About Herbs

Bottom Line: It is not clear from clinical trials whether chamomile mouth wash helps prevent chemotherapy-induced mucositis. It may have a slight sedative effect, but there is no evidence to support any other effects.

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 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. However, no clinical trials have been performed to test whether all of these effects occur when humans use chamomile.

Chemotherapy-induced mucositis:
A clinical trial evaluated the use of a chamomile mouthwash for the treatment of mucositis (inflammation of the mucous membranes of the mouth) resulting from chemotherapy with 5-fluorouracil. Starting on the first day of chemotherapy, half of the patients used a chamomile mouthwash and the other half used a placebo mouthwash three times a day for two weeks. Mouth inflammation ratings were not very different between the groups, indicating that chamomile mouthwash is not helpful in treating chemotherapy-induced mucositis.

The ability of a chamomile mouthwash to prevent chemotherapy- or radiation therapy-induced mucositis was examined in 20 patients being treated with radiation and 46 patients receiving chemotherapy. Prophylactic use of the chamomile rinse prevented the occurrence of mucositis in 78% of the patients receiving chemotherapy and delayed the onset and reduced the intensity of radiation-induced mucositis. However, because there is no placebo group in this study, the researchers could not compare the effects of the chamomile mouthwash to no treatment at all.

Matricaria recutita L.

Hungarian chamomile, wild chamomile, Chamomilla recutita

Derived from the flower. Chamomile is widely used in teas for its relaxing effect. Topical and oral administrations are safe except in patients with allergies to ragweed or chrysanthemums ⁽²⁾. Studies of chamomile mouthwash produced conflicting results regarding its benefit in reducing 5-FU induced mucositis ^{(8) (9)}. Potential drug interactions include platelet inhibition leading to additive anticoagulant effect and potentially increased sedation from sedatives or hypnotics ⁽⁴⁾.

Flower head

• Coumarins
• Flavonoids (up to 8%): Quercetin, rutin, apigenin, luteolin, apigetrin and apiin
• Volatile oils: Alpha bisabolol (up to 50%), azulene and chamazulene
• Other constituents: Amino acids, choline polysaccharide, plant and fatty acids, tannin, triterpene hydrocarbons
  ⁽¹⁾

In animal studies, a wide range of pharmacological activities has been documented including antibacterial, anti-inflammatory, antispasmodic, anti-ulcer, antiviral, and hypouraemic activities. Apigenin, a flavone, interacts with GABA(A)-benzodiazepine receptors in vitro and inhibits locomoter behavior in rats ⁽⁵⁾. The azulene components of the volatile oil are thought to contribute by inhibiting histamine release, and they have been reported to prevent allergic seizures in animals. Matricin, the precursor to chamazulene, is reported to be a more effective anti-inflammatory agent than chamazulene. Anti-inflammatory and antiulcerogenic activity has also been documented for the alpha bisabolol compound. Antibacterial activity has been documented for the coumarin constituents. Antispasmodic activity has been documented for the flavonoid and bisabolol constituents ⁽²⁾.

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

Reported: Hypersensitivity reactions in people allergic to ragweed or members of the Compositae family, ranging from contact dermatitis to anaphylaxis ^{(2) (3)}.

Anticoagulants / Antiplatelets: Chamomile may increase anticoagulant effects and inhibit platelets due to coumarin content ⁽¹⁰⁾.
Sedatives: Chamomile may cause additive drowsiness⁽⁴⁾.

May increase PT, APTT, and INR

Fidler P, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 1996;77: 522-5.
A phase III, double-blind, placebo-controlled clinical trial with 164 patients equally randomized to both treatment groups. Patients received 30 minutes of oral cryotherapy prior to bolus of 5-FU-based chemotherapy. Chamomile or placebo mouthwash was used three times a day for fourteen days beginning on the first day of chemotherapy. Graded stomatitis scores were not significantly different between the two treatment groups. Chamomile mouthwash did not appear to be beneficial in the prevention of 5-FU induced stomatitis.

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.
Twenty patients treated with radiation and 46 patients receiving systemic chemotherapy participated in prophylactic oral care with a chamomile oral rinse. Thirty-two patients were treated therapeutically after mucositis had developed. Prophylactic use of the rinse prevented the occurrence of mucositis in 78% of the patients receiving chemotherapy and delayed the onset and reduced the intensity of radiation-induced mucositis.