Valerian insomnia

Valerian Insomnia, anxiety Fatigue, tremor, headache, paradoxical insomnia (not advised with other sedative-hypnotics)... 

The term pasaon flower is used to denote many of the approximately 400 species of the herb. F saon flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinsonism. F saon flower is often used in combination with other herbs , such a valerian, chamomile, and hops, for promoting relaxation, rest and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patientstaking the monoamine oxidase inhibitors (MAOIs). Fission flower contains coumarin, and the risk of bleeding may be increased when used in patientstaking warfarin and pasaon flower. 

Clinicians should ask patients if they take any herbs and supplements, as they may not volunteer this information. The most common herbs and supplements that patients ask about are vitamins, melatonin, valerian, and coenzyme Q10. There is very little support for using creatinine, gingko, ginseng, green tea, ginger, yohimbine, and St lohn s wort in patients with PD. Patients should be cautioned that supplements and herbs are not well controlled by the FDA and may not contain the amounts indicated on the label. Melatonin and valerian may improve insomnia, but they are not commonly used because there is insufficient information in PD patients.39... 

Antihistamines such as diphenhydramine are known for their sedating properties and are frequently used over-the-counter medications (usual doses 25-50 mg) for difficulty sleeping. Diphenhydramine is approved by the FDA for the treatment of insomnia and can be effective at reducing sleep latency and increasing sleep time.43 However, diphenhydramine produces undesirable anticholinergic effects and carryover sedation that limit its use. As with TCAs and BZDRAs, diphenhydramine should be used with caution in the elderly. Valerian root is an herbal sleep remedy that has inconsistent effects on sleep but may reduce sleep latency and efficiency at commonly used doses of 400 to 900 mg valerian extract. Ramelteon, a new melatonin receptor agonist, is indicated for insomnia characterized by difficulty with sleep onset. The recommended dose is 8 mg at bedtime. Ramelteon is not a controlled substance and thus may be a viable option for patients with a history of substance abuse. 

Mischoulon, D. (2002). The herbal anxiolytics kava and valerian for anxiety and insomnia. Psychiatric Annals, 32, 55-60. 

Side effects may be as mild and rare as headache, nausea, and stomach upset for saw palmetto [23,24], However, some supplements may have serious side effects. Hypertension, euphoria, restlessness, nervousness, insomnia, skin eruptions, edema, and diarrhea were reported in 22 patients following long-term ginseng use at an average dose of 3 g of ginseng root daily [38]. Side effects reported with valerian use include headaches, hangover, excitability, insomnia, uneasiness, and cardiac disturbances. Valerian toxicity including ataxia, decreased sensibility, hypothermia, hallucinations, and increased muscle relaxation have been reported [39]. 

The use of valerian extends back at least 1000 years, and it gained a reputation in sixteenth-century Europe as a treatment for epilepsy (Tyler 1994 Temkin 1971). Its reported uses are broad (digestive aid, muscle relaxant, antipyretic, etc.) but it is commonly known to treat insomnia and anxiety (Gruenwald et al. 1998 Kowalchick and Hylton 1987). Valerian has a distinct, unpleasant odor. Perhaps appropriately, it is believed to be an herb in the writings of Galen and Dioscorides, called phu (Leyel 1994). 

Valerian root, an over-the-counter herbal supplement, has also been used for insomnia. Thought to act, like the benzodiazepines, by increasing the activity of the neurotransmitter GABA, preliminary studies indicate that 400 mg of valerian root decreases sleep latency and enhances sleep quality. 

Valerian (Valeriana officinalis) Reduces nervousness and insomnia... 

Valerian root pills are said to reduce insomnia and nervousness. (Will and Deni Mclntyre/Photo Researchers, Inc.)... 

Temazepam (Restoril) [C-IV] [Sedative/Hypnotic/ Benzodiazepine] Uses Insomnia, anxiety, depression, panic attacks Action Benzodiaz ine Dose 15-30 mg PO hs PRN X in elderly Caution [X, /-] Potentiates CNS dqjressive effects of opioids, barbs, EtOH, antihistamines, MAOIs, TCAs Contra NAG Disp Caps SE Confusion, dizziness, drowsiness, hangover Interactions T Effects W/ cimetidine, disulfiram, kava kava, valerian T CNS depression W/ anticonvulsants, CNS depressants, EtOH t effects OF haloperidol, phenytoin X effects W/ aminophylline, dyphylline, OCPs, oxtriphylline, rifampin, theophylline, tobacco X effects OF levodopa EMS Use caution w/ other benzodiazepines, antihistamines, opioids and verapamil, can T CNS depression concurrent EtOH can T CNS depression abruptly D/C after >10 d use may cause withdrawal OD May cause profound CNS depression, confusion, bradycardia, hypotension, and altered reflexes flumazenil can be used as antidote, activated charcoal may be effective... 

As with studies of many other herbs and nutritional supplements, interpretation of clinical trials of valerian is hampered by small sample sizes, suboptimal study design, lack of specified inclusion and exclusion criteria, and unknown composition of valerian extract (Plushner, 2000). Furthermore, none of the trials have included children or teenagers. Nevertheless, several studies have showed a mild hypnotic action in persons with insomnia and in normal sleepers, as well as a mild sedative effect (Leathwood and Chauffard, 1983, 1985 Balderer and Borbely, 1985). One report has described an anxiolytic effect (Kohnen and Oswald, 1988). There are suggestions that valerian may have beneficial effects on sleep latency, frequency of waking, nighttime motor activity, and overall sleep quality. 

Valerian Valeriana officinalis) The roots of this plant are dried to produce a potent extract that induces sleepiness and helps treat insomnia. Like lavender, it depresses the activity of the central nervous system in a fashion similar to stronger prescription tranquilizers such as benzodiazepines and barbiturates, but without the dulling or hangover effects the next day or impairing the ability to drive a car. 

Tea Tree (Melaleuca alternifolia) Uses Rx of superficial wounds (bacterial, viral, fungal, insect bites, minor burns, cold sores, acne Action Broad-spectrum antibiotic activity against E. coli, S. aureus, C. albicans Available forms Topical creams, lotions, oint, oil apply topically PRN Notes/SE Ataxia, contact dermatitis, D, drowsiness, GI mucosal irritation Interactions Effects OF drugs that affect histamine release EMS effects of Benadryl Valerian (Valeriana officinalis) Uses Anxiolytic, antispasmodic, dys-menorrheal, restlessness, sedative Action Inhibits uptake stimulates release of GABA, which T GABA concentration extracellularly causes sedation Available forms Ext 400-900 mg PO 30 min < hs, tea 2-3 g (1 tsp of crude herb) qid, PRN, tine 3-5 mL (1/2-1 tsp) (1 5 ratio) PO qid, PRN Efficacy Probably effective sedative (reduces sleep latency) Notes/SE GI upset, HA, insomnia, N/V, palpitations, restlessness, vision changes Interactions T Effects OF barbiturates, benzodiazepines, opiates, EtOH, catnip, hops, kavakava, passion flower, skullcap effects OF MAOIs, phenytoin, warfarin EMS T Effects of benzodiazepines and opiates abruptly D/C may cause withdrawal symptoms... 

In recent years, natural products such as melatonin and herbs such as valerian have become popular over-the-counter remedies for insomnia. There are no comprehensive evaluations of safety and efficacy of these products. Beyond questions of safety and efficacy, there is no consensus on what their doses should be. Nevertheless, these products continue to be used widely by some patients. 

Once recognized as a tonic, tranquilizer, and antispasmodic, skullcap was therefore used as an ingredient in many patent medicines for female weakness. It was also combined with other reputedly calming herbs, such as hops and valerian, and promoted as a sedative or anxiolytic. Other traditional uses include treatment of epilepsy, headache, insomnia, various other neurological and psychiatric disorders, hypertension, fever, rheumatism, and stress. 

Today, valerian is used for treating insomnia. It is known to have sedative, mild anodyne, hypnotic, antispasmodic, carminative, and hypotensive properties. Traditionally, it has been used for the treatment of fatigue, seizures, hysterical states, excitability, insomnia, hypochondriasis, migraine, cramp, intestinal colic, rheumatic pains, dysmenorrhea, and specifically for conditions producing nervous excitability. 

Many of the hop s constituents, including valerianic acid, have a sedative effect, and it is now used to treat insomnia, restlessness, and anxiety. Its bitter principals, humulon and lupulon, are gastrointestinal stimulants used to treat indigestion and loss of appetite. These bitter acids also have antibacterial and antimicrobial properties. The hop is believed to contain chemicals that promote menstruation, and certain flavonoids have shown potential chemopreventive activity against breast and ovarian cancer. 

Valerian is used in the treatment of insomnia and stress and anxiety. The important active compounds of valerian are the valepotriates (iridoid molecules) and valeric acid. These compounds are found exclusively in valerian. Originally, it was thought that just the valepotriates were responsible for valerian s sedative effects but, recently, an aqueous extract of valerian has also been shown to have a sedative effect. As the valepotriates are not soluble in water, it was concluded that valeric acid also possesses sedative action and is the chemical factor responsible for the sedative effect noted in human clinical trials with aqueous extracts of valerian (Murray, 1995). Valerian inhibits the uptake of GABA and enhances the release of GABA. 

Valerian is used in the short-term treatment of insomnia characterized by difficulty in falling asleep and poor sleep quality. Valeriana officinalis L. inhibits reuptake of and stimulates the release of y-aminobutyric acid (GABA), contributing to its sedative properties. 

This book compares the hypnotic and sedative actions of valerian used for thousand years to treat insomnia with those of benzodiazepine derivatives in altering GABAergic transmission. 

A range of medications is available to treat insomnia, ranging from herbal preparations such as valerian to the recently introduced z compounds, zopiclone, zolpidem and zaleplon. Many drugs used for other primary purposes have sedative and sleep-inducing properties as side effects these include many tricyclic antidepressants and antihistamines. 

The properties of Scullcap are said to have been first appreciated by Vandesveer in 1772 for use against hydrophobia. Scullcap is now employed, often with Valerian, in hysteria and insomnia, and is reputed to be effective in the treatment of epilepsy. 

Diazepam is better indicated if insomnia is associated with daytime anxiety. Other benzodiazepines prescribed for insomnia include nitrazepam, flur-azepam, loprazolam, lormetazepam and temazepam. The non-benzodiazepine hypnotics zaleplon, zolpidem and zopiclone are not licensed for long-term use. The sedative antipsychotic promethazine hydrochloride is sometimes used to facilitate sleep, with a 25-50 mg recommended dose. Melatonin has proved effective for some clients, mostly in regulating the sleep/waking cycle. Although evidence of efficacy is limited, some clients use herbs such as valerian and chamomile. If Mr AB will finally be diagnosed with depression, a trial with an antidepressant will be indicated. 

Herbal preparations. Randomised clinical trials have shown some effect of valerian in mild to moderate insomnia, and hops, lavender and other herbal compounds show promise in pilot studies that are presently being pursued more fully. 

In a pilot study, 24 patients with stress-induced insomnia were treated for 6 weeks with kava 120 mg/day, followed by a 2-week washout period and then treatment with valerian 600 mg/day for another 6 weeks (4). Stress was measured in three areas, including social, personal, and life events, and insomnia was assessed by evaluating the time taken to fall... 

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