Insomnia and Valerian

Valerian (Valeriana officinalis), is perennial herb which grows in North America, Asia, and Europe. The root of valerian herb is a traditional sleep remedy. There are over 250 valerian species, but Valeriana officinalis is the species commonly used in the United States and Europe.

The root of the valerian plant has a mix of compounds that are thought to produce sedation, including valepotriates, valeric acid and volatile oils. Valerian contains various compounds including: sesquiterpenes of the volatile oil, iridoids (valepotriates), alkaloids, furanofuran lignans, and free amino acids such as g-aminobutyric acid (GABA), tyrosine, arginine, and glutamine.

Valerian's medicinal properties are generally believed to result from interactions among its various compounds. The sesquiterpene components of the volatile oil are believed to influence most of valerian's biologic effects, but findings of some studies show that the individual components valepotriates and valeric, produce direct sedative effects and interaction with neurotransmitters.

Read more details about Valerian.

There are many studies on valerian's efficacy in the treatment of insomnia. One study have shown that valerian improves symptoms by reducing sleep latency, this is the length of time that it takes to accomplish the transition from full wakefulness to sleep.

The positive effects of valerian extract on sleep were found to be more pronounced in older male patients who considered themselves to be poor sleepers, female poor sleepers, younger poor sleepers, smokers, and those who typically have lengthy sleep latencies.

Several studies have shown the positive effects of valerian extract in patients who do not have sleep disturbances. A small study proved that patients who were given 450 and 900 mg of an aqueous extract of valerian root experienced more than 50 percent improvement in sleep latency and wake time after sleep onset.

The effects of valerian was compared to oxazepam over a six-week period in a randomized, double-blind study of 75 participants with nonorganic insomnia. Participant were randomly assigned to receive 600 mg of a standardized commercial valerian extract or 10 mg oxazepam for 28 days. Investigators evaluated results using sleep, mood scale, and anxiety questionnaires as well as sleep rating by a physician. Treatment result was measured using a 4-step rating scale on the last day of the study. Both groups experienced same improvement in sleep quality but the valerian group reported fewer side effects.

Although findings of some studies suggest that valerian may be useful for insomnia and other sleep disorders, results of other studies say otherwise. Limitations of the studies such as small sample size, varying doses and sources of valerian complicated the interpretation of results. Hence, reviewers still find these trials inconclusive.

Valerian is available in various preparations. Dietary supplements are made from its roots and stems. Dried roots are prepared as teas or tinctures, and dried plant materials and extracts are put into capsules or added to tablets. Valerian is sometimes combined with other herbs.

Valerian improves sleep when taken nightly over one- to two-week periods, it also appears to be a safe sedative/hypnotic choice for mild to moderate insomnia.

Safety Issues

Valerian is on the FDA's GRAS (generally recognized as safe) list and is approved for use as a food. In animals, it takes enormous doses of valerian to produce any serious adverse effects. ¹ Valerian has shown an excellent safety profile in clinical trials. ² In a suicide attempt, one young woman took approximately 20 g of valerian (20 to 40 times the recommended dose). Only mild symptoms developed, including stomach cramps, fatigue, chest tightness, tremors, and light-headedness. All of these resolved within 24 hours, after two treatments with activated charcoal. ³ The woman's lab tests—including tests of her liver function—remained normal. Keep in mind that this does not mean that you can safely exceed the recommended dose!

One report did find toxic results from herbal remedies containing valerian mixed with several other herbal ingredients, including skullcap . Four individuals who took these remedies later developed liver problems. ⁴ However, skullcap products are sometimes contaminated with the liver-toxic herb germander, and this could have been the explanation.

There have also been about 50 reported cases of overdose with a combination preparation called Sleep-Qik, which contains valerian as well as conventional medications. ⁵ Researchers specifically looked for liver injury, but found no evidence that it occurred.

There are some safety concerns about valepotriates, constituents of valerian, because in test tube studies they have been found to affect DNA and cause other toxic effects. However, valepotriates are not present to a significant extent in any commercial preparations. ⁶ Although no animal studies or controlled human trials have found evidence that valerian causes withdrawal symptoms when stopped, one case report is sometimes cited in support of the possibility that this might occur. ⁷ It concerns a 58-year-old man who developed delirium and rapid heartbeat after surgery. According to the patient's family, he had been taking high doses of valerian root extract (about 2.5 g to 10 g per day) for many years. His physicians decided that he was suffering from valerian withdrawal. However, considering the many other factors involved (such as multiple medications and general anesthesia), it isn't really possible to conclude that valerian caused his symptoms.

In clinical trials, use of valerian has not been associated with any significant side effects. A few people experience mild gastrointestinal distress, and there have been rare reports of people developing a paradoxical mild stimulant effect from valerian.

Valerian does not appear to impair driving ability or produce morning drowsiness when taken at night. ^{8 9 10} As noted above, most studies have failed to find any immediate sedative effect with valerian. However, one study reported finding mild impairment of attention for a couple of hours after taking valerian. ¹¹ For this reason, it isn't a good idea to drive immediately after taking it.

There have been no reported drug interactions with valerian, and two studies found reasons to believe that valerian should not raise or lower the blood levels of too many medications. ¹² Nonetheless, there are at least theoretical concerns that valerian might amplify the effects of sedative drugs. A 1995 study was somewhat reassuring on this score because it found no interaction between alcohol and valerian. ¹³ However, animal studies have found that valerian extracts may prolong the effects of some sedatives, ¹⁴ and there have been some worrisome case reports suggesting that the combination of valerian and alcohol can lead to excessive sedation in some people. ¹⁵ For this reason, we recommend that you do not combine valerian with central nervous system depressants except under doctor’s supervision.

Safety in young children, pregnant or nursing women, or those with severe liver or kidney disease has not been established.

Interactions You Should Know About

If you are taking sedative drugs such as benzodiazepines ; don't take valerian in addition to them, except under physician supervision.

Valerian's therapeutic use dates back to at lease that time of ancient Greece and Rome. Its medicinal benefits were described by Hippocrates, the father of medicine. In the 2nd century, the Greek physician Galen, alluded the sedative qualities of valerian and prescribed it for insomnia. During the 16th century, valerian was used to relieve a number of symptoms including nervousness, trembling, headaches, and heart palpitations. However, in the mid-19th century, valerian's medicinal properties were held in low regard. At the time, valerian was considered a stimulant that causes some of the symptoms that it was believed to treat. During World War II, valerian was prescribed to relieve symptoms of stress.

1. Rosecrans JA, Defeo JJ, Youngken HW Jr. Pharmacological investigation of certain Valeriana officinalis L. extracts. J Pharm Sci. 1961;50:240-244.
2. Taibi DM, Landis CA, Petry H, et al. A systematic review of valerian as a sleep aid: Safe but not effective. Sleep Med Rev. 2007;11:209-230.
3. Willey LB, Mady SP, Cobaugh DJ, Wax PM. Valerian overdose: a case report. Vet Hum Toxicol. 37(4):364-5.
4. MacGregor FB, Abernethy VE, Dahabra S, Cobden I, Hayes PC. Hepatotoxicity of herbal remedies. BMJ. 299(6708):1156-7.
5. Chan TY, Tang CH, Critchley JA. Poisoning due to an over-the-counter hypnotic, Sleep-Qik (hyoscine, cyproheptadine, valerian). Postgrad Med J. 71(834):227-8.
6. Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York, NY: Pharmaceutical Products Press; 1994:118.
7. Garges HP, Varia I, Doraiswamy PM. Cardiac complications and delirium associated with valerian root withdrawal. JAMA. 280(18):1566-7.
8. Albrecht M, Berger W, Laux P, et al. Psychopharmaceuticals and safety in traffic [translated from German]. Z Allgemeinmed. 1995;71:1215-1225.
9. Gerhard U, Linnenbrink N, Georghiadou C, et al. Vigilance-decreasing effects of 2 plant-derived sedatives. Schweiz Rundsch Med Prax. 1996;85:473-481.
10. European Scientific Cooperative on Phytotherapy. Valerianae radixMonographs on the Medicinal Uses of Plant Drugs Exeter. UK: ESCOP; 1996-1997:2.
11. Gerhard U, Linnenbrink N, Georghiadou C, et al. Vigilance-decreasing effects of 2 plant-derived sedatives. Schweiz Rundsch Med Prax. 1996;85:473-481.
12. Donovan JL, DeVane CL, Chavin KD, et al. Multiple night-time doses of valerian ( Valeriana officinalis ) had minimal effects on CYP3A4 activity and no effect on CYP2D6 activity in healthy volunteers. Drug Metab Dispos. 2004;32:1333-1336.
13. Albrecht M, Berger W, Laux P, et al. Psychopharmaceuticals and safety in traffic [translated from German]. Z Allgemeinmed. 1995;71:1215-1225.
14. Sakamoto T, Mitani Y, Nakajima K. Psychotropic effects of Japanese valerian root extract. Chem Pharm Bull (Tokyo). 40(3):758-61.
15. Chen D, Klesmer J, Giovanniello A, Katz J. Mental status changes in an alcohol abuser taking valerian and gingko biloba. Am J Addict. 11(1):75-7.

Hadley, S.,Petry, J.Valerian. American Family Physician. 2003 (Online)

http://www.aafp.org/afp/20030415/1755.html accessed 10/23/09

Office of Dietary Supplements National Institutes of Health.

http://dietary-supplements.info.nih.gov/factsheets/valerian.asp Updated:1/16/2008

accessed 10/23/09

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.

Balderer G, Borbely AA. Effect of valerian on human sleep. Psychopharmacology [Berl] 1985;87:406-9.

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.

Grieve M: Valerian. In: A Modern Herbal. New York: Hafner Press, 1974: 824-830.