Valerian

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Valerian

Common Names

  • Garden valerian
  • Indian valerian
  • Pacific valerian
  • Mexican valerian

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

Valerian may provide modest improvements in sleep, but study results are mixed.

Valerian is sold as a dietary supplement for calmness and to improve sleep quality. It has a distinct odor that some may find unpleasant. In lab studies, valerian extract appears to have calming effects related to the nervous system. Studies in humans suggest valerian products have a modest effect on sleep quality.

Valerian products may interact with a number of drugs or health conditions. More research is needed to determine the benefits and safety of this botanical.

Purported Uses
  • To treat anxiety
    There is not enough evidence to determine whether valerian can treat anxiety.
  • To treat insomnia
    Valerian may provide modest improvements in sleep quality. Although a study in cancer patients did not find this to be true, valerian appeared to improve other symptoms such as fatigue, how long it took to fall asleep, and quantity of sleep per night.
  • To calm muscle spasms
    A small study suggests valerian may be helpful for menstrual cramps, but additional studies are needed.
  • To treat menopausal symptoms
    A few studies suggest valerian may improve hot flashes and insomnia in postmenopausal women.
Patient Warnings
  • Valerian should be stopped at least 1 week before surgery because it can interfere with general anesthesia.
  • Patients should not drive or operate dangerous machinery after taking valerian because it could disrupt the ability to process information, perform tasks, or be alert.
  • Withdrawal symptoms may occur in those taking valerian for a period of time, if valerian is discontinued abruptly.
Do Not Take If
  • You are taking barbiturates, benzodiazepines, or other CNS drugs to treat anxiety, insomnia, seizures, or psychiatric disorders: Valerian lengthens sedation time of these drugs and may have other added effects.
  • You are taking haloperidol: Valerian may increase effects and cause liver damage.
  • You are taking P-gp substrate drugs: Valerian may increase the risk of side effects of these drugs, although clinical relevance is not known.
  • You are taking CYP450 substrate drugs: Valerian may increase the risk of side effects of these drugs, although clinical relevance is not known.
  • You have pancreatic, liver, or gallbladder disease: There have been case reports of liver damage and pancreatic infection with valerian use.
  • You are driving or operating machinery: Valerian may affect your performance or functioning.
  • You are pregnant or nursing: Animal experiments have shown reduced levels of essential micronutrients in fetal mouse brain tissue.
Side Effects

Occasional, anecdotal, or possibly related:

  • Bitter taste
  • Daytime drowsiness/dullness
  • Depression
  • Diarrhea
  • Dizziness
  • Headache
  • Heart palpitations
  • Impaired alertness
  • Irritability
  • Liver toxicity
  • Sweating
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For Healthcare Professionals

Scientific Name
Valeriana officinalis, Valeriana jatamansi, Valeriana fauriei, Valeriana wallichii
Clinical Summary

Derived from the root of the plant V. officinalis, valerian is sold as a dietary supplement for calmness, sedation, and to improve sleep quality. Other species including V. jatamansi, V. fauriei, and V. wallichii are also used in traditional medicine to treat insomnia and anxiety. Valerian products are usually available in extracts or teas that have a distinct odor.

In vitro, valerian exhibits antioxidant (1), cytoprotective (2), and neuroprotective (3) effects. In animal models, valerian has demonstrated antihypertensive, antispasmotic (4) (5), anxiolytic (6), and antidepressant (7), but not sedative (8) effects.

Human studies show that valerian has modest effects on improving sleep quality (9) (10) (11), but its sleep-inducing properties are not superior to placebo (12) (13) (14) (15). Valerian also failed to improve sleep in a study of cancer patients (16). Other studies suggest that valerian may improve sleep and anxiety in HIV patients on antiretroviral therapy (53), reduce hot flashes (17) (54) and dysmenorrhea (18), facilitate supervised benzodiazepine withdrawal (19), and relieve symptoms of obsessive-compulsive disorder (20). However, sample sizes in these studies are too small to draw firm conclusions. Reviews of the clinical literature have also concluded the evidence for valerian as an anxiolytic in humans is insufficient (21) (22).

The valerian derivative isovaleroxy-hydroxy dihydrovaltrate showed anticancer effects against human ovarian cancer cells in vitro and in vivo (23). Chlorovaltrates in valerian have shown moderate cytotoxicity against lung, prostate, colon and liver cancer cell lines (24). However, no clinical trials on these effects have been conducted.

Although valerian products are generally safe, cases of liver and pancreatic toxicity have been reported (25) (26) (27). Valerian inhibits CYP3A4 enzymes and P-glycoprotein transporters and is prone to interact with many drugs (27). Valerian is also thought to have estrogenic activities (17) (28), but this is not observed in vitro (29).

Purported Uses
  • Anxiety
  • Insomnia
  • Menstrual cramps
  • Menopause symptoms
Mechanism of Action

In vitro, valerian protects against lipid peroxidation, deoxyribose degradation, and ROS production (1). Iridoids, germacrane-type sesquiterpenoids, and lignans in valerian are associated with neuroprotective effects (3) (34). Valerian constituents can also bind to various neurotransmitter receptors implicated in circadian rhythms and anxiety such as serotonin receptors (35). In vitro and animal models indicate that anxiolytic activity is due to valerenic acid (VA) which could be inhibited by VA derivatives such as hydroxy-VA that do not modulate GABAA receptors (36). VA in animals inhibits the enzyme system responsible for central catabolism of GABA, increasing GABA concentration and decreasing CNS activity, and direct binding of this constituent to GABA-receptors has been demonstrated (37). VA interaction with the GABAAergic system has been noted to act in a manner similar to that of benzodiazepines (6). Sesquiterpenes and valepotriates were identified as having varying levels of antidepressant activity (7) (38). Chronic treatment of rodents with valepotriate-rich extract increased norepinephrine and dopamine levels (38). Valerian exhibits antispasmodic and hypotensive effects via potassium channel activation, which may be useful in gastrointestinal and cardiovascular disorders (5). Valerian also exhibited a protective effect against vasopressin-induced coronary spasm and pressor response, suggesting coronary and systemic vasodilation (4).

In healthy volunteers, valerian was found to modulate intracortical facilitatory circuits (55). Valerian iridoids may have choleretic activity and this may increase the risk of gallstone formation, and therefore explain the increased risk for development of acute pancreatitis (27).

Warnings
  • Valerian should be discontinued at least 1 week before surgery because it may interact with anesthesia (40) (41).
  • Patients should not drive or operate dangerous machinery after taking valerian as it could disrupt information processing, task performance, and vigilance (35).
  • Abrupt discontinuation of valerian in those who may have developed a dependency may cause benzodiazepine-like withdrawal (40).
Contraindications
  • Patients with liver or pancreatic disease should avoid valerian as there have been case reports of hepatotoxicity (25) (26) as well as a possible association of valerian iridoids with an increased risk for development of acute pancreatitis (27).
  • Patients should not drive or operate dangerous machinery when taking valerian as early studies indicate that single-dose valerian could disrupt information processing, task performance, and vigilance in humans 1–2 hours post-administration (35).
  • Individuals who are pregnant or nursing should avoid valerian, as it has not adequately been studied and preliminary animal models indicate some adverse effects on fetal brain development (42).
Adverse Reactions

Occasional, anecdotal, or possibly related: Headache, diarrhea and other GI complaints, daytime sedation/dullness, impaired alertness, depression, irritability, dizziness, sweating, heart palpitations, bitter taste, benzodiazepine-like withdrawal symptoms with supplement cessation (10) (16) (35) (43).

Case Reports
Hepatotoxicity:
Two separate cases in women with the use of valerian products, with eventual symptom resolution after discontinuation (25) (26).
Risk of acute pancreatitis: A case-control study identified valerian use as a potential contributor to cases of idiopathic acute pancreatitis (27).

Herb-Drug Interactions

Barbiturates: In animal models, valerian prolonged pentobarbital-induced sleep (40) (44). Clinical relevance has yet to be determined.
Benzodiazepines: An animal study and case report suggest valerian may have synergistic effects (45) (46). Clinical relevance has yet to be determined.
Haloperidol: An animal study suggests valerian may have an additive effect, causing hepatic damage (47). Clinical relevance has yet to be determined.
Cytochrome P450 substrates: Valerian inhibits CYP2D6 (48) and CYP3A4 (41) (49), and may affect serum concentration of drugs metabolized by these enzymes. Clinical relevance has yet to be determined.
P-glycoprotein substrates: Valerian may inhibit P-gp transporters and affect the intracellular concentration of substrate drugs (17) (28) (49). Clinical relevance has yet to be determined.
Uridine 5’-diphospho-glucuronosyltransferase substrates: Preclinical studies suggest valerian modulates UGT enzymes and may increase the side effects of drugs metabolized by them (50). Clinical relevance has yet to be determined.

Dosage (OneMSK Only)
References
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  2. de Oliveria DM, Barreto G, De Andrade DV, et al. Cytoprotective effect of Valeriana officinalis extract on an in vitro experimental model of Parkinson disease. Neurochem Res. Feb 2009;34(2):215-220.
  3. Xu J, Guo Y, Xie C, et al. Isolation and neuroprotective activities of acylated iridoids from Valeriana jatamansi. Chem Biodivers. Jul 2012;9(7):1382-1388.
  4. Circosta C, De Pasquale R, Samperi S, et al. Biological and analytical characterization of two extracts from Valeriana officinalis. J Ethnopharmacol. Jun 13 2007;112(2):361-367.
  5. Gilani AH, Khan AU, Jabeen Q, et al. Antispasmodic and blood pressure lowering effects of Valeriana wallichii are mediated through K+ channel activation. J Ethnopharmacol. Sep 14 2005;100(3):347-352.
  6. Murphy K, Kubin ZJ, Shepherd JN, et al. Valeriana officinalis root extracts have potent anxiolytic effects in laboratory rats. Phytomedicine. Jul 2010;17(8-9):674-678.
  7. Liu XG, Gao PY, Wang GS, et al. In vivo antidepressant activity of sesquiterpenes from the roots of Valeriana fauriei Briq. Fitoterapia. Apr 2012;83(3):599-603.
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  11. Taavoni S, Ekbatani N, Kashaniyan M, et al. Effect of valerian on sleep quality in postmenopausal women: a randomized placebo-controlled clinical trial. Menopause. Sep 2011;18(9):951-955.
  12. Diaper A, Hindmarch I. A double-blind, placebo-controlled investigation of the effects of two doses of a valerian preparation on the sleep, cognitive and psychomotor function of sleep-disturbed older adults. Phytother Res. Oct 2004;18(10):831-836.
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  16. Barton DL, Atherton PJ, Bauer BA, et al. The use of Valeriana officinalis (Valerian) in improving sleep in patients who are undergoing treatment for cancer: a phase III randomized, placebo-controlled, double-blind study (NCCTG Trial, N01C5). J Support Oncol. Jan-Feb 2011;9(1):24-31.
  17. Mirabi P, Mojab F. The effects of valerian root on hot flashes in menopausal women. Iran J Pharm Res. Winter 2013;12(1):217-222.
  18. Mirabi P, Dolatian M, Mojab F, et al. Effects of valerian on the severity and systemic manifestations of dysmenorrhea. Int J Gynaecol Obstet. Dec 2011;115(3):285-288.
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  24. Lin S, Zhang ZX, Chen T, et al. Characterization of chlorinated valepotriates from Valeriana jatamansi. Phytochemistry. Jan 2013;85:185-193.
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  27. Douros A, Bronder E, Andersohn F, et al. Drug-induced acute pancreatitis: results from the hospital-based Berlin case-control surveillance study of 102 cases. Aliment Pharmacol Ther. Oct 2013;38(7):825-834.
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  32. Muller LG, Salles LA, Stein AC, et al. Antidepressant-like effect of Valeriana glechomifolia Meyer (Valerianaceae) in mice. Prog Neuropsychopharmacol Biol Psychiatry. Jan 10 2012;36(1):101-109.
  33. Pyle BW, Tran HT, Pickel B, et al. Enzymatic synthesis of valerena-4,7(11)-diene by a unique sesquiterpene synthase from the valerian plant (Valeriana officinalis). FEBS J. Sep 2012;279(17):3136-3146.
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  37. Benke D, Barberis A, Kopp S, et al. GABA A receptors as in vivo substrate for the anxiolytic action of valerenic acid, a major constituent of valerian root extracts. Neuropharmacology. Jan 2009;56(1):174-181.
  38. Sah SP, Mathela CS, Chopra K. Antidepressant effect of Valeriana wallichii patchouli alcohol chemotype in mice: Behavioural and biochemical evidence. J Ethnopharmacol. Apr 26 2011;135(1):197-200.
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  42. Mahmoudian A, Rajaei Z, Haghir H, et al. Effects of valerian consumption during pregnancy on cortical volume and the levels of zinc and copper in the brain tissue of mouse fetus. Zhong Xi Yi Jie He Xue Bao. Apr 2012;10(4):424-429.
  43. Taibi DM, Landis CA, Petry H, et al. A systematic review of valerian as a sleep aid: safe but not effective. Sleep Med Rev. Jun 2007;11(3):209-230.
  44. Komori T, Matsumoto T, Motomura E, et al. The sleep-enhancing effect of valerian inhalation and sleep-shortening effect of lemon inhalation. Chem Senses. Oct 2006;31(8):731-737.
  45. Carrasco MC, Vallejo JR, Pardo-de-Santayana M, et al. Interactions of Valeriana officinalis L. and Passiflora incarnata L. in a patient treated with lorazepam. Phytother Res. Dec 2009;23(12):1795-1796.
  46. Bhatt C, Kanaki N, Nayak R, et al. Synergistic potentiation of anti-anxiety activity of valerian and alprazolam by liquorice. Indian J Pharmacol. Mar-Apr 2013;45(2):202-203.
  47. Dalla Corte CL, Fachinetto R, Colle D, et al. Potentially adverse interactions between haloperidol and valerian. Food Chem Toxicol. Jul 2008;46(7):2369-2375.
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  50. Mohamed ME, Frye RF. Effects of herbal supplements on drug glucuronidation. Review of clinical, animal, and in vitro studies. Planta Med. Mar 2011;77(4):311-321.
  51. Leathwood PD, Chauffard F. Aqueous extract of valerian reduces latency to fall asleep in man. Planta Med. Apr 1985(2):144-148.
  52. Balderer G, Borbely AA. Effect of valerian on human sleep. Psychopharmacology (Berl). 1985;87(4):406-409.
  53. Ahmadi M, Khalili H, Abbasian L, et al. Effect of Valerian in Preventing Neuropsychiatric Adverse Effects of Efavirenz in HIV-Positive Patients: A Pilot Randomized, Placebo-Controlled Clinical Trial. Ann Pharmacother. Jun 2017;51(6):457-464.
  54. Jenabi E, Shobeiri F, Hazavehei SMM, et al. The effect of Valerian on the severity and frequency of hot flashes: A triple-blind randomized clinical trial. Women Health. Mar 2018;58(3):297-304.
  55. Mineo L, Concerto C, Patel D, et al. Valeriana officinalis Root Extract Modulates Cortical Excitatory Circuits in Humans. Neuropsychobiology. 2017;75(1):46-51.
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