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Clinician’s Corner: Valerian

Valerian (Valeriana officinalis) is a perennial plant native to North America, Europe and Asia.  For hundreds of years it has been used in Europe to relieve insomnia, anxiety, muscle spasms and stress induced palpitations.

Source: Valerian products are made from its underground stems, and horizontal stems. Dried roots are prepared as teas or tinctures, and dried plant materials and extracts are put into capsules.

Efficacy: Some studies suggest that valerian may be useful for insomnia and other sleep disorders; results of other studies do not. Some of these studies had small sample sizes, used different amounts and sources of valerian, measured different outcomes, or did not consider potential bias resulting from high participant withdrawal rates. Overall, the evidence from these trials for the sleep-promoting effects of valerian is inconclusive.

Numerous trials have not shown it to be better than placebo, while some other trials showed it had less side effects than placebo! One study showed a decrease in slow-wave sleep onset (13.5 minutes) compared with placebo (21.3 minutes).

Another study enlisting 75 patients comparing Valerian 600mg to  the prescription drug oxazepam (Serax®) 10mg.  Both groups had the same improvement in sleep quality but the valerian group reported fewer side effects than did the oxazepam group.  Those patients experienced less morning drowsiness.

Adverse effects: Few adverse events have been reported because of valerian. As we would expect from its sedative properties, valerian can cause drowsiness or dizziness. The risk of respiratory depression should be considered if valerian is used with multiple sedating drugs  and/or significant alcohol consumption. Valerian can cause abdominal pain in large doses.

Worth recommending? Valerian is a seems to be a safe herbal choice for the treatment of mild insomnia and has good tolerability. Valerian seems to be more effective when used continuously rather than as an acute sleep aid. Most references recommend using 400mg-900mg one hour before bedtime. Best results occur when a person takes it for at least 28 days. A potential advantage of valerian over benzodiazepines (drugs like Valium, Xanax and Klonopin) is the lack of sleepiness on awakening when used at the recommended dosages. Valerian also may be helpful in weaning patients with insomnia from benzodiazepines (drugs like Valium, Xanax and Klonopin).

When combined with opioids, benzodiazepines can cause an increase in opioid deaths. More than 30 percent of overdoses involving opioids also involve benzodiazepines.  According to Psychiatry-Online (18March2016) between 1996 and 2013, the number of adults filling a benzodiazepine prescription increased 67 percent, from 8.1 million to 13.5 million. Among those filling benzodiazepine prescriptions, the median cumulative quantity filled over the year increased by 140 percent, from 86.8 mg to 208.0 mg lorazepam equivalents.  Meanwhile in this time frame deaths involving benzodiazepine increased fivefold.

Pharmacists and prescribers are feeling the heat when it comes to prescribing benzodiazepines and opioids, especially in combination.  Valerian root might be an option, rather than another new start on a benzodiazepine.

Your Thompson Pharmacist wants to keep you safe and healthy.  Options to help with anxiety are available without causing more problems like dependence and drowsiness.  We’re here to help.  At Thompson Pharmacy it’s all for YOU!