Health Care Professional Information

Scientific Name
Passiflora incarnata
Common Name

Maypop, apricot vine, passion vine, purple passion flower, fleur de la passion, passiflore, corona de cristo, maracuja

Brand Name

Sedacalm®, Passipay™, Passipy™ IranDarouk

Clinical Summary

Derived from the aerial parts of the plant, passionflower is used by patients to treat insomnia, anxiety, epilepsy, neuralgia, and withdrawal syndromes from opiates or benzodiazepines. The alkaloid components (e.g., harman, harmaline) are thought to produce monoamine oxidase inhibition, while other constituents, like maltol and gamma-pyrone derivatives, cause activation of GABA receptors (1). Theoretically, passionflower may potentiate the sedative effect of centrally acting substances (e.g., benzodiazepines, barbiturates, alcohol) (2).

A small pilot study evaluated passionflower for generalized anxiety and showed comparable efficacy to oxazepam (3), but a systematic review concluded that randomized controlled studies are needed to confirm such effects (4). In patients undergoing surgery, preoperative passionflower use reduced anxiety (5) (16). However, one study found that administration of five different Passiflora incarnata extracts to mice in their drinking water produced anxiogenic effects. Two of these extracts did show an anticonvulsant effect against pentylenetetrazol-induced seizures (6).
Consumption of a low dose of passionflower tea affected short-term benefits in sleep quality in healthy adults (17).
When used concurrently, passionflower was shown to enhance the pharmocological effects of St. John's Wort (18).

Not all passionflower extracts are standardized because of which dosages and activities may vary.

Purported Uses
  • Benzodiazepine withdrawal
  • Drug withdrawal symptoms
  • Epilepsy
  • Insomnia
  • Neuralgia
Constituents
  • Alkaloids: Harman, harmaline, harmalol, harmol, harmine
  • Flavonoids: Vitexin, isovitexin, apigenin, luteolin glycosides (orientin, homoorientin, lucenin), kaempferol, quercetin, rutin
  • Other: Carbohydrates, benzopyrones, fatty acids, gamma-pyrone derivatives (maltol, ethylmaltol), passicol
    (8) (9)
Mechanism of Action

The activation of GABA receptors by maltol and gamma-pyrone derivatives may account for passionflower's anxiolytic and sedative properties (11). It was also suggested that the harman alkaloids have monoamine oxidase inhibitor activity (1). Passionflower exhibits mild anti-inflammatory activity (12). An ethanolic extract of passionflower reduced carrageenan-induced edema, leukocyte migration, and granuloma formation in mice, although the effect was less than that seen with aspirin (13).

Pharmacokinetics

No formal pharmacokinetic studies have been conducted.

Adverse Reactions

Reported: Dizziness, sedation, ataxia, allergic reaction, and impaired cognitive function (3).
Case report: Nausea, vomiting, bradycardia, and ECG changes including non-sustained ventricular tachycardia, QTc prolongation, and nonspecific ST-T wave changes. Patient recovered following discontinuation of supplement (6).

Herb-Drug Interactions

Pentobarbital: Passionflower may potentiate the effects of pentobarbital (2).
Benzodiazepines: Passionflower may increase the sedative effects of benzodiazepines by increasing the binding activity of benzodiazepines to GABA receptors (14).
 

Literature Summary and Critique

Movafegh A, et al. Preoperative oral Passiflora incarnata reduces anxiety in ambulatory surgery patients: a double-blind, placebo-controlled study. Anesth Analg. Jun 2008;106(6):1728-1732.
To determine if preoperative oral passionflower could alter anxiety, 60 ambulatory surgery patients received passionflower (500 mg, Passipy™ IranDarouk) or placebo 90 minutes prior to surgery. Both anxiety and sedation were assessed using the numerical rating scale (NRS) at different time points before the surgery. Psychomotor evaluations were also performed. Whereas the NRS anxiety scores were significantly reduced in the intervention group as compared to the placebo group, no other differences were detected, suggested that passionflower effectively reduces pre-surgical anxiety without altering psychomotor function. Further studies are necessary to determine if passionflower can reduce anxiety in patients undergoing more extensive surgery.

Dosage (Inside MSKCC Only)
This field is only visible to only OneMSK users.
References
  1. Dhawan K, Kumar S, Sharma A. Anti-anxiety studies on extracts of Passiflora incarnata Linneaus. J Ethnopharmacol. Dec 2001;78(2-3):165-170.
  2. Speroni E, Billi R, Mercati V, et al. Sedative effects of crude extract of passiflora incarnata after oral administration. Phytotherapy Res 1996;10:S92-S94.
  3. Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. Oct 2001;26(5):363-367.
  4. Miyasaka LS, Atallah AN, Soares BG. Passiflora for anxiety disorder. Cochrane Database Syst Rev. 2007(1):CD004518.
  5. Movafegh A, Alizadeh R, Hajimohamadi F, et al. Preoperative oral Passiflora incarnata reduces anxiety in ambulatory surgery patients: a double-blind, placebo-controlled study. Anesth Analg. Jun 2008;106(6):1728-1732.
  6. Elsas S-M, Rossi DJ, Raber J, et al. Passiflora incarnata L. (Passionflower) extracts elicit GABA currents in hippocampal neurons in vitro and show anxiogenic and anticonvulsant effects in vivo, varying with extraction method. Phytomedicine. 2010 Oct;17(12):940-9.
  7. Fisher AA, Purcell P, Le Couteur DG. Toxicity of Passiflora incarnata L. J Toxicol Clin Toxicol. 2000;38(1):63-66.
  8. Dhawan K, Kumar S, Sharma A. Anxiolytic activity of aerial and underground parts of Passiflora incarnata. Fitoterapia. Dec 2001;72(8):922-926.
  9. Grice ID, Ferreira LA, Griffiths LR. Identification and simultaneous analysis of harmane, harmine, harmol, isovitexin, and vitexin in passiflora incarnata extracts with a novel hplc method. J Liq Chrom Rel Technol 2001;24(16):2513-2523.
  10. Newall CA, Anderson LA, Phillipson JD. Herbal Medicines: A Guide for Health-Care Professionals. 1st ed. London: Pharmaceutical Press; 1996.
  11. Grundmann O, Wang J, McGregor GP, et al. Anxiolytic Activity of a Phytochemically Characterized Passiflora incarnata Extract is Mediated via the GABAergic System. Planta Med. 2008 Dec;74(15):1769-73.
  12. Soulimani R, Younos C, Jarmouni S, et al. Behavioural effects of Passiflora incarnata L. and its indole alkaloid and flavonoid derivatives and maltol in the mouse. J Ethnopharmacol. Jun 1997;57(1):11-20.
  13. Borrelli F, Pinto L, Izzo AA, et al. Anti-inflammatory activity of passiflora incarnata l. in rats. Phytotherapy Res. 1996;10:S104-S106.
  14. Carrasco MC, Vallejo JR, Pardo-de-Santayana M, et al. Interactions of Valeriania officilanis L. and Passiflora incarnata L. in a patient treated with lorazepam. Phytother Res. 2009;23:1795-1796.
  15. Brinker F. Herb Contraindications and Drug Interactions. 3rd ed. Sandy (OR): Eclectic Medical Publications; 2001.
  16. Aslanargun P, Cuvas O, Dikmen B, Aslan E, Yuksel MU. Passiflora incarnata Linneaus as an anxiolytic before spinal anesthesia. J Anesth. 2012 Feb;26(1):39-44.
  17. Ngan A, Conduit R. A double-blind, placebo-controlled investigation of the effects of Passiflora incarnata (passionflower) herbal tea on subjective sleep quality. Phytother Res. 2011 Aug;25(8):1153-9.
  18. Fiebich BL, Knörle R, Appel K, Kammler T, Weiss G. Pharmacological studies in an herbal drug combination of St. John's Wort (Hypericum perforatum) and passion flower (Passiflora incarnata): in vitro and in vivo evidence of synergy between Hypericum and Passiflora in antidepressant pharmacological models. Fitoterapia. 2011 Apr;82(3):474-80.

Consumer Information

How It Works

Bottom Line: Passionflower may reduce anxiety, but its long-term safety and effectiveness are not known.

Passiflora incarnata is a perennial wildflower that is commonly found in the southern United States. Passionflower extract is contained in many dietary supplement products marketed as sleep aids or anxiety relievers. A handful of studies in humans support these claims, although it is still unknown whether passionflower extracts are safe and effective in the long-term. Scientists are not sure how this herb works, but have speculated that compounds in passionflower may interact with receptors in the brain that would mediate a relaxation response. Studies done in mice suggest that passionflower extracts have mild anti-inflammatory activity.

 

 

Purported Uses
  • To relieve anxiety
    One small clinical trial suggested that passionflower may be as effective as oxazepam, a common drug used for treating general anxiety. In addition, another clinical trial showed that passionflower reduced anxiety in presurgical patients. However, the safety and effectiveness of its long-term use are not known.
  • As a sleep aid, for insomnia
    Passionflower may reduce anxiety (see above), which may help induce sleep. A small study showed benefits of passionflower in sleep quality in healthy adults.
  • To treat neuralgia (nerve pain)
    Passionflower may help reduce anxiety (see above), and could thereby reduce the perception of pain. However, other than this theoretical association, no scientific evidence supports the use of passionflower for nerve pain.
Research Evidence

Anxiety
This study was conducted to find out if use of preoperative oral passionflower reduced anxiety. Sixty patients were either given passionflower (500 mg, Passipy™ IranDarouk) or placebo 90 minutes before their surgery and anxiety was measured at different time points before surgery. In patients who received passionflower, anxiety was reduced compared to the placebo group. However, larger studies are required to confirm such effects.

 

Do Not Take If
  • You are taking pentobarbital (Passionflower may have additive effects).
  • You are taking benzodiazepines such as Ativan® or Valium® (Passionflower may increase the sedative effects of these medications).
Side Effects
  • Dizziness
  • Sedation
  • Ataxia (lack of coordinated muscle activity)
  • Allergic reaction
  • Impaired cognitive function
  • Case report: One patient experienced nausea, vomiting, decreased heart rate, and several abnormalities in heart rhythm after using a passionflower supplement. The patient recovered once the supplement was discontinued.
Special Point
  • Passionflower extracts that are available over-the-counter are not always standardized with respect to content and activity, and therefore dosages may vary.
E-mail your questions and comments to aboutherbs@mskcc.org.