Valerian (Valeriana officinalis L.)

 
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Valerian
Valerian

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 2,000 years. For example, in the 2nd 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 United States 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, blessed herb, capon's tail, common valerian, English valerian, fixed valerian-hops extract combination Ze91019, fragrant valerian, garden heliotrope, garden valerian, German valerian, great wild valerian, herba benedicta, heliotrope, Indian valerian, Jacob's ladder, Japanese valerian, katzenwurzel, laege-baldrian, Li 156, 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, tagara, theriacaria, Ticalma®,  V. edulis ,  V. faurieri ,  V. foliis pinnatis ,  V. jatamansi ,  V. radix ,  V. sitchensis ,  V. wallichii , valariana, Valerianaceae (family), Valerianaheel®, valeriane, Valmane®, vandal root, Vermont valerian, wild valerian.

 

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*
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 four to six weeks. Ongoing nightly use may be more effective than single-dose use, with increasing effects over four 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.

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;
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.

Acne, amenorrhea (lack of menstruation), angina, anorexia, anti-seizure, antiperspirant, antiviral, arthritis, asthma, bloating, bronchospasm, 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), epilepsy, fatigue, fever, flatulence (gas), hangovers, headache, heart disease, heartburn, high blood pressure, HIV, hot flashes, hypochondria, irritable bowel syndrome, liver disorders, measles, memory enhancement, menopausal symptoms, 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.

Adults (18 years and older)
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. Valerian has historically been used in the form of a tea (1.5 to 3 grams root steeped for five to 10 minutes in 150 milliliters boiling water), although this formulation has not been studied. Doses of 300-1,800 milligrams of valerian have also been taken by mouth in capsule form.

 

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 four to six weeks in recommended doses. Valerian has occasionally been reported to cause headache, excitability, stomach upset, uneasiness, dizziness, unsteadiness (ataxia) and low body temperature (hypothermia). Chronic use (longer than two to four months) may result in insomnia. Slight reductions in concentration or complicated thinking may occur for a few hours after taking valerian. Use caution if 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 and Drug Administration's GRAS (generally regarded as safe) list, and no deaths due to overdose are currently available.

 

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.

 

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
Based on animal and human studies, valerian may increase the amount of drowsiness caused by some drugs, although this is an area of controversy. 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. In one human study, a combination of valerian and the beta-blocker drug propranolol (Inderal®) reduced concentration levels more than valerian alone. A brief episode of confusion was reported in one patient using valerian with loperamide (Imodium®) and St. John's wort ( Hypericum perforatum  L.).

 

An episode of agitation, anxiety and self-injury was reported in a patient after taking valerian with fluoxetine (Prozac®) for a mood disorder (the person was also drinking alcohol). In theory, valerian may interact with anti-seizure medications, although human data is lacking. Valerian tinctures may contain high alcohol content (15-90%), and theoretically may cause vomiting if taken with metronidazole (Flagyl®) or disulfiram (Antabuse®). Valerian may interact with certain drugs metabolized by the liver or vasopressin.

 

Interactions with Herbs & Dietary Supplements
Based on theoretical concerns, valerian may increase the amount of drowsiness caused by some herbs or supplements.

 

A brief episode of confusion was reported in one patient during use of valerian with loperamide (Imodium®) and St. John's wort ( Hypericum perforatum  L.). Nausea, sweating, muscle cramping, weakness, elevated pulse and high blood pressure were reported after a single dose of a combination product with St. John's wort, kava, and valerian. Valerian may interact with certain herbs and supplements that are metabolized by the liver.