Passion flower (Passiflora incarnata L.)

 
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Passion flower
Passion flower

Background

The dried aerial parts of  Passiflora incarnata  have historically been used as a sedative and hypnotic (for insomnia), and for "nervous" gastrointestinal complaints. However, clinical evidence supporting any therapeutic use in humans is lacking. Pre-clinical studies provide preliminary support for a benzodiazepine-like calming action.

 

Evidence for significant adverse effects is also unclear, and is complicated by the variety of poorly classified, potentially active constituents in different  Passiflora  species.

 

Passion fruit ( P. edulis Sims ), a related species, is used as a food flavoring.

 

Synonyms

Apricot vine, banana passion fruit ( P. mollissima ), Calmanervin (combination product), Compoz (combination product), corona de cristo, EUP, Euphytose (combination product), Fleischfarbige, fleur de la passion, flor de passion, granadilla, grenadille, Jamaican honeysuckle ( P.  laurifolia ), madre selva, maypops, Naturest, passiflora, passionflower, passion vine, Passionsblume, purple passion flower, Sedacalm, water lemon, wild passion flower.

 

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 evidence Grade*
Congestive heart failure

An extract containing passionflower and hawthorn has been studied in people with congestive heart failure for the treatment of shortness of breath and difficulty exercising. People using this combination of herbs have experienced improvements in these symptoms. However, any positive effects may have resulted from hawthorn, which is more commonly used for congestive heart failure. High quality human research of passion flower alone and compared to prescription drugs used for this condition is needed before a recommendation can be made.

C
Sedation (agitation, anxiety, insomnia)

Passion flower has a long history of use for symptoms of restlessness, anxiety, or agitation. There is preliminary evidence in support of these uses from animal research and from poor-quality human studies. Better research is needed beforea firm conclusion can be drawn.

C

 

*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;
F: Strong scientific evidence against this use.

 

Grading rationale

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.

Alcohol withdrawal, antibacterial, anti-seizure, anti-spasm, aphrodisiac, asthma, attention deficit hyperactivity disorder (ADHD), burns (skin), cancer, chronic pain, cough, drug addiction, Epstein-Barr virus, gastrointestinal discomfort (nervous stomach), hemorrhoids, high blood pressure, insomnia, menopausal symptoms (hot flashes), nerve pain, pain (general), tension, wrinkle prevention.

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.

Adults (18 years and older)
General: Safety and effectiveness have not been established for any dose. There are no standard or well-studied doses of passion flower. Different preparations and doses have been used traditionally.

 

Dried herb: 0.5 to 2 grams taken three to four times daily by mouth has been used.

 

Tincture (1:8): 1 to 4 milliliters taken three to four times daily by mouth has been used.

 

Tea: Tea made from four to eight grams of dried herb, taken daily has been used.

 

Infusion: 2.5 grams has been used three to four times daily.

 

Children (younger than 18 years)
There is not enough scientific data to recommend passion flower for use in children at any dose.

 

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
Hypersensitivity reaction with hives and skin blood vessel inflammation (vasculitis), as well as occupational asthma with runny nose, have been reported with the use of passion flower products.

 

Side Effects and Warnings
Passion flower is generally considered to be a safe herb, with few reported serious adverse events. In cases of side effects, the products being used have rarely been tested for contamination (which may have been the cause). Cyanide poisoning has been associated with passiflora fruit but this has not been proven in human studies.

 

Rapid heart rate and rhythm, nausea, and vomiting have been reported. Side effects may also include drowsiness/sedation and mental slowing. Patients should use caution if driving or operating heavy machinery.

 

Passion flower may theoretically increase the risk of bleeding and alter blood tests that measure blood clotting (international normalized ratio or "INR").

 

There is a case report of liver failure and death of a patient taking a preparation of passion flower with kava. Patients should use caution with any kava-containing products, as kava has been associated with liver damage. The cause of the liver damage is less likely related to the presence of passion flower.

 

Pregnancy and Breastfeeding
There is not enough scientific evidence to recommend the safe use of passion flower in any dose during pregnancy or breastfeeding. During the 1930s, animal studies found uterine stimulant action in components of  Passiflora .

 

Many tinctures contain high levels of alcohol, and should be avoided during pregnancy.

 

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. 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.

Interactions with Drugs
Certain substances (harmala alkaloids) with monoamine oxidase inhibitory (MAOI) action have been found in small amounts in some species of  Passiflora.  Although levels of these substances may be too low to be cause noticeable effects, in theory, use of passion flower with MAOI drugs may cause additive effects. MAOI drugs include Isocarboxazid (Marplan®), phenelzine (Nardil®), and tranylcypromine (Parnate®).

 

Based on animal research, use of passion flower with alcohol or other sedativesmay increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

 

Passionflower may in theory increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

 

Many tinctures contain high levels of alcohol, and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).

 

Interactions with Herbs and Dietary Supplements
Certain substances (harmala alkaloids) with monoamine oxidase inhibitory (MAOI) action have been found in small amounts in some species of  Passiflora.  Although levels of these substances may be too low to be cause noticeable effects, in theory, use of passion flower with herbs or supplements with MAOI activity may cause additive effects.

 

Based on animal research, use of passion flower with sedative-hypnotic herbs or supplements may increase the amount of drowsiness caused by some herbs or supplements.

 

Passionflower may in theory increase the risk of bleeding when taken with herbs or supplements that increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of  Ginkgo biloba , and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

 

Passion flower contains lycopene and may have additive effects when taken with lycopene supplements.