Safe and Effective Use of Herbal Sedatives in Cancer Care

[Guest guest]

 

Safe and Effective Use of Herbal Sedatives in Cancer Care JoAnn Guest Dec 29,

2004 14:18 PST

 

Herbal Sedatives

December 15, 2004 HC# 080641-270

 

Re: Safe and Effective Use of Herbal Sedatives in Complementary Cancer

Care

 

Block K, Gyllenhaal C, Mead M. Safety and efficacy of herbal sedatives

in cancer care. Integrative Cancer Therapies. 2004;3(2):128-148.

 

Insomnia and other sleep disturbances are common in cancer patients.

Long-term use of sleep-inducing drugs such as benzodiazepines is

associated with dependence, side effects, and other risks.

Non-pharmacologic strategies for improving sleep quality are needed for

integrative cancer care. The purpose of this article was to explore the

safety and efficacy of herbal sedatives and sleep agents for people with

cancer. The article includes summaries of key herbal constituents and

mechanisms of action, results of clinical trials on sleep quality, and

adverse effects and safety concerns.

 

Valerian

Valerian root (Valeriana officinalis) has been used since the 17th

century for its mild sedative and tranquilizing properties. Monoterpenes

and sesquiterpenes in the essential oil can inhibit the breakdown of

gamma-aminobutyric acid (GABA, a neurotransmitter or chemical messenger)

in the nervous system, which leads to sedation. Multiple randomized,

controlled clinical trials show relief of insomnia when valerian is

given for longer than two weeks, and several uncontrolled trials suggest

improvement in sleep quality. Valerian may also have anti-anxiety

properties. Because insomnia, fatigue, and anxiety are highly correlated

in cancer patients, anxiety relief may contribute to better sleep

quality. No serious side effects have been reported with normal doses of

valerian and it appears to have a wide margin of safety. There is no

evidence of interactions with chemotherapy drugs or other drugs commonly

used by cancer patients.

 

Kava

Kava (Piper methysticum) has a long history of use in Pacific Island

populations as a ceremonial and tranquilizing beverage. It is currently

used to relieve anxiety and sleep disorders. Kava root contains

kavalactones that act as sedatives and central nervous system

depressants, apparently by influencing the uptake of the

neurotransmitters GABA and noradrenaline (a neurotransmitter). Several

randomized, controlled clinical trials show relief of anxiety and

insomnia in people taking kava. Although kava has a long history of safe

use in South Pacific populations, there are recent reports of liver

toxicity with use of kava supplements. There is also a potential for

interactions between kava and drugs that are metabolized by the

cytochrome P450 enzymes. For this reason, people who are undergoing

cancer treatment or taking cancer-related medications should avoid kava

products.

 

Chamomile

Tea made from the flowers of chamomile (Matricaria recutita) has long

been a popular bedtime beverage. Chamomile has very mild sedative

effects that are attributed to apigenin, a flavonoid that binds to

benzodiazepine receptors in the central nervous system. There are no

controlled clinical trials demonstrating beneficial effects of chamomile

on insomnia or anxiety. Rare adverse effects of chamomile include

allergic reactions and contact dermatitis. Animal studies indicate

chamomile may interact with anthracycline drugs, and patients undergoing

chemotherapy with anthracyclines should avoid chamomile.

 

Other Herbs

Aromatherapy with lavender oil (Lavandula angustifolia) is used as a

sedative and animal studies suggest lavender oil has sedative and

anxiety-reducing effects. However, there are no controlled clinical

trials demonstrating beneficial effects of lavender on insomnia or

anxiety. There are anecdotal and historical accounts of sleep-enhancing

benefits of hops (Humulus lupulus) and lemon balm (Melissa officinalis).

No controlled clinical trials support their use in insomnia, but

uncontrolled trials suggest calming effects of these herbs.

Passionflower (Passiflora incarnata) is also reported to be a mild

sedative. One controlled trial indicated that passionflower had similar

sedative effects as the drug oxazepam. St. John's wort (Hypericum

perforatum) has clinical support for its effects in treatment of mild to

moderate depression. There is some evidence that sleep improvement may

accompany relief of depression. However, St. John's wort interacts with

the chemotherapy drug irinotecan and has the potential to interact with

other drugs.

 

The authors conclude that valerian and kava have the strongest clinical

research to support their use in insomnia and other sleep disorders.

They caution that reports of liver toxicity make kava unsuitable for use

in cancer patients. The authors provide the following summary points:

(1) much work remains to be done on the long-term safety and efficacy of

herbal sedatives in cancer patients, the elderly, and others who take

multiple drugs for chronic conditions, (2) cancer care providers should

ask patients about the use of herbal products and document any such use

in the patient's medical record, and (3) future research should identify

the active components of herbs, investigate their stability in various

formulations, and further the cause of standardization of herbal

ingredients.

 

This article provides a thorough review of the safety and efficacy of

herbs for use in insomnia and anxiety-related sleep disorders as well as

extensive information on the causes and treatment of insomnia and an

excellent discussion of herbal products in general. The article may be

particularly valuable for practitioners or patients who are not familiar

with herbal products.

 

 

—Heather S. Oliff, Ph.D.

 

http://www.herbalgram.org/nowfoods/herbclip/review.asp?i=44030