Valerian (Valeriana officinalis L.)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
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, heliotrope, herba benedicta, 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®, Valeriana edulis, Valeriana faurieri, Valeriana foliis pinnatis, Valeriana jatamansi, Valeriana radix, Valeriana sitchensis, Valeriana wallichii, valariana, Valerianaceae (family), Valerianaheel®, valeriane, Valmane®, vandal root, Vermont valerian, wild valerian.
Valerian is an herb native to Europe and Asia that currently 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 (chest pain).
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.
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.
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.
There is not enough available scientific evidence in this area.
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.
There is not enough available scientific evidence in this area.
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.
*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 (it may not work); F: Strong scientific evidence against this use (it likely does not work).
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 health care professional.
Acne, amenorrhea (lack of menstruation), angina (chest pain), anorexia, anti-seizure, antiperspirant, antiviral, arthritis, asthma, bloating, bronchospasm, congestive heart failure, constipation, cough, cramping (abdominal, pelvic, menstrual), 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, 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.
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 the use of valerian in children.
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.
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), restlessness, agitation, nervousness, and an exaggerated sense of well being. 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 (FDA'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 and the possibility of contamination with unlisted herbs.
Pregnancy and 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.
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.
Based on secondary sources, valerian may have antispasmodic properties.
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.
Based on secondary sources, valerian may have antispasmodic properties.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
Andreatini R, Sartori VA, Seabra ML, et al. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res 2002;16(7):650-654. View Abstract
Diaper A, Hindmarch I. A double-blind, placebo-controlled investigation of the effects of two doses of a valerian preparation on the sleep, cognitive and psychomotor function of sleep-disturbed older adults. Phytother.Res 2004;18(10):831-836. View Abstract
Dominguez RA, Bravo-Valverde RL, Kaplowitz BR, et al. Valerian as a hypnotic for Hispanic patients. Cultur Divers Ethni Minor Psychol 2000;6(1):84-92. View Abstract
Francis AJ, Dempster RJ. Effect of valerian, Valeriana edulis, on sleep difficulties in children with intellectual deficits: randomized trial. Phytomedicine 2002;9(4):273-279. View Abstract
Eadie MJ. Could valerian have been the first anticonvulsant? Epilepsia 2004;45(11):1338-1343. View Abstract
Garges HP, Varia I, Doraiswamy PM. Cardiac complications and delirium associated with valerian root withdrawal. JAMA 1998;280(18):1566-1567. View Abstract
Garrard J, Harms S, Eberly LE, et al. Variations in product choices of frequently purchased herbs: caveat emptor. Arch Intern.Med 10-27-2003;163(19):2290-2295. View Abstract
Giedke H, Breyer-Pfaff U. Critical evaluation of the effect of valerian extract on sleep structure and sleep quality. Pharmacopsychiatry 2000;33(6):239. View Abstract
Gutierrez S, Ang-Lee MK, Walker DJ, et al. Assessing subjective and psychomotor effects of the herbal medication valerian in healthy volunteers. Pharmacol Biochem Behav 2004;78(1):57-64. View Abstract
Kuhlmann J, Berger W, Podzuweit H, et al. The influence of valerian treatment on "reaction time, alertness and concentration" in volunteers. Pharmacopsychiatry 1999;32(6):235-241. View Abstract
Muller D, Pfeil T, von den Driesch V. Treating depression comorbid with anxiety--results of an open, practice-oriented study with St John's wort WS 5572 and valerian extract in high doses. Phytomedicine 2003;10 Suppl 4:25-30. View Abstract
Stevinson C, Ernst E. Valerian for insomnia: systematic review of randomized clinical trials. Sleep Med 2000;1:91-99. View Abstract
Sun J. Morning/Evening menopausal formula relieves menopausal symptoms: a pilot study. J Altern Complement Med 2003;9(3):403-409.
Taibi DM, Bourguignon C, Taylor AG. Valerian use for sleep disturbances related to rheumatoid arthritis. Holist Nurs Pract 2004;18(3):120-126. View Abstract
Ziegler G, Ploch M, Miettinen-Baumann A, et al. Efficacy and tolerability of valerian extract LI 156 compared with oxazepam in the treatment of non-organic insomnia--a randomized, double-blind, comparative clinical study. Eur J Med Res 2002;7(11):480-486. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017