DR CLARE'S MATERIA MEDICA
Introduction to the Dispensing of Dr Clare’s Blended Herbs
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(Last edited: Thursday, 20 April 2017, 12:14 AM)
Also Known As:
All-Heal, Common Valerian, Fragrant Valerian, Garden Heliotrope,
Valeriana officinalis; Valeriana edulis; Valeriana angustifolia; Valeriana jatamansii, synonym Valeriana wallichii; Valeriana sitchensis.
People Use This For: Valerian is used for insomnia, and for anxiety-associated restlessness and sleeping disorders. It has also been used for mood disorders such as depression, and chronic fatigue syndrome (CFS). It is also used orally for muscle and joint pain, and conditions associated with anxiety and psychological stress including nervous asthma, excitability, headaches, migraine, and stomach upset. Valerian is also used for menstrual cramps and symptoms associated with menopause, including hot flashes and anxiety. In manufacturing, the extracts and essential oil are used as flavoring in foods and beverages.
Safety: No concerns regarding safety when used in amounts commonly found in foods. Valerian has Generally Recognized as Safe (GRAS) status in the US.60
No concerns regarding safety when used orally and appropriately, short-term. Clinical studies have reported safe use of valerian for medicinal purposes in over 12,000 patients in trials lasting up to 28 days.61,62,63,64,65,66 The safety of long-term use is unknown.
Children: No concerns regarding safety when used orally and appropriately, short-term. Valerian has been safely used in children in studies lasting 4-8 weeks.74,80
Pregnancy and Lactation: Refer to a Medical Herbalist.
Insomnia. Most research shows that taking valerian orally reduces the time to sleep onset (sleep latency), and improves subjective sleep quality. The greatest benefit is usually seen in patients using 400-900 mg valerian extract up to 2 hours before bedtime.67,68,69,70
Valerian does not relieve insomnia as fast as benzodiazepines.65 Continuous nightly use for several days to four weeks might be needed for significant effect.68,71
Valerian is often used in combination with other sedative herbs. Taking a combination product containing valerian extract 187 mg plus hops extract 41.9 mg per tablet, two tablets at bedtime, seems to modestly improve subjective sleep measures including subjective sleep latency compared to placebo after 28 days of treatment; however it was not significantly better than placebo after only 14 days of treatment.66 A combination of valerian with lemon balm might also improve the quality and quantity of sleep in healthy people.72
Valerian also seems to improve the sleep quality of insomniacs who have recently withdrawn from benzodiazepines. After tapering the benzodiazepine over two weeks, 300 mg valerian extract in three divided daily doses might subjectively improve sleep quality.73
There is also preliminary clinical research that suggests valerian improves sleep in intellectually impaired children.74
Not all evidence is positive. Some evidence suggests that valerian does not significantly improve insomnia compared to placebo.79
INSUFFICIENT RELIABLE EVIDENCE to RATE
Anxiety. There is contradictory evidence about the effectiveness of valerian for anxiety. Some evidence shows that taking valerian orally reduces self-reported stress in social anxiety.75,76 However, another preliminary study found no significant difference in anxiety scores in patients with generalized anxiety disorder compared to placebo.77,78 Additional preliminary evidence suggests that valerian does not significantly decrease anxiety compared to placebo.79
Restless Sleep. Preliminary (980 Participants open trial :definite benefit) evidence suggests that a specific combination product providing valerian root extract 160 mg and lemon balm leaf extract 80 mg (Euvegal forte, Dr. Willmar Schwabe Pharmaceuticals) 1-2 tablets once or twice daily might decrease symptoms in children under age 12 years who have pathological restlessness or dyssomnia.80
More evidence is needed to rate valerian for these uses.
Mechanism of Action:
The applicable part of valerian is the root and rhizome. Valerian is thought to have sedative-hypnotic, anxiolytic, antidepressant, anticonvulsant, and antispasmodic effects.62,63,81 Valerian might also have hypotensive properties.75
The pharmacological effects of valerian have primarily been attributed to valepotriates.62,82,83 Other potentially active constituents include flavonoids.83
Because valerian extracts without some of these constituents can still have similar effects, it is likely that multiple constituents are responsible for its pharmacological effects.
Valepotriate constituents have sedative-hypnotic and spasmolytic effects. Valepotriates have also been shown to decrease benzodiazepine withdrawal in an animal model and to bind dopamine receptors.62,82 The valepotriates might act as prodrugs.82
The sesquiterpenes have been shown to cause sedation in animals.83 Valerenic acid and other constituents of valerian may increase GABA (neurotransmitter) concentrations and decrease central nervous system activity.82,84 Valerian may stimulate the release and reuptake of GABA84
Valerian might also affect sleep regulation with activity on adenosine and 5-hydroxytryptamine-1.84
The valerian flavonoid constituents also seem to have a role in the sedative-hypnotic effects of valerian.83
A few patients can find that valerian is a stimulant and they should avoid its use. (This is generally at higher doses (DC).)
In some individuals, valerian can aggravate a sensation of drowsiness or tiredness, particularly at higher doses, but this is usually a case of an increased awareness of the body’s needs than a negative depressant effect.R1 pp.587
Valerian can cause headache, excitability, uneasiness, palpitations, and insomnia.62 Occasionally, valerian may cause gastric discomfort, dry mouth, vivid dreams,64 and morning drowsiness.61
Taking valerian extracts in doses up to 1800 mg does not appear to significantly affect mood or psychomotor performance.85,86 Valerian does not usually have a negative impact on reaction time, alertness, and concentration the morning after intake. Impairment that does occur is dose-dependent and seems to peak within the first few hours after an oral valerian dose.61
Interactions with Herbs & Supplements:
Herbs and Supplements with Sedative Properties: Use of valerian with other herbs and supplements with sedative properties might enhance therapeutic and adverse effects.82
Interactions with Drugs:
Alchol (Ethanol): Alcohol may be used as a CNS depressant which reduces performance of motor skills. Do not add the sedative effects of Valerian.87
Anxiolytics: Patients may require less medication for anxiety if they use herbal remedies with all of their attendant side effects but do not combine them within 4-5 hours of each other.
Interactions with Foods: None known.
Interactions with Lab Tests: None known.
Interactions with Diseases or Conditions: None Known.
Dr Clare’s Blends: Dose 455mgs per day. 1.5mls 1:3 Tincture.
ORAL: For insomnia, most studies have used 400-900 mg valerian extract up to 2 hours before bedtime for as long as 28 days.61,62,65,73,69,70,85 Other studies have used valerian extract 300-450 mg given in three divided doses.62,73Valerian should be given 30 minutes to 2 hours before bedtime.87
Specific References: VALERIAN
60. FDA. Center for Food Safety and Applied Nutrition, Office of Premarket Approval, EAFUS: A food additive database. Available at: vm.cfsan.fda.gov/~dms/eafus.html.
61. Kuhlmann J, Berger W, Podzuweit H, Schmidt U. The influence of valerian treatment on "reaction time, alertness and concentration" in volunteers. Pharmacopsychiatry 1999;32:235-41.
62. Klepser TB, Klepser ME. Unsafe and potentially safe herbal therapies. Am J Health Syst Pharm 1999;56:125-38.
63. Plushner SL. Valerian: Valerian officinalis. Am J Health Syst Pharm 2000;57:328,333,335.
64. Wheatley D. Stress-induced insomnia treated with kava and valerian: singly and in combination. Hum Psychopharmacol 2001;16:353-6.
65. Dorn M. [Efficacy and tolerability of Baldrian versus oxazepam in non-organic and non-psychiatric insomniacs: a randomized, double-blind, clinical, comparative study]. [Article in German]. Forsch Komplementarmed Klass Naturheilkd 2000;7:79-84.
66. Morin CM, Koetter U, Bastien C, et al. Valerian-hops combination and diphenhydramine for treating insomnia: a randomized placebo-controlled clinical trial. Sleep 2005;28:1465-71.
67. Leathwood PD, Chauffard F, Heck E, Munoz-Box R. Aqueous extract of valerian root (Valeriana officinalis L.) improves sleep quality in man. Pharmacol Biochem Behav 1982;17:65-71.
68. Donath F, Quispe S, Diefenbach K, et al. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsych 2000;33:47-53.
69. Bent S, Patterson M, Garvin D. Valerian for sleep: a systematic review and meta-analysis. Alternative Therapies 2001;7:S4.
70. Leathwood PD, Chauffard F. Aqueous extract of valerian reduces latency to fall asleep in man. Planta Med 1985;2:144-8.
71. Stevinson C, Ernst E. Valerian for insomnia: a systematic review of randomized clinical trials. Sleep Med 2000;1:91-9.
72. Cerny A, Shmid K. Tolerability and efficacy of valerian/lemon balm in healthy volunteers (a double blind, placebo-controlled, multicentre study). Fitoterapia 1999;70:221-8.
73. Poyares DR, Guilleminault C, Ohayon MM, Tufik S. Can valerian improve the sleep of insomniacs after benzodiazepine withdrawal? Prog Neuropsychopharmacol Biol Psychiatry 2002;26:539-45.
74. Francis AJ, Dempster RJ. Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomised trial. Phytomedicine 2002;9:273-9.
75. 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;16:23-7.
76. Kohnen R, Oswald WD. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions. Pharmacopsychiatry 1988;21:447-8.
77. Andreatini R, Sartori VA, Seabra ML, Leite JR. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res 2002;16:650-4.
78. Miyasaka LS, Atallah AN, Soares BG. Valerian for anxiety disorders. Cochrane Database Syst Rev 2006;(4):CD004515.
79. Jacobs BP, Bent S, Tice JA, et al. An internet-based randomized, placebo-controlled trial of kava and valerian for anxiety and insomnia. Medicine (Baltimore) 2005;84:197-207.
80. Muller SF, Klement S. A combination of valerian and lemon balm is effective in the treatment of restlessness and dyssomnia in children. Phytomedicine 2006;13:383-7.
81. Eadie MJ. Could valerian have been the first anticonvulsant? Epilepsia 2004;45:1338-43.
82. Houghton PJ. The scientific basis for the reputed activity of Valerian. J Pharm Pharmacol 1999;51:505-12.
83. Fernandez S, Wasowski C, Paladini AC, Marder M. Sedative and sleep-enhancing properties of linarin, a flavonoid-isolated from Valeriana officinalis. Pharmacol Biochem Behav 2004;77:399-404
84. Yuan CS, Mehendale S, Xiao Y, et al. The gamma-aminobutyric acidergic effects of valerian and valerenic acid on rat brainstem neuronal activity. Anesth Analg 2004;98:353-8.
85. Glass JR, Sproule BA, Herrmann N, et al. Acute pharmacological effects of temazepam, diphenhydramine, and valerian in healthy elderly subjects. J Clin Psychopharmacol 2003;23:260-8.
86. Gutierrez S, Ang-Lee MK, Walker DJ, Zacny JP. Assessing subjective and psychomotor effects of the herbal medication valerian in healthy volunteers. Pharmacol Biochem Behav 2004;78:57-64.
87. Hadley S, Petry JJ. Valerian. Am Fam Physician 2003;67:1755-8.