Valerian for insomnia
* Products made from extracts of the root of Valeriana officinalis are widely used as sleep aids for insomnia.
* Clinical studies have suggested efficacy, but long-term safety data are lacking.
History of Use
The ancient physicians Dioscorides and Galen both wrote of the medicinal properties of a common plant they aptly termed phu, allegedly because of the herb’s distinctive–and unpleasant–odor. It first was referred to as valerian in the Anglo-Saxon “leech books,” or medical texts, around the 10th century, and it remained a common medieval home remedy.
In Gerard’s 17th-century herbal, he describes the varied uses of valerian, or setwall, as being “preservative against the pestilence … used generally in sleight cuts, wounds, and small hurts … [and for those who are] troubled with the crampe and other convulsions.”
Fabio Colonna (1567-1650), a Neapolitan nobleman who had suffered from epilepsy since birth, claimed to have cured himself with valerian root. His botanical writings became influential. In subsequent centuries, the plant became a common treatment for epilepsy and other “nervous disorders.”
Valerian later was much favored by the 19th-century American physicians who called themselves the Eclectics because of their adoption of remedies from various schools of medical practice, including botanical medicine and homeopathy. The Eclectics used valerian for rheumatism, fevers, and nervous irritability. It remained on the United States Pharmacopoeia until 1936 and in the National Formulary until 1946.
Mechanisms of Action
Multiple compounds in valerian root, including sesquiterpenoids and valepotriates, have pharmacologic activity, but the active components responsible for its sedative effects have yet to be identified. As with benzodiazepines, the CNS effects of valerian are thought to result from increased secretion of the inhibitory neurotransmitter gamma-aminobutyric acid, and inhibition of its reuptake.
A group of Swiss researchers published several studies in the 1980s about the effects of valerian extracts on sleep quality and latency. In one double-blind study, 128 healthy volunteers received valerian extract, a commercial preparation containing valerian and hops, or a placebo. The valerian dose was 400 mg in both active-treatment groups. Both valerian groups had significant improvement in sleep quality and latency; effects were greater with the pure extract and in subjects who considered themselves poor sleepers (Pharmacol. Biochem. Behav. 17:65-71, 1982).
A systematic review identified nine trials that were methodologically sound, but noted inconsistencies in study design, procedures, and patients, determining that the evidence was inconclusive (Sleep Med. 1:91-99, 2000).
In a subsequent trial, 75 patients with insomnia were randomized to valerian, 300 mg twice daily, or oxazepam, 5 mg twice daily, for 28 days. Sleep quality improved significantly in both groups, but no intergroup differences were detected. The authors recommended further study of valerian because of its favorable side effect profile (Forsch Komplementarmed Klass Naturheilkd. 7:79-84, 2000).
A more recent, double-blind trial randomized 202 patients to 600 mg/day of valerian extract or 10 mg/day of oxazepam for 6 weeks. The mean duration of insomnia was 3.5 months. Sleep quality improved significantly in both groups. In the valerian group. 82.8% rated the treatment “very good,” as did 73.4% in the oxazepam group (Eur. J. Med. Res. 7:480-86, 2002). Equivalent benefits were seen on secondary end points, including psychosomatic symptoms and duration of sleep.
Some patients report mild headache or gastrointestinal disturbances with valerian use. There have been at least five reports of hepatotoxicity; these were not dose related and were considered idiosyncratic (Drug Saf. 17:342-56, 1997). There has been one case report of a withdrawal syndrome similar to that seen with benzodiazepines in a man who used high doses of the herb for many years (JAMA 280: 1566-67, 1998). Long-term safety studies have not yet been done with valerian. In theory, valerian could interact with barbiturates, benzodiazepines, opiates, or alcohol.
As with all herbal products in the United States, quality control can be problematic. One source of information for patients is the Web site ConsumerLab.com, which has evaluated products such as herbs, vitamins, and supplements. In 2000, the site analyzed the valerenic acid content and accuracy of labeling of 17 valerian products (www.consumerlab.com/results/valerian.asp).
To achieve a “passing” score, a label had to list the proper plant name, part used, form used (root powder, extract, or tincture), and amount of valerian per pill or dose, and meet its label claims for total valerenic acid content. The products chosen were common brands purchased online or from retail stores or catalogues. Biochemical evaluation was performed using high performance liquid chromatography.
Only nine products passed. The researchers reported, “Out of the eight that failed, four products had no detectable levels of the expected valerenic acids and another four had only about half the expected or claimed amounts. The six products that were made exclusively from root powder had the worst results–only one passed–while four of the seven products made from extract alone passed.”
Further, they wrote that “it is difficult to know why so many products did not have the amount of valerian stated on the label.” A possible explanation for their inability to detect the marker compounds might have been that the wrong species of valerian (there are many) was used.
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