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Drug-Herb Interaction

  • Studies of valerian’s influence on vigilance have revealed no effects that would impair coordination or decrease alertness. 6 However, while alcohol does not potentiate the effects of valerian, 7 as do many synthetic tranquilizers, because of additive effect caution should be exercised with joint consumption regarding driving and operating heavy machinery.
  • While no drug interactions have been reported in humans, studies in rodents indicate a potential for reaction with barbiturates and benzodiazepines, 8 perhaps contraindicating valerian while undergoing treatment with barbiturates. On the other hand, the demonstrated affinity of valerian extracts and valepotriates for GABA and benzodiazepine receptor sites, as well as the diminution of diazepam withdrawal effects observed in rats treated intraperitoneally with valepotriates, suggest that valepotriate-rich preparations may be helpful in easing withdrawal from benzodiazepines. .
  • European clinical monographs list no contraindications to valerian use in pregnancy or during lactation. Also, studies with pregnant rats indicate no deleterious effects of oral consumption of valepotriates. 9 Nonetheless, erring on the side of caution, ingestion of appreciable quantities of valepotriates is generally disavowed, recommending either removal by extraction or sufficient length of storage to promote degradation of these iridoids.
  • The World Health Organization contraindicates the use of valerian in children under 12 years of age without medical supervision.
Information on the relationship between substances and disease is provided for general information, in order to convey a balanced review of the scientific literature. In many cases the relationship between a substance and a disease is tentative and additional research is needed to confirm such a relationship.

  • Facts

    • Scientific Name: Valeriana officinalis L and related Valeriana species including V. wallichii DC syn. V. jatamansi Jones (Indian valerian), V. edulis Nutt. syn. V. mexicana DC (Mexican valerian) and V. fauriei Briquet (Japenese valerian). 1
    • Family: Valerianaceae.
    • Other Common Names: All-heal, amantilla (Spanish), baldrian (German) Belgian valerian, Capon’s Tail, cat’s love/valerian Fragrant valerian, garden heliotrope, setwall, spikenard, vandal root. 2 .
    • Valerian root consists of the dried roots, with or without rhizomes and underground stems (stolons) of V. officinalis. Valerian is a tall (up to 2m.) herbaceous perennial that grows in temperate regions of North America, Europe, and Asia.
    • Tiny white to reddish clusters of flowers bloom in summer and the herb emits an unpleasant odor when crushed or dried . There are about 250 valerian species, but V.officinalis is the most frequently used medicinally, worldwide.
    • The roots contain essential oil with monoterpenes and sesquiterpenes, including valerenic acids, valerenal and valeranone. 3
    • Valerian roots contain two main groups of substances of pharmacologic importance, namely, sesquiterpenes and valepotriates (valerian epoxy trimesters). . Both classes of compounds are thought to have sedative effects, although the exact mechanism of action is unknown.
    • Valerenic acids (present only in V. officinalis) are most often the basis of standardization efforts and valepotriates, occasionally targeted are regarded as potentially cytotoxic and often deliberately degraded.

  • Functions

    • Sedative
    • Sleep-promoting
    • Anxiolytic

  • Dosage

    • In the treatment of restlessness and sleep disorders, in 1995 the German Commission E recommended 1-3g of dried root and rhizome, daily. .
    • 450 mg of extract, as sleep-aid, taken as at least one hour before bedtime, and for symptomatic treatment of anxiety, 200-300 mg of extract in the morning. .
    • Tincture (!:5, 70% ethanol): 1-3 ml, taken once to several times daily, or an Infusion: 2-3 g per cup, up to several times daily.

  • Toxicity

    • No health hazards have been associated with proper use of the recommended therapeutic doses of valerian preparatios.
    • In all the clinical trials of valerian preparations so far conducted, only mild side effects such as stomach upset, headaches and itching have occasionally been noted. 4 No sub-chronic or chronic toxicity data are available.
    • A recent case report, involving consumption of more than 20 times the recommended dose of powdered valerian root by an 18-year-old female college student, in an apparent suicide attempt, revealed only mild symptoms, all of which resolved within 24hr. 5 The symptoms noted were fatigue, abdominal cramping, chest tightness, lightheadedness and foot and hand tremor.

  • Research Summary

    Most of the clinical studies with valerian relate to sleep disorders, mainly treatment of insomnia. Those studies have generally employed valepotriate-free aqueous extracts of root/rhizome, although hydroalcoholic extracts with substantial sesquiterpene content and very low content in valepotriates, have also been tested. Combinations of extracts of valerian root with extracts of hop floweres, lemon balm leaves and pssionflower aerial parts have also been evaluated.

    Sleep Disorders / Insomnia
    The most commonly used treatments for insomnia are benzodiazepines, but these can be associated with side effects. Some side effects include dependence, rebound insomnia, poor sleep quality and poor functioning during the day. Due to these undesirable side effects, herbal treatments, especially valerian, have been submitted to extensive scientific evaluation as therapeutic alternatives.
    • A systematic review of nine randomized controlled trials which met the criteria for inclusion were evaluated as to the effects of valerian in insomnia. Three of the trials investigated the effect of valerian following repeated administration. One study found improvements between 2 and 4 weeks. Of six trials giving single dosing of valerian, three reported positive results, while the remaining three showed no measurable difference compared with placebo. The review found huge differences between trials in terms of experimental design and methodological rigor, therefore making it possible that any number of factors may have confounded the findings. Overall, the authors found the evidence for valerian in treatment for insomnia was inconclusive. 10
    • However, Lindahl and Lindwall 11 conducted a randomized double-blinded crossover comparison of two combination preparations. The first preparation, a commercial product (Valerian Natt) containing valerian extract equivalent to 400 mg of root, standardized to and containing primarily sesquiterpenes, and with only traces of valepotriates, combined with hop and lemon balm extracts. The second preparation contained valerian extract equivalent to only 4 mg of root, combined with “a full dose of Flores humuli and Lemon melissa”. Any observed differences would be attributed to the difference in valerian content. Eight-nine percent of the 27 subjects reported improved sleep and 44% “perfect sleep” form Valerian Natt. No side effects were reported, nor nightmares which had been experienced with customary sedatives.
    • More recently, three trials were conducted with commercial preparation, Sedonium®, in the form of coated tablets each containing 300 mg of a dry extract of valerian root. 12, 13, 14 Each study involved 16 patients in a randomized double-blind, placebo-controlled, crossover design. The first of these trials examined the effects on EEG approximated those produces by psychosedative anxiolytic drugs. The second trial used polysomnographic tests to measure slow-wave sleep (SWS) and SWS-latency among other parameters. In objective measurements, valerian decreased SWS-latency, compared to placebo, while increasing the duration of SWS compared to baseline; subjectively, the time to sleep onset was reduced by valerian as compared to placebo. The third trial assessed the short-term (single dose of 2x300mg tablets) and long-term (14 days with multiple dosage) treatment being administered one hour before bedtime. No effects on sleep structure and subjective sleep assessment were observed after a single dose of valerian. After the multi-dose treatment, however, as in the second trial, significant differences were noted in SWS and SWS-latency between verum and placebo groups. Interestingly, polysomnographic comparisons with baseline values indicated significant increases in sleep efficiency for both placebop and multiple-dose treatment groups.

  • Uses

    • Restlessness
    • Sleeping disorders based on nervous conditions.
    • Other conditions: Treating anxiety, relaxing the body, damping nervous tension, helping control panic attacks, headaches, intestinal and menstrual cramps.

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