Health Care Professional Information

Scientific Name
Matricaria recutita L.
Common Name

Hungarian chamomile, wild chamomile, Chamomilla recutita

Clinical Summary

Chamomile, an aromatic annual herb, has a long history of use in traditional medicine to treat muscle spasms, menstrual disorders, insomnia, ulcers, wounds, stomach disorders, rheumatic pain, hay fever, and hemorrhoids. It is widely used in teas for its relaxing and calming effects.
In vitro and animal studies indicate that chamomile extracts have anti-inflammatory (11), antihyperglycemic (12), antigenotoxic (13), and anticancer (14). Apigenin, a flavone present in chamomile, has strong chemopreventive effects (15). Bisabololoxide A, another constituent of chamomile, was shown to reduce the dose of 5-fluorouracil when used together against leukemic cells (19).
Preliminary data suggest modest benefits of chamomile in improving chronic insomnia (20). Chamomile extract showed a mild to moderate effect in patients with generalized anxiety disorder (16) and may also have antidepressant effects (30). In another controlled trial, application of a chamomile compress was shown to be effective, and superior to hydrocortisone ointment, in facilitating healing of peristomal skin lesions in patients following colostomy (21).

Chamomile mouthwash reduced 5-fluorouracil-induced mucositis in hamsters (17), but data from human studies are conflicting (8) (9). More research is warranted.

Purported Uses
  • Colic
  • GI disorders
  • Hemorrhoids
  • Infections
  • Inflammation
  • Mastitis
  • Mucositis
  • Sedation
  • Skin ulcers
  • Spasms
  • Stomach and intestinal gas
Constituents
  • Coumarins
  • Flavonoids: Quercetin, rutin, apigenin, luteolin, apigetrin and apiin
  • Volatile oils: Alpha bisabolol (nearly 50%), azulene and chamazulene
  • Tannins, triterpene hydrocarbons
    (22)
Mechanism of Action

The anti-inflammatory activity of chamomile involves the release of LPS-induced prostaglandin E(2) in RAW 264.7 macrophages via inhibition of COX-2 enzyme activity (11). Methanol extracts of chamomile exert anti-allergic effects by inhibiting histamine release from mast cells (23). They also showed neuroprotective activity by decreasing lipid peroxidation (LPO) and increasing superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), and total thiol levels (24). In another study, a chamomile extract was shown to afford gastroprotection against ethanol-induced ulceration by increasing glutathione levels (25). Apigenin, a flavone component of chamomile, interacts with GABA (A) (gamma-aminobutyric acid)-benzodiazepine receptors in vitro and inhibits locomotor behavior in rats (5). It was also shown to affect alternative splicing of key mRNAs by inhibiting dimerization of hnRNPA2, a factor associated with many cellular malignancies and in mRNA metabolism and splicing (32)

Contraindications

People allergic to ragweed or members of the Compositae family, such as chrysanthemums, should avoid this product.

Adverse Reactions

Hypersensitivity reactions including asthma, contact dermatitis, and anaphylaxis have been reported following exposure to chamomile (26) (27).
Case reports
Premature constriction of fetal ductus arteriosus has been reported following consumption of camomile tea by the mother during pregnancy (31).
A 38-year-old Caucasian man developed an episode of severe anaphylaxis with generalized urticaria, angioedema and severe dyspnea one hour after consuming chamomile tea. The symptoms improved following treatment with an intravenous antihistamine (18).
A 70-year-old woman was hospitalized with multiple internal hemorrhages following concurrent use of chamomile products and warfarin. Her symptoms resolved after treatment with intravenous heparin (28).

Herb-Drug Interactions

Anticoagulants / Antiplatelets: Chamomile may increase anticoagulant effects and inhibit platelet activity due to its coumarin content (28).
Sedatives: Chamomile may increase their effects (4).
Cytochrome P450 substrates: Chamomile inhibits CYP1A2, CYP2C9, CYP2D6 and CYP3A4 and can affect the intracellular concentration of drugs metabolized by these enzymes (29).

Literature Summary and Critique

Amsterdam JD, Li Y, Soeller I, et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009 Aug;29(4):378-82.
This randomized, double-blind, placebo-controlled efficacy and tolerability trial involved 57 patients with mild to moderate generalized anxiety disorder (GAD). Patients received chamomile extract or placebo. Those in the chamomile group were given one 220 mg chamomile capsule daily/week 1; 2 capsules daily/week 2. Patients with a 50% reduction or less in total HAM-A (Hamilton Anxiety Rating) score versus baseline were increased to 3 capsules daily during week 3, and then, to 4 capsules daily during week 4 of therapy. Patients who continued to have a 50% reduction or less in baseline HAM-A score were increased to 5 capsules daily during study weeks 5 through 8 of therapy. Primary outcome was difference in change over time in total HAM-A scores. Secondary outcomes included change in the Beck Anxiety Inventory, Psychological Well Being, and Clinical Global Impression and Severity scores and the proportion of patients with 50% reduction or more in baseline HAM-A score.
A significantly greater reduction in the mean total HAM-A score was observed in the chamomile group compared to the placebo group (P = 0.047), along with a positive change in all secondary outcomes. One patient in each treatment group discontinued treatment due to adverse events, but the number of patients who experienced adverse events was not significantly different between groups (P = 0.417). Researcher concluded that chamomile may have modest benefits for those with mild to moderate GAD.
Larger studies are needed to confirm these effects.

Dosage (Inside MSKCC Only)
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References
  1. Blumenthal, et al. Herbal Medicine, Expanded Commission E Monographs, 1st ed. Austin: American Botanical Council; 2000.
  2. Newall C, et al. Herbal Medicines: A Guide for Health-Care Professionals. London: Pharmaceutical Press; 1996.
  3. Tyler, V. Herbs of Choice, the Therapeutical Use of Phytomedicinals. Binghamton: Pharmaceutical Press; 1994.
  4. Brinker F. Herb Contraindications and Drug Interactions, 3rd ed. Sandy (OR): Eclectic Medical; 2001.
  5. Avallone R, et al. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol 2000;59:1387-94.
  6. Kyokong O, et al. Efficacy of chamomile-extract spray for prevention of post-operative sore throat. J Med Assoc Thai 2002;85(suppl):S180-5.
  7. Budzinski JW, et al. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82.
  8. Fidler P, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 1996;77: 522-5.
  9. Carl W, et al. Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J Prosthet Dent 1991;30:395-6.
  10. Segal R, et al. Warfarin interaction with Matricaria chamomilla. CMAJ. 2006 Apr 25;174(9):1281-2.
  11. Srivastava JK, Pandey M, Gupta S. Chamomile, a novel and selective COX-2 inhibitor with anti-inflammatory activity. Life Sci. 2009 Nov 4;85(19-20):663-9.
  12. Cemek M, Kaða S, Simþek N, Büyükokuroðlu ME, Konuk M. Antihyperglycemic and antioxidative potential of Matricaria chamomilla L. in streptozotocin-induced diabetic rats. J Nat Med. 2008 Jul;62(3):284-93.
  13. Hernández-Ceruelos A, Madrigal-Bujaidar E, de la Cruz C. Inhibitory effect of chamomile essential oil on the sister chromatid exchanges induced by daunorubicin and methyl methanesulfonate in mouse bone marrow. Toxicol Lett. 2002 Sep 5;135(1-2):103-110.
  14. Srivastava JK, Gupta S. Antiproliferative and apoptotic effects of chamomile extract in various human cancer cells. J Agric Food Chem. 2007 Nov 14;55(23):9470-8.
  15. Patel D, Shukla S, Gupta S. Apigenin and cancer chemoprevention: progress, potential and promise (review). Int J Oncol. 2007 Jan;30(1):233-45.
  16. Amsterdam JD, Li Y, Soeller I, et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009 Aug;29(4):378-82.
  17. Pavesi VC, Lopez TC, Martins MA, et al. Healing action of topical chamomile on 5-fluouracil induced oral mucositis in hamster. Support Care Cancer. 2011 May;19(5):639-46.
  18. Andres C, Chen WC, Ollert M, et al. Anaphylactic reaction to camomile tea. Allergol Int. 2009 Mar;58(1):135-6.
  19. Ogata-Ikeda I, Seo H, Kawanai T, Hashimoto E, Oyama Y. Cytotoxic action of bisabololoxide A of German chamomile on human leukemia K562 cells in combination with 5-fluorouracil. Phytomedicine. 2011 Mar 15;18(5):362-5.
  20. Zick SM, Wright BD, Sen A, Arnedt JT. Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study. BMC Complement Altern Med. 2011 Sep 22;11:78.
  21. Charousaei F, Dabirian A, Mojab F. Using chamomile solution or a 1% topical hydrocortisone ointment in the management of peristomal skin lesions in colostomy patients: results of a controlled clinical study. Ostomy Wound Manage. 2011 May;57(5):28-36.
  22. Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Report. 2010 Nov 1;3(6):895-901.
  23. Chandrashekhar VM, Halagali KS, Nidavani RB, et al. Anti-allergic activity of German chamomile (Matricaria recutita L.) in mast cell mediated allergy model. J Ethnopharmacol. 2011 Sep 1;137(1):336-40.
  24. Ranpariya VL, Parmar SK, Sheth NR, Chandrashekhar VM. Neuroprotective activity of Matricaria recutita against fluoride-induced stress in rats. Pharm Biol. 2011 Jul;49(7):696-701.
  25. Al-Hashem FH. Gastroprotective effects of aqueous extract of Chamomilla recutita against ethanol-induced gastric ulcers. Saudi Med J. 2010 Nov;31(11):1211-6.
  26. Vandenplas O, Pirson F, D'Alpaos V, et al. Occupational asthma caused by chamomile. Allergy. 2008 Aug;63(8):1090-2.
  27. Jacob SE, Hsu JW. Reactions to Aquaphor: is bisabolol the culprit? Pediatr Dermatol. 2010 Jan-Feb;27(1):103-4.
  28. Segal R, et al. Warfarin interaction with Matricaria chamomilla. CMAJ. 2006 Apr 25;174(9):1281-2.
  29. Ganzera M, Schneider P, Stuppner H. Inhibitory effects of the essential oil of chamomile (Matricaria recutita L.) and its major constituents on human cytochrome P450 enzymes. Life Sci. 2006 Jan 18;78(8):856-61.
  30. Amsterdam JD, Shults J, Soeller I, et al. Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: an exploratory study. Altern Ther Health Med. 2012 Sep-Oct;18(5):44-9.
  31. Sridharan S, Archer N, Manning N. Premature constriction of the fetal ductus arteriosus following the maternal consumption of camomile herbal tea.Ultrasound Obstet Gynecol. 2009 Sep;34(3):358-9.
  32. Arango D, Morohashi K, Yilmaz A, et al. Molecular basis for the action of a dietary flavonoid revealed by the comprehensive identification of apigenin human targets. Proc Natl Acad Sci U S A. 2013 May 22. [Epub ahead of print]

Consumer Information

How It Works

Bottom Line: Chamomile may benefit those with anxiety disorder and insomnia. It has not been shown to treat or prevent cancer.

Several studies have used chamomile extracts in animals to test their effects. They show that substances in chamomile can kill bacteria, reduce inflammation, calm muscle spasms, inhibit the growth of polio and herpes viruses and cancer cells, and prevent the growth of ulcers. Several chemicals found in chamomile leaves are known to inhibit substances in the body that cause an inflammatory response. Apigenin, a compound isolated from chamomile, binds to brain cells in the same areas as well-known depressant drugs, which could explain chamomile's sedative effects. Small clinical trials show that chamomile may have a modest effect on generalized anxiety disorder, insomnia, and in healing skin lesions after colostomy (a surgical procedure that brings one end of the large intestine out through the abdominal wall). 

Purported Uses
  • Topically, as an antiseptic and to treat skin ulcers
    Studies in animals show that substances in chamomile can kill bacteria and viruses, reduce inflammation, and prevent the growth of ulcers. Clinical trials have not been conducted.
  • Topically, to reduce the inflammation of hemorrhoids
    Animal studies show that substances in chamomile can reduce inflammation. Human data are lacking.
  • Sedation or relaxation
    It has long been thought that chamomile tea can induce relaxation. However, clinical data are lacking.
  • As a mouthwash, to treat mucositis associated with radiation therapy and chemotherapy
    Clinical trials show conflicting results for this use. More research is needed.
  • To relieve flatulence
    No scientific evidence supports this use.
  • To alleviate muscle spasms
    Animal studies show that substances in chamomile can calm muscle spasms. Human data are lacking.
Research Evidence

Generalized Anxiety Disorder (GAD):
Fifty-seven patients with GAD were given chamomile extract or placebo. Those in the chamomile group received one 220 mg chamomile capsule daily/week 1; 2 capsules daily/week 2. Patients with a 50% reduction or less in total HAM-A (Hamilton Anxiety Rating) score were increased to 3 capsules daily during week 3, and then, to 4 capsules daily during week 4 of therapy. Patients who continued to have a 50% reduction or less in HAM-A score were increased to 5 capsules daily during study weeks 5 through 8 of therapy.
Researchers observed a significant reduction in the anxiety scores between the two groups. Chamomile may have modest benefits for those with mild to moderate GAD.

Do Not Take If
  • You are allergic to ragweed or flowers in the Compositae family.
  • You take warfarin or other blood thinners (chamomile may increase the risk of bruising or bleeding).
  • You use sedatives (chamomile may have additive effects).
  • You are taking drugs that are substrates of Cytochrome P450 (chamomile may increase the risk of side effects of these drugs).
Side Effects
  • Hypersensitivity allergic reactions, ranging from dermatitis (redness and swelling of the skin) to anaphylactic shock have been reported.
  • Case reports
    Premature constriction of ductus arteriosus (a small blood vessel that is very important for circulation in the developing fetus) was reported following consumption of camomile tea by the mother during pregnancy.
    A 38-year-old Caucasian man developed an episode of severe anaphylaxis (life-threatening allergic reaction) one hour after consuming chamomile tea. The symptoms improved followed an emergency treatment with an intravenous antihistamine.
    A 70-year-old woman was hospitalized with multiple internal hemorrhages following use of chamomile products along with warfarin. Her symptoms resolved after treatment with intravenous heparin.
E-mail your questions and comments to aboutherbs@mskcc.org.