Chasteberry

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Chasteberry

Common Names

  • Chasteberry
  • Vitex
  • Chaste tree fruit
  • Monk’s pepper

For Patients & Caregivers

Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.


How It Works

There is evidence to suggest that chasteberry helps improve premenstrual symptoms, but more studies are needed.

Chasteberry is used widely to treat infertility and premenstrual syndrome (PMS). Lab studies show chasteberry contains substances that can prompt hormonal changes in the body. Various studies in humans suggest chasteberry can help reduce breast pain and other PMS symptoms, but not menopause symptoms.

Because chasteberry has phytoestrogenic properties, patients with hormone-sensitive cancers should consult their physicians before using it.

Purported Uses
  • To ease difficult and painful menstruation
    A few studies support this use in women aged 20–40 whose ovarian function was not greatly impaired and who had no other hormone imbalances.
  • To prevent premenstrual symptoms
    A few studies support this use in women aged 20–40 whose ovarian function was not greatly impaired and who had no other hormone imbalances.
  • To treat breast pain
    A few clinical trials support this use for breast pain associated with menstruation.
  • To prevent menopausal symptoms
    One study that evaluated chasteberry taken with St. John’s wort determined it did not help relieve menopausal symptoms.
Do Not Take If
  • You are taking CYP2C19 or CYP3A4 substrate drugs: Lab studies suggest chasteberry may increase the risk for side effects with these drugs. Clinical relevance has yet to be determined.
  • You are taking psychiatric drugs such as chlorpromazine, haloperidol, or prochlorperazine: Lab studies suggest chasteberry may interfere with their effectiveness or enhance their side effects. Clinical relevance has yet to be determined.
  • You are taking medicines for Parkinson’s disease: Chasteberry may interfere with their effectiveness or enhance their side effects.
  • You are taking hormonal medications such as birth control pills: Lab studies suggest chasteberry may interfere with their effectiveness. Clinical relevance has yet to be determined.
  • You are pregnant or nursing.
Side Effects

Nausea, headache, GI disturbances, menstrual disorders, acne, itching, redness/rash

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For Healthcare Professionals

Scientific Name
Vitex agnus castus
Clinical Summary

The fruit of chasteberry is widely used to relieve premenstrual symptoms and to treat infertility. It is said to have a normalizing action on the menstrual cycle and contain nonsteroidal progestins that can interact with and activate hormone receptors in the body (1).

Chasteberry has opioidergic (2), dopaminergic (3), hepatoprotective (4), and antiproliferative (5) properties in vitro. Clinical studies suggest it can reduce PMS symptoms (6) (7) (8) (22), but a systematic review highlighted the need for well-designed studies for definitive conclusions (23). Preliminary data also suggest chasteberry may help reduce mastalgia (9) (24), but in combination with St. John’s wort, it was ineffective for treating menopausal symptoms (10).

Because chasteberry has phytoestrogenic properties (11) (12) (13), patients with hormone-sensitive cancers should consult their physicians before using it.

Purported Uses
  • Dysmenorrhea
  • Mastalgia
  • Menopausal symptoms
Mechanism of Action

In vitro studies have identified several flavonoids in chasteberry, especially casticin, which exerts opioidergic effects through activation of mu- and delta-opioid receptor subtypes (2). Casticin reduced lung inflammation in a murine model by inhibiting numbers of neutrophils, macrophages, and lymphocytes, and by reducing levels of proinflammatory cytokines and chemokines (25).

Dopaminergic compounds, particularly clerodadienols, dose-dependently inhibited pituitary prolactin release, which could explain its effect during the premenstrual cycle when serum prolactin levels can be chronically elevated (3). Other diterpenes including rotundifuran also modulate dopamine receptors (14). Linoleic acid from chasteberry binds to estrogen receptors (ER) and can induce certain estrogen genes (12). The flavonoid apigenin was identified as the most active ER isoform-selective phytoestrogen (11), and can also induce progestogenic activity (13).

In human studies, chasteberry restores progesterone concentrations, prolongs the hyperthermic phase in the basal temperature curve, and restores the luteinizing hormone-releasing hormone test to normal. It is thought to act on the pituitary-hypothalamic axis rather than directly on ovaries (11).

Contraindications
  • Because chasteberry has phytoestrogenic properties (11) (12) (13), patients with hormone-sensitive cancers should consult their physicians before using it.
  • Chasteberry should be avoided during pregnancy and lactation (17) (18).
Adverse Reactions

Nausea, headache, GI disturbances, menstrual disorders, acne, pruritus, and erythematous rash (9) (19)

Herb-Drug Interactions

Antipsychotics (Phenothiazines, Dopamine D2-Antagonists): Preclinical studies suggest chasteberry may interfere with the action of these drugs or enhance their side effects (17) (20). Clinical relevance has yet to be determined.
Antiparkinson agents (Dopamine agonists): Preclinical studies suggest chasteberry may interfere with the action of these drugs or enhance their side effects (17) (20). Clinical relevance has yet to be determined.
CYP450 substrates: In vitro, chasteberry inhibits CYP2C19 and CYP3A4 and may affect drugs metabolized by these enzymes (21). Clinical relevance has yet to be determined.
Hormonal therapies: Preclinical studies suggest chasteberry may decrease the effects of hormone therapies (11) (12) (18). Clinical relevance has yet to be determined.
Oral contraceptives: Preclinical studies suggest chasteberry may decrease the effects of contraceptives (18). Clinical relevance has yet to be determined.

Dosage (OneMSK Only)
References
  1. Toh MF, Sohn J, Chen SN, et al. Biological characterization of non-steroidal progestins from botanicals used for women’s health. Steroids. Jun 2012;77(7):765-773.
  2. Webster DE, He Y, Chen SN, et al. Opioidergic mechanisms underlying the actions of Vitex agnus-castus L. Biochem Pharmacol. Jan 1 2011;81(1):170-177.
  3. Wuttke W, Jarry H, Christoffel V, et al. Chaste tree (Vitex agnus-castus)—pharmacology and clinical indications. Phytomedicine. May 2003;10(4):348-357.
  4. Tandon VR, Khajuria V, Kapoor B, et al. Hepatoprotective activity of Vitex negundo leaf extract against anti-tubercular drugs induced hepatotoxicity. Fitoterapia. Dec 2008;79(7-8):533-538.
  5. Weisskopf M, Schaffner W, Jundt G, et al. A Vitex agnus-castus extract inhibits cell growth and induces apoptosis in prostate epithelial cell lines. Planta Med. Oct 2005;71(10):910-916.
  6. Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. Jan 20 2001;322(7279):134-137.
  7. He Z, Chen R, Zhou Y, et al. Treatment for premenstrual syndrome with Vitex agnus castus: A prospective, randomized, multi-center placebo controlled study in China. Maturitas. May 20 2009;63(1):99-103.
  8. Zamani M, Neghab N, Torabian S. Therapeutic effect of Vitex agnus castus in patients with premenstrual syndrome. Acta Med Iran. 2012;50(2):101-106.
  9. Carmichael AR. Can Vitex agnus castus be Used for the Treatment of Mastalgia? What is the Current Evidence? Evid Based Complement Alternat Med. Sep 2008;5(3):247-250.
  10. van Die MD, Burger HG, Bone KM, et al. Hypericum perforatum with Vitex agnus-castus in menopausal symptoms: a randomized, controlled trial. Menopause. Jan-Feb 2009;16(1):156-163.
  11. Jarry H, Spengler B, Porzel A, et al. Evidence for estrogen receptor beta-selective activity of Vitex agnus-castus and isolated flavones. Planta Med. Oct 2003;69(10):945-947.
  12. Liu J, Burdette JE, Sun Y, et al. Isolation of linoleic acid as an estrogenic compound from the fruits of Vitex agnus-castus L. (chaste-berry). Phytomedicine. Jan 2004;11(1):18-23.
  13. Hajirahimkhan A, Dietz BM, Bolton JL. Botanical modulation of menopausal symptoms: mechanisms of action? Planta Med. May 2013;79(7):538-553.
  14. Meier B, Berger D, Hoberg E, et al. Pharmacological activities of Vitex agnus-castus extracts in vitro. Phytomedicine. Oct 2000;7(5):373-381.
  15. Li S, Qiu S, Yao P, et al. Compounds from the Fruits of the Popular European Medicinal Plant Vitex agnus-castus in Chemoprevention via NADP(H):Quinone Oxidoreductase Type 1 Induction. Evid Based Complement Alternat Med. 2013;2013:432829.
  16. Hajimehdipoor H, Shekarchi M, Piralihamedani M, et al. A Validated HPTLC-Densitometric Method for Assay of Aucubin in Vitexagnus-castusL. Iran J Pharm Res. Fall 2011;10(4):705-710.
  17. Roemheld-Hamm B. Chasteberry. Am Fam Physician. Sep 1 2005;72(5):821-824.
  18. Dugoua JJ, Seely D, Perri D, et al. Safety and efficacy of chastetree (Vitex agnus-castus) during pregnancy and lactation. Can J Clin Pharmacol. Winter 2008;15(1):e74-79.
  19. Daniele C, Thompson Coon J, Pittler MH, et al. Vitex agnus castus: a systematic review of adverse events. Drug Saf. 2005;28(4):319-332.
  20. Jarry H, Leonhardt S, Gorkow C, et al. In vitro prolactin but not LH and FSH release is inhibited by compounds in extracts of Agnus castus: direct evidence for a dopaminergic principle by the dopamine receptor assay. Exp Clin Endocrinol. 1994;102(6):448-454. 
  21. Ho SH, Singh M, Holloway AC, et al. The effects of commercial preparations of herbal supplements commonly used by women on the biotransformation of fluorogenic substrates by human cytochromes P450. Phytother Res. Jul 2011;25(7):983-989. 
  22. Cerqueira RO, Frey BN, Leclerc E, Brietzke E. Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. Arch Womens Ment Health. 2017 Dec;20(6):713-719.
  23. Verkaik S, Kamperman AM, van Westrhenen R, Schulte PFJ. The treatment of premenstrual syndrome with preparations of Vitex agnus castus: a systematic review and meta-analysis. Am J Obstet Gynecol. 2017 Aug;217(2):150-166.
  24. Mirghafourvand M, Mohammad-Alizadeh-Charandabi S, Ahmadpour P, Javadzadeh Y. Effects of Vitex agnus and Flaxseed on cyclic mastalgia: A randomized controlled trial. Complement Ther Med. 2016 Feb;24:90-5.
  25. Lee H, Jung KH, Lee H, Park S, Choi W, Bae H. Casticin, an active compound isolated from Vitex fructus, ameliorates the cigarette smoke-induced acute lung inflammatory response in a murine model. Int Immunopharmacol. 2015 Oct;28(2):1097-101.
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