valerian

Valerian is an herbal supplement made from Valeriana species of perennial plants, used as a mild sleep aid in people with insomnia.

Among the various species, Valeriana officinalis, native to Europe and Asia and naturalized in North America, is the most commonly used plant for the preparation of valerian herbal supplements. Valerian roots, rhizomes and stems are dried and used to make teas and tinctures, or powdered and made into tablets and capsules. Valerian is marketed as a dietary supplement over the counter in the U.S.

The medicinal properties of valerian are believed to be from the chemical compounds in valerian, including valerenic acids, sesquiterpenes and valepotriates. It is not clear, however, which of the valerian compounds are responsible for the sedative effects or their exact mechanism of action. It is possible that valerian’s effects result from multiple constituents acting independently or together. The constituents of valerian vary significantly among plants, resulting in great variability in valerian preparations.

Valerian may possibly increase the concentration of gamma-aminobutyric acid (GABA), the major inhibitory chemical (neurotransmitter) in the brain. Studies suggest that valerian may stimulate the release of GABA from nerve cells (neurons) and also inhibit its reuptake, a natural process after completion of neurotransmission. In addition, valerenic acid inhibits an enzyme that breaks down GABA. Valerian extracts themselves also contain GABA, but it is not clear if they can cross the blood-brain barrier.

Many valerian preparations contain other substances as well, hence determining their effects are difficult. The data available from the few scientific clinical studies on valerian use for sleep disorders as a single agent show inconclusive results for its efficacy in promoting sleep. Valerian may promote falling asleep, but does not reduce night awakenings. Valerian is used for many other conditions as well, however, there is no scientific evidence to support any of its uses.

Valerian’s suggested uses include:

• Insomnia/sleep disorders
• Attention deficit hyperactivity disorder (ADHD)
• Anxiety disorders
• Depression
• Epilepsy
• Infantile convulsions
• Menopausal symptoms
• Menstrual cramps
• Restlessness
• Tremors

• Do not use valerian if you are pregnant or breastfeeding.
• Do not give valerian to children younger than 3 years of age.
• Taking valerian concurrently with other sedative medications such as benzodiazepines, barbiturates and drugs that can depress the central nervous system, including alcohol, can have additive effects.
• Dietary supplements such as St. John’s wort, kava, and melatonin can have additive effects.
• Use with caution if you are taking other medications metabolized by the liver.

Common side effects of valerian include:

• Allergic reactions such as:
  • Skin rash
  • Hives (urticaria)
  • Itching
  • Swelling of face, lips and tongue
• Headache
• Dizziness
• Stomach upset
• Heart disturbances
• Uneasiness
• Excitability
• Mental dullness
• Drowsiness in the morning after, especially with high doses
• Insomnia
• Vivid dream
• Dry mouth
• Liver toxicity
• Withdrawal symptoms with discontinuation after prolonged use

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

There isn't enough reliable information to know what an appropriate dose of valerian might be.

Suggested Dosing

Insomnia

• Aqueous Extract: 400-900 mg orally up to 2 hours before bedtime
• Ethanolic extract: 600 mg orally at bedtime
• Root (fresh or dried): 2-3 grams orally three times daily
• Combinations with hops or lemon balm: 320-500 mg orally at bedtime
• No more than 28 days

• Long term use of valerian may cause dependence and withdrawal symptoms upon discontinuation. Long term use is also associated with liver toxicity.
• In intentional valerian overdose cases, there were serious effects such as tremor, stupor and elevated liver enzymes, but no life-threatening effects.
• In case of overdose, seek medical help or contact Poison Control.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Valerian has no known severe interactions with other drugs.
• Valerian has serious interactions with at least 65 different drugs.
• Valerian has moderate interactions with at least 52 different drugs.
• Mild interactions of valerian include:
  • irinotecan
  • irinotecan liposomal

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• There isn’t enough information about the safety of valerian use in pregnancy and breastfeeding. Avoid use if you are pregnant or breastfeeding.

• Valerian is possibly safe for a short period for most adults.
• Take valerian exactly as per label instructions. Avoid taking for longer than 28 days.
• Many herbal supplements contain several ingredients, check labels carefully.
• Valerian is marketed as an herbal supplement in the U.S. and is not regulated by the FDA. Products may differ in formulations and strengths, and there may be discrepancy between the labeling and the actual contents and their amounts. Exercise caution in choosing your product.
• Check with your healthcare provider before taking any supplement, including valerian.
• Store valerian safely out of reach of children.