicit and document a history of herbal medication use. Physicians should be familiar with the potential perioperative effects of the commonly used herbal medications to prevent, recognize, and treat potentially serious problems associated with their use and discontinuation.

Dietary Supplements↗
PubMed1994

Effect of valepotriates on the behavior of rats in the elevated plus-maze during diazepam withdrawal.

The effect of a mixture of valepotriates on the elevated plus-maze performance of diazepam withdrawn rats was evaluated. The rats were chronically (28 days) treated with diazepam (doses increased up to 5.0 mg/kg) and then treated with control solution for 3 days to induce a withdrawal syndrome. Chronically vehicle-treated rats were used as control. The abstinent animals treated with vehicle showed a significant decrease in the percentage of time spent in the open arms when compared with the control animals. Diazepam and valerian 12.0 mg/kg reversed this anxiogenic effect. Valerian 6.0 mg/kg did not show any difference in relation to the others group.

Analysis of Variance↗
PubMed2004

Essential oil of Valeriana officinalis L. cultivars and their antimicrobial activity as influenced by harvesting time under commercial organic cultivation.

The essential oil content and the composition of subterranean parts of two valerian (Valeriana officinalis, L.) cultivars Select and Anthose, from certified commercial organic fields, were determined by hydrodistillation, followed by gas chromatography (GC) and GC/mass spectrometry analysis. Eight and fourteen month old cv. Select had 0.67 and 0.87% essential oil, while similar aged cv. Anthose contained 0.97 and 1.1% essential oil. Forty-three and fifty-three components from cv. Select and cv. Anthose oils were detected, respectively. The oil composition significantly varied due to the cultivar type, plant age, and/or harvesting time. The major components for cv. Select were valerenal, bornyl acetate, 15-acetoxy valeranone, valerenic acid, and camphene, while cv. Anthose had valerenal, (-)-bornyl acetate, alpha-humulene, camphene, 15-acetoxy valeranone, and valerenic acid. With further aging of the plants, the valerenal, valerenic acid, and alpha-humulene contents increased. The oil of cv. Select had a strong antimicrobial effect against Aspergillus niger, Escherichia coli, Staphylococcus aureus, and Saccharomyces cerevisiae, while cv. Anthose showed low or no activity against all test microbes, including Pseudomonas aeruginosa, suggesting that the inhibitory activity of valerian oil depends on the cultivar and its developmental stage. The oil profile of our cultivars did not match the literature proposed chemotype profiles.

Agriculture↗
PubMed2001

Mitigation of stress-induced suppression of contact hypersensitivity by odorant inhalation.

BACKGROUND: Various skin functions are affected by stress. We have previously shown that odorant inhalation can regulate skin immune reactions. OBJECTIVES: To test the hypothesis that certain odorants can mitigate the effects of stress on skin immune reactions. METHODS: Contact hypersensitivity (CH) reactions were elicited in C57BL/6 mice. Mice were subjected to immobilization stress and were exposed to odorants for 2 days. Epidermal sheets were stained for I-A antigens and analysed by confocal laser scanning microscopy. Serum corticosterone levels were assayed by radioimmunoassay. RESULTS: Exposure of mice to 1,3-dimethoxy-5-methylbenzene (DMMB) had no effect on the intact CH reaction, but it upregulated the reaction suppressed by immobilization stress. Other odorants, including terpinyl acetate and valerian oil, had minor effects on the CH reaction. Suppression of I-A-positive cells was prevented by DMMB inhalation. Valerian oil, but not DMMB, downregulated stress-induced plasma corticosterone levels. CONCLUSIONS: Results suggest that odorant inhalation modulates various physiological pathways, some of which result in regulation of skin function.

Animals↗
PubMed2001

Herbal-drug therapy interactions: a focus on dementia.

Older people with dementia are often prescribed numerous medications. Use of herbal therapies in addition to these conventional drug therapies may lead to interactions that result in an adverse drug event. We have conducted a systematic review to identify all studies that examined interactions between herbal and conventional drug therapies (i.e. prescription or over-the-counter). Using a MEDLINE search of English-language studies published between 1980 and 2000, we limited our search to those herbal therapies most likely to be used for the treatment of dementia (memory loss and decreased concentration) and related symptoms. We identified 28 articles that describe interactions between these herbal (i.e. St. John's wort, ginkgo biloba, kava, valerian, and ginseng) and conventional drug therapies. Of these articles, 11 examined St. John's wort, four examined ginkgo biloba, five examined kava, one examined valerian, and seven examined ginseng. We identified a series of potential interactions between herbal and conventional drug therapy that place older people at risk for an adverse drug event. Health care professionals need to be aware of these potential interactions.

Aged↗
PubMed2004

Safety and efficacy of herbal sedatives in cancer care.

Insomnia and other sleep disturbances are common in cancer patients. Insomnia is a multifactorial health concern that currently affects at least 1 in 3 cancer patients, and yet most insomnia sufferers do not consult their physician regarding pharmaceutical options for relief. Use of hypnotic drugs (primarily benzodiazepines) is associated with increasing tolerance, dependence, and adverse effects on the central nervous system. While hypnotic drug use declined substantially in the past decade, the use of herbal sedatives appeared to increase. Mostly self-prescribed by lay people, herbal sedatives hold widespread appeal, presumably because of their lower cost and higher margin of safety when compared to pharmaceuticals. Studies of better-known herbal sedatives, notably valerian and kava, showed moderate evidence for both safety and efficacy for valerian while revealing disturbing toxicity concerns for kava. Milder sedatives or anxiolytics in need of clinical study include German chamomile, lavender, hops, lemon balm, and passionflower; St. John's wort may have anxiolytic effects with relevance to sleep. Herb-drug interactions are a possibility for some of these species, including St. John's wort. Although sufficient evidence exists to recommend some of these agents for short-term relief of mild insomnia, long-term trials and observational studies are needed to establish the safety of prolonged use as well as overall efficacy in the context of cancer treatment and management.

Humans↗
PubMed1999

Assessing the risks and benefits of herbal medicine: an overview of scientific evidence.

The use of herbal medicine is widespread and growing, with as many as 3 in 10 Americans using botanical remedies in a given year. Because many herbal medicines have significant pharmacological activity, and thus potential adverse effects and drug interactions, healthcare professionals must be familiar with this therapeutic modality. This article summarizes the history and current use of plant-based medicine and highlights the evidence of the risks and benefits associated with 6 plants: echinacea, garlic, ginger, ginkgo, St John's wort, and valerian. Therapies outside the medical mainstream tend to suffer from a dearth of research and critical evaluation. Critics and supporters alike note the conceptual and practical difficulties in studying many complementary and alternative therapies such as acupuncture, homeopathy, and meditation. Herbal medicine, however, lends itself well to standard evaluation methods. This article summarizes and evaluates evidence from randomized controlled trials and meta-analyses. We present the results of meta-analyses and subsequent randomized controlled trials for garlic and St John's wort; a comprehensive critical review and subsequent randomized controlled trials for ginkgo; and summaries of all identified randomized controlled trials for echinacea, ginger, and valerian.

Ericales↗
PubMedDate not supplied

Chemical fingerprinting of valeriana species: simultaneous determination of valerenic acids, flavonoids, and phenylpropanoids using liquid chromatography with ultraviolet detection.

The roots and rhizomes of various valeriana species are currently used as a sleeping aid or mild sedative. A liquid chromatography method has been developed that permits the analysis of chlorogenic acid, lignans, flavonoids, valerenic acids, and valpotrates in various valerian samples. The best results were obtained with a Phenomenex Luna C18(2) column using gradient elution with a mobile phase consisting of water and 0.05% phosphoric acid and 2-100% acetonitrile-methanol (1 + 1) with 0.05% phosphoric acid. The flow rate was 0.8 mL/min and ultraviolet detection was at 207, 225, 254, 280, and 325 nm. Different valerian species and commercial products showed remarkable quantitative variations. Chlorogenic acid (0.2-1.2%), 3 lignans, linarin (0.002-0.24%), and valepotriates were detected in all the valeriana species analyzed. Highest amounts of valerenic acids were detected in V. officinalis L., trace amounts in V. sitchensis, and none in the other species analyzed.

Acetonitriles↗
PubMedDate not supplied

Authentication of Valeriana procera Kunth and comparative account of five Valeriana species.

Valeriana procera Kunth (Mexican Valerian) is a commercially important species, sometimes used as a substitute for Valeriana officinalis L., an important sedative in herbal medicine. A detailed macroscopic and microscopic account was provided for V. procera Kunth and a comparison was made between the wild and cultivated samples of V. procera Kunth. Macro- and microscopic comparative analyses were performed to differentiate V. procera Kunth from V. officinalis L. and other commercially important Valerian species such as V. jatamansi Jones, Valeriana edulis Nutt, and V. sitchensis Bong.

Chemistry Techniques, Analytical↗
PubMed1998

[Comparative study for assessing quality of life of patients with exogenous sleep disorders (temporary sleep onset and sleep interruption disorders) treated with a hops-valarian preparation and a benzodiazepine drug].

This randomized, double-blind, controlled clinical trial in parallel group design demonstrated equivalent efficacy and tolerability of a hop-valerian preparation compared with a benzodiazepine preparation in patients suffering from sleep disorders according to DSM-IV criteria. Sleep quality, fitness and quality of life were determined by psychometric tests, psychopathologic scales and sleep-questionnaires at the beginning of the therapy, end of therapy (duration 2 weeks) and then 1 week after cessation of therapy. Patients' state of health (4-point scale) and medication tolerability (occurrence of adverse events) were documented. Using the following as parameters "Alphabetischer Durchstreichtest, Feinmotoriktest, Befindlichkeitsskala, Beschwerdeliste, Schlaffragebögen A and B" the differences between beginning and the end of the therapy were analyzed by simultaneous testing of the equality or superiority of the test preparation. The equivalence of both therapies according to sleep quality, fitness and quality of life was proven by a Mann-Whitney-Statistic of 0.50 with a lower boundary of the 95% confidence interval of 0.46. The patients' state of health improved during therapy while showing a deterioration after cessation with both preparations. Withdrawal symptoms, however, were documented with benzodiazepine. Only one adverse drug reaction was reported during this study, namely stomach complaints from both the test and reference medication. This study shows that the investigated hop-valerian preparation in the appropriate dose is a sensible alternative to benzodiazepine for the treatment of nonchronic and non-psychiatric sleep disorders.

Adult↗
PubMed1998

The case of the salad shooters: intravenous injection of wild lettuce extract.

Three young adult drug users obtained wild lettuce and valerian root, prepared a crude aqueous extract of the wild lettuce, and injected the extract i.v. One also injected an alcohol extract of the valerian root. All 3 rapidly became ill with fevers, chills, abdominal pain, flank and back pain, neck stiffness, headache, leucocytosis and mild liver function abnormalities, but recovered over the next 3 d. Various literature and internet sources claim that wild lettuce has opiate properties not demonstrated in this case.

Adult↗