Valerian (Valeriana officinalis L.)
  
Valerian (Valeriana officinalis L.)
Background
Valerian is an herb native to Europe and Asia, and now grows in most parts of the world. The name is believed to come from the Latin word "valere" meaning to be healthy or strong. The root of the plant is believed to contain its active constituents. Use of valerian as a sedative and anti-anxiety treatment has been reported for more than 2000 years. For example, in the 2 nd century AD, Galen recommended valerian as a treatment for insomnia. Related species have been used in traditional Chinese and Indian Ayurvedic medicine. Preparations for use on the skin have been used to treat sores and acne, and valerian by mouth has been used for other conditions such as digestive problems, flatulence (gas), congestive heart failure, urinary tract disorders, and angina.
Valerian extracts became popular in the U.S. and Europe in the mid-1800s, and continued to be used by both physicians and the lay public until it was widely replaced by prescription sedative drugs.
Valerian remains popular in North America, Europe, and Japan and is widely used to treat insomnia and anxiety. Although the active ingredients in valerian are not known, preparations are often standardized to the content of valerenic acid.
Synonyms
All-heal, amantilla, balderbrackenwurzel, baldrian, baldrianwurzel, baldrion, Belgian valerian, common valerian, fragrant valerian, garden heliotrope, garden valerian, great wild valerian, herba benedicta, heliptrope, Indian valerian, Jacob's ladder, Japanese valerian, katzenwurzel, laege-baldrian, Mexican valerian, Nervex®, Neurol®, Orasedon®, pacific valerian, phu, phu germanicum, phu parvum, pinnis dentatis, racine de valèriane, radix valerian, red valerian, Sanox-N®, Sedonium®, setewale capon's tail, setwall, setwell, theriacaria, Ticalma®, V. edulis, V. faurieri , V. foliis pinnatis, V. jatamansi, V, radiz, V. sitchensis, V. wallichii , valerianae radix, Valerianaceae (family) , Valerianaheel®, valeriane, Valmane®, vandal root.
Evidence
These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Uses based on scientific evidenceGrade*Insomnia
Several studies in adults suggest that valerian improves the quality of sleep and reduces the time to fall asleep (sleep latency), for up to 4-6 weeks. Ongoing nightly use may be more effective than single-dose use, with increasing effects over 4 weeks. Better effects have been found in poor sleepers. However, most studies have not used scientific ways of measuring sleep improvements, such as sleep pattern data in a sleep laboratory. Studies of combination valerian-hops or valerian-St. John's wort products are promising, but further study is needed before a strong recommendation can be made. It is not clear how valerian compares to prescription sleep aids. Initial research suggests that valerian may also be helpful in children with sleep disorders.
B
Anxiety disorder
Several studies of valerian have reported benefits in reducing non-specific anxiety symptoms. Valerian has also been given in combination with other herbs, such as passionflower and St. John's wort to treat anxiety. However, most studies have been small and poorly designed. More research is needed before a recommendation can be made.
C
Sedation
Although valerian has not been studied specifically as a sedative, evidence from studies conducted for other purposes suggests that valerian may not have significant sedative effects when used at recommended doses. Therefore, even though valerian could be helpful as a sleep aid, it does not appear to cause sedation.
D
* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).
Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Acne, amenorrhea (lack of menstruation), angina, anorexia, anti-seizure, antiperspirant, antiviral, anxiety, arthritis, asthma, bloating, bronchospasm/asthma, congestive heart failure,constipation, cough, cramping (abdominal, pelvic, menstrual), depression, digestive problems, diuretic (increase urine flow), dysmenorrhea (pain with menstrual cycle), emmenagogue (stimulation of menstrual blood flow), fatigue, fever, flatulence (gas), hangovers, headache, heart disease, heartburn, high blood pressure, HIV, hypochondria, irritable bowel syndrome, liver disorders, measles, memory enhancement, menopause, migraine, mood enhancement, muscle pain/spasm/tension, nausea, nerve pain, pain relief, restlessness, stomach ulcers, premenstrual syndrome (PMS), restless leg syndrome, rheumatic pain, skin disorders, stress, urinary tract disorders, vaginal infections, vertigo, viral gastroenteritis, vision problems, withdrawal from tranquilizers.
Dosing
The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.
Standardization
Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. Some valerian products are standardized to contain 0.8% to 0.3% valerenic or valeric acid, although other chemical components may be responsible for valerian's activity in the body.
Adults (18 years and older)
Insomnia : Studied doses range from 400 to 900 milligrams of an aqueous or aqueous-ethanolic extract (corresponding to 1.5 to 3 grams of herb), taken 30 to 60 minutes before going to bed. The better designed studies have used 600 milligrams daily, taken one hour before bedtime. Valerian has historically been used in the form of a tea (1.5 to 3 grams root steeped for 5 to 10 minutes in 150 milliliters boiling water), although this formulation has not been studied.
Sedation/Anxiety : One study evaluated the effect of 100 milligrams of aqueous or aqueous-ethanolic extract before a stressful event. Valerian is also used traditionally as a relaxant in the form of a tea (1.5 to 3 grams root steeped for 5 to 10 minutes in 150 milliliters boiling water), although this formulation has not been studied.
Children (younger than 18 years)
There is not enough scientific evidence to recommend use of valerian in children.
Safety
The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.
Allergies
People with allergies to plants in the Valerianaceae family may be allergic to valerian.
Side Effects and Warnings
Studies report that valerian is generally well tolerated for up to 4 to 6 weeks in recommended doses, and side effects may occur no more often than with placebo (sugar pill). Valerian has occasionally been reported to cause headache, excitability, stomach upset, uneasiness, dizziness, unsteadiness (ataxia) and low body temperature (hypothermia). Chronic use (longer than 2-4 months) may result in insomnia. Slight reductions in concentration or complicated thinking may occur for a few hours after taking valerian. Use caution if you are driving or operating heavy machinery. Some research suggests that valerian may not cause sedation.
A drug "hangover" effect has been reported in people taking high doses of valerian extracts. "Valerian withdrawal" may occur if you stop using valerian suddenly after chronic high-dose use, including confusion (delirium) and rapid heartbeat. These symptoms may improve with the use of benzodiazepines such as lorazepam (Ativan®). Although unknown, valerian may have similar brain activity as benzodiazepines (which are commonly used to treat anxiety and insomnia), through effects on the brain chemical gamma-amino-butyric-acid (GABA).
Valerian has been on the U.S. Food & Drug Administration's GRAS (generally regarded as safe) list, and no deaths due to overdose have been reported. Symptoms with overdose or chronic use may include low blood pressure, slow or abnormal heart rhythm, chest tightness, lightheadedness, constipation, excitability, blurred vision, tremor, headache, hypersensitivity (allergic) reactions, insomnia, and stomach upset.
Liver toxicity has been associated with some multi-herb preparations that include valerian. However, the contribution of valerian itself is not clear due to the potential liver toxicity of other included ingredients, or the possibility of contamination with unlisted herbs.
Pregnancy & Breastfeeding
Because there is limited human safety data, valerian use during pregnancy and breastfeeding is not recommended. There are theoretical concerns over the adverse effects of chemical components that are toxic in laboratory studies.
References
1. Abebe W. An overview of herbal supplement utilization with particular emphasis on possible interactions with dental drugs and oral manifestations. J Dent Hyg 2003;77(1):37-46.
2. Abebe W. Herbal medication: potential for adverse interactions with analgesic drugs. J Clin Pharm Ther 2002;27(6):391-401.
3. Andreatini R, Sartori VA, Seabra ML, et al. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res 2002;16(7):650-654.
4. Chan TY. An assessment of the delayed effects associated with valerian overdose. Int J Clin Pharmacol Ther 1998;36 (10) :569.
5. Chen D, Klesmer J, Giovanniello A, et al. Mental status changes in an alcohol abuser taking valerian and gingko biloba. Am J Addict 2002;11(1):75-77.
6. Cropley M, Cave Z, Ellis J, Middleton RW. Effect of kava and valerian on human physiological and psychological responses to mental stress assessed under laboratory conditions. Phytother Res 2002;16(1):23-27.
7. De Feo V, Faro C. Pharmacological effects of extracts from Valeriana adscendens Trel. II. Effects on GABA uptake and amino acids. Phytother Res 2003;17(6):661-664.
8. Dergal JM, Gold JL, Laxer DA, et al. Potential interactions between herbal medicines and conventional drug therapies used by older adults attending a memory clinic. Drugs Aging 2002;19(11):879-886.
9. Dominguez RA, Bravo-Valverde RL, Kaplowitz BR, et al. Valerian as a hypnotic for Hispanic patients. Cultur Divers Ethni Minor Psychol 2000;6(1):84-92.
10. Donath F, Quispe S, Diefenbach K, et al. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsychiatry 2000;33(2):47-53.
11. Francis AJ, Dempster RJ. Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomized trial. Phytomedicine 2002;9(4):273-279.
12. Garges HP, Varia I, Doraiswamy PM. Cardiac complications and delirium associated with valerian root withdrawal. JAMA 1998;280(18):1566-1567.
13. Giedke H, Breyer-Pfaff U. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsychiatry 2000;33(6):239.
14. Glass JR, Sproule BA, Herrmann N, et al. Acute pharmacological effects of temazepam, diphenhydramine, and valerian in healthy elderly subjects. J Clin Psychopharmacol 2003;23(3):260-268.
15. Hadley S, Petry JJ. Valerian. Am Fam Physician 2003;67(8):1755-1758.
16. Hariya T, Kobayashi Y, Aihara M, et al. Effects of sedative odorant inhalation on patients with atopic dermatitis [Article in Japanese]. Arerugi 2002;51(11):1113-1122.
17. Houghton PJ. The scientific basis for the reputed activity of valerian. J Pharm Pharmacol 1999;51(5):505-512.
18. Kapadia GJ, Azuine MA, Tokuda H, et al. Inhibitory effect of herbal remedies on 12-o-tetradecanoylphorbol-13-acetate-promoted Epstein--Barr virus early antigen activation. Pharmacol Res 2002;45(3):213-220.
19. Kuhlmann J, Berger W, Podzuweit H, et al. The influence of valerian treatment on "reaction time, alertness and concentration" in volunteers. Pharmacopsychiatry 1999;32(6):235-241.
20. Morozova SV, Zaitseva OV. Correction of autonomic sensory disorders in middle ear diseases [Article in Russian]. Vestn Otorinolaringol 2002;(3):38-41.
21. Muller D, Pfeil T, von den Driesch V. Treating depression comorbid with anxiety--results of an open, practice-oriented study with St John's wort WS 5572 and valerian extract in high doses. Phytomedicine 2003;10 Suppl 4:25-30.
22. Murakami N, Ye Y, Kawanishi M, et al. New Rev-transport inhibitor with anti-HIV activity from Valerianae Radix. Bioorg Med Chem Lett 2002;12(20):2807-2810.
23. Poyares DR, Guilleminault C, Ohayon MM, Tufik S. Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? Prog Neuropsychopharmacol Biol Psychiatry 2002(3):539-545.
24. Spinella M. The importance of pharmacological synergy in psychoactive herbal medicines. Altern Med Rev 2002;7(2):130-7.
25. Stevinson C, Ernst E. Valerian for insomnia: systematic review of randomized clinical trials. Sleep Med 2000;1:91-99.
26. Sun J. Morning/Evening menopausal formula relieves menopausal symptoms: a pilot study. J Altern Complement Med 2003;9(3):403-409.
27. Wheatley D. Stress-induced insomnia treated with kava and valerian: singly and in combination. Hum Psychopharmacol Clin Exp 2001;16(4):353-356.
28. Ziegler G, Ploch M, Miettinen-Baumann A, et al. Efficacy and tolerability of valerian extract LI 156 compared with oxazepam in the treatment of non-organic insomnia--a randomized, double-blind, comparative clinical study. Eur J Med Res 2002;7(11):480-486.
February 01, 2004 
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