Place in therapy
Efficacy
Valerian can be used for insomnia; however, the evidence for its efficacy is limited and somewhat conflicting. The studies that have been done have many limitations such as small patient populations, subjective outcome measures, and other methodological flaws. Despite the limitations of these studies, some similar outcomes have been achieved such as a reduction in sleep latency and improvement in sleep quality. These outcomes are subjective as they have been patient reported, mainly by the use of sleep diaries.
Overall, if valerian does show efficacy for insomnia, it is the improvement of sleep quality and reduction in sleep latency.1,2 Valerian has not been shown to improve sleep duration or other sleep measures. Although one study did suggest valerian may improve day time energy level.3 Valerian could be recommended if the patient prefers a natural product to improve sleep quality or reduce sleep latency. Valerian should be taken for a number of days consecutively, as the efficacy may improve with continued use.2
Safety
Valerian has been shown to be safe when used for the treatment of insomnia. In randomized controlled trials, valerian was shown to have a similar number of adverse effects compared to placebo.3,4 The use of valerian in pregnancy and during breastfeeding is not recommended.1,2
Valerian should be used with caution with other CNS depressants due to increased sedation.1,2 Valerian may inhibit CYP 3A4 and caution should be taken when using in combination with medications metabolized by this enzyme as well as in patients with hepatic impairment.2 The safety of valerian has not been fully established in children < 18, and should therefore be avoided in this patient population.1
References
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Efficacy
Valerian can be used for insomnia; however, the evidence for its efficacy is limited and somewhat conflicting. The studies that have been done have many limitations such as small patient populations, subjective outcome measures, and other methodological flaws. Despite the limitations of these studies, some similar outcomes have been achieved such as a reduction in sleep latency and improvement in sleep quality. These outcomes are subjective as they have been patient reported, mainly by the use of sleep diaries.
Overall, if valerian does show efficacy for insomnia, it is the improvement of sleep quality and reduction in sleep latency.1,2 Valerian has not been shown to improve sleep duration or other sleep measures. Although one study did suggest valerian may improve day time energy level.3 Valerian could be recommended if the patient prefers a natural product to improve sleep quality or reduce sleep latency. Valerian should be taken for a number of days consecutively, as the efficacy may improve with continued use.2
Safety
Valerian has been shown to be safe when used for the treatment of insomnia. In randomized controlled trials, valerian was shown to have a similar number of adverse effects compared to placebo.3,4 The use of valerian in pregnancy and during breastfeeding is not recommended.1,2
Valerian should be used with caution with other CNS depressants due to increased sedation.1,2 Valerian may inhibit CYP 3A4 and caution should be taken when using in combination with medications metabolized by this enzyme as well as in patients with hepatic impairment.2 The safety of valerian has not been fully established in children < 18, and should therefore be avoided in this patient population.1
References
- Valerian (Valeriana officinalis L.) Natural Standard Professional Monograph, Copyright © 2012 (www.naturalstandard.com).
- Valerian. Natural Medicines Comprehensive Database Professional Monograph, Copyright © 2012 (http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND)
- Coxeter PD, Schluter PJ, Eastwood HL, Nikles CJ, Glasziou PP. Valerian does not appear to reduce symptoms for patients with chronic insomnia in general practice using a series of n-of-1 trials. Complement Ther Med. 2003;11:215-222.
- Oxman AD, Flottorp S, Havelsrud K et al. A televised, web-based randomized trial of an herbal remedy (valerian) for insomnia. 2007; PLoS ONE 2(10): e1040.
- Jerome Sarris, Gerard J. Byrne. A systematic review of insomnia and complementary medicine. Sleep Med Rev. 2011; 15: 99-106
- Salter S, Brownie S. Treating primary insomnia: The efficacy of valerian and hops. Aust Fam Physician. 2010: 39(6): 433-437.
- Fernández-San-Martín I, Masa-Font R, Palacios-Soler L, Sancho-Gómez P, Calbó-Caldentey C, Flores-Mateo G. Effectiveness of Valerian on insomnia: A meta-analysis of randomized placebo-controlled trials. Sleep Med. 2010; 11: 505–511.
- Bent S, Padula A, Moore D, Patterson M, Mehling W. Valerian for Sleep: A Systematic Review and Meta-Analysis. Am J Med. 2006; 119, 1005-1012.
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