Lesión hepática inducida por consumo de Valeriana officinalis y Passiflora incarnata, reporte de caso / Hepatic injury induced by the consumption of Valeriana officinalis and Passiflora incarnata, a case report

Los medicamentos homeopáticos y fitoterapéuticos que contienen productos herbarios son cada vez más utilizados, sin embargo, se desconoce el potencial de efectos adversos por parte de los usuarios y personal sanitario. Se reporta el caso de una mujer de 34 años quien consulta por dolor abdominal y náuseas, con alteraciones al ingreso de función hepática con patrón hepatocelular, se descartaron múltiples etiologías y se consideró que pudiera ser lesión hepática medicamentosa secundaria al consumo de medicamentos desde hacía una semana para dismenorrea, y a fitoterapéuticos que consumía de forma crónica, los cuales se suspendieron. A los doce días de su egreso, reingresó por sintomatología similar; se documentó nuevamente perfil hepático con patrón hepatocelular. Al reinterrogatorio, la paciente comentó la ingesta crónica de Valeriana officinalis y Passiflora incarnata, que retomó al egreso hospitalario, por lo que luego de descartar diagnósticos diferenciales, se consideró que el cuadro era inducido por el consumo de dichos medicamentos. Durante la hospitalización se suspendió su consumo, con normalización del perfil hepático. Es importante que los consumidores estén informados sobre los riesgos potenciales de los productos herbarios, sus efectos por consumos prolongados y las implicaciones de la autoformulación.

Homeopathic and phytotherapeutic medicines containing herbal products are increasingly used, however the potential for adverse effects on users and healthcare personnel is unknown. We report the case of a 34-year-old woman who consulted for abdominal pain and nausea, accompanied by hepatocellular pattern on liver function tests. Multiple etiologies were ruled out and it was considered that it could be a drug-induced liver injury secondary to the consumption of medications she had been taking a week prior for dysmenorrhea, and phytotherapeutics that she had been taking for seve-ral years, which were all discontinued. Twelve days after her discharge, she was readmitted due to similar symptoms; a liver profile with a hepatocellular pattern was again documented. Upon further questioning, the patient mentioned a chronic intake of Valeriana officinalis and Passiflora incarnata, which she resumed upon discharge. After ruling out the differential diagnoses, it was concluded that the symptoms of the patient were induced by the consumption of these herbal products. During hos-pitalization, their consumption was suspended, with normalization of the liver profile. It is important that consumers are informed about the potential risks of herbal products, their effects from long-term use, and the implications of self-medication.

Historical Study on the Usage and the Name of Crude Drug “Valerian” in Japan / 日本東洋医学雑誌

Japanese valerian root (kanokoso, the dried root of Valeriana fauriei) has been known as a substitute for European valerian root (the dried root of V. officinalis). However, the usage of Japanese valerian root and the change of its crude drug name from ancient times in Japan have not been clear. We investigated ancient literatures, and revealed that Japanese valerian root might be used as folk medicine with the name of Japanese nard (wakansho) in the mid Edo period. Similar to the usage of European valerian root, Japanese valerian root had been used in the treatment for hysteria specifically in the late Edo period. It is considered that Japanese valerian root began to be used as women’s home medicines since hysteria had come to be assorted in women’s medical disorders in the early Showa era. Japanese valerian root had been originally named as kesso. However, kesso had been recognized as European valerian root since the plant name of V. officinalis was translated into Japanese as kanokoso in the late Edo period. In the early Showa era, the name of Japanese valerian root was changed into kissokon, and the Japanese nomenclatures for both Japanese and European valerian roots became recognized separately. After World War II, the description of kanokoso changed from kanji into katakana characters in Japanese.

Efficacy of Valerian Extract on Sleep Quality after Coronary Artery bypass Graft Surgery: A Triple-Blind Randomized Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To assess the effect of valerian root extract on the sleep quality of patients after coronary artery bypass graft (CABG) surgery.@*METHODS@#The patients who participated in this triple-blind clinical trial were selected by permuted block randomization. The participants were assigned to the valerian (n=36) and placebo (n=36) groups. The valerian group received 530 mg of valerian capsules for 30 nights after CABG surgery, and the placebo group received 530 mg of the placebo capsules containing wheat flour. The Pittsburgh Sleep Quality Index (PSQI), the prothrombin time (PT) and partial thromboplastin time (PTT) were assessed on four occasions, including the baseline, the 3rd, 14th and 30th days following intervention.@*RESULTS@#The odds ratio of worsened sleep quality significantly varied over time (the interaction of time and group) in the valerian group compared to the placebo group in various dimensions including total sleep quality (P=0.001), sleep latency (P<0.01), sleep duration (P=0.020), sleep efficiency (P=0.001) and daytime dysfunction (P=0.025). No significant difference was observed in the alterations of the odds ratio of PT in the two groups over time. (P=0.371).@*CONCLUSION@#The consumption of oral valerian root extract over 30 nights could significantly improve the patients' sleep quality safely after CABG surgery.

Preliminary study on Q-markers of anti-tumor activity extracts of Polygonum orientale / 中草药

Objective: Based on the concept of quality marker (Q-marker), the components and the quality of the ethyl acetate extract of Polygonum orientale (POEa) was analyzed and studied. Methods: Firstly, the components of POEa were identified using the UPLC-ESI-HRMS method and standard compounds. Secondly, the main active compounds were determined by HPLC. Antitumor activities of these compounds were reviewed and its Q-marker was predicted. Finally, we evaluated the effects of POEa and the compound of gallic acid, isoquercetin, valerin, vitexin, luteolin, and quercetin on proliferation, apoptosis and migration of A549 cells. Results: A new quality method for simultaneous determining these six compounds of POEa was established. The six chemical ingredients were detected in each sample and the total content was more than 10%. The number of apoptotic cells in A549 cells treated with POEa and six chemical mixtures were all substantial increased, and the migration amount were significantly decreased. Tow groups showed no significantly differeances. Conclusion: The six components are scientific and reasonable to be considered as potential Q-marker represented the anti-tumor activity of POEa. The HPLC method can be used as accurate and stable quality control strategy of POEa.

Efficacy of single dose antihistamine vs. single dose valerian-hops in subjective sleep measures among war refugees: a comparison trial

Abstract Background Many sedatives and anxiolytics are used in single dose or chronically to aid sleep. Clinically important sedatives include valerian-hops and antihistamines as they are used over the counter and are highly accessible and safe agents. Objectives To evaluate and compare a single dose of chlorpheniramine versus valerian-hops combination in modulating subjective sleep measures in insomniac war refugees. Methods Insomnia among refugees was screened using the Insomnia Severity Index (ISI). Insomniac subjects were randomized to received a single dose valerian-hops (320/80 mg) (n = 65), or chlorpheneramine (4 mg) (n = 50) or placebo (n = 76) two hours prior sleeping. Participants were instructed to complete Leeds Sleep Evaluation Questionnaire (LSEQ), visual analogue scales of anxiety and sedation. Also sleep latency, total hours slept and self-rated improvement were obtained. Results Almost 75% of screened refugees had insomnia. Chlorpheneramine reduced sleep latency and anxiety significantly, however it resulted in poor sleep quality. Valerian-hops group showed marked anxiolysis one hour after dosing, a sleep quality similar to placebo and better than chlorpheneramine, and better alertness compared to placebo. Participants satisfaction was higher with chlorpheneramine and there was no difference in the total hours slept. Discussion Valerian-hops combination may provide better sleep quality than antihistamines.

Effect of Valerian Ligusticum Pill on angiogenesis after injury of cerebral ischemia reperfusion in rats / 药学学报

This study was designed to detect the impact of Valerian Ligusticum Pill (VLP) on cerebral ischemia reperfusion injury in rats, and explore the mechanism of angiogenesis. Sixty SD male rats were randomly divided into five groups, including sham operation group, model group, VLP-low (30mg·kg-1) group, VLP-high (50mg·kg-1) group and nimodipine (10mg·kg-1) group. The ischemia reperfusion injury model was induced by occlusion of middle cerebral artery with suture embolus, reperfusion after 30 minutes' ischemia. When the rats were awake, the first neurological function scores was determined with modified neurological severity score (mNSS). The rats were given VLP (30mg·kg-1, 50mg·kg-1) and nimodipine (10mg·kg-1) through intragastric administration at 2 mL, once a day for a total of 7 days, while an equal amount of distilled water was used in the sham operation group and model control group. After 7 days, the rats were given second neurological function scores, and improvement of neurological function=[the first score]-[the second score]. The rats were sacrificed to investigate the infarction volume percentage with 2,3,5-triphenyl tetrazolium chloride method; do the qualitative and half quantitative analyses for protein vascular endothelial growth factor receptor 2 (VEGFR2) in the tissue of cortex infarction around by Western blot; detect the new blood vessels of cortex infarction around by ki67/lectin immunofluorescence double staining method. Results suggest that VLP could significantly improve the neurological function, reduce the percentage of infarct volume, increase the expression of VEGFR2 and number of new blood vessels in the cortex infarction around compared with model group. In conclusion, VLP may relive the acute cerebral ischemia reperfusion injury in rats by inducing angiogenesis.

Analgesic effect of Hypericum perforatum, Valeriana officinalis and Piper methysticum for orofacial pain

To evaluate in vivo the association of hypericum Hypericum perforatum, valerian Valeriana officinalis and kava Piper methysticum with analgesia by assessing their effects in reducing orofacial pain as well as the possible hepatic, hematologic and biochemical alterations induced by regular administration of these extracts. METHODS: Orofacial pain was induced in mice with the administration of 2.5% formalin in the upper lip. After 60 min, the animals were treated with saline, carbamazepine and hydroalcoholic plant extracts. The nociceptive intensity was determined by the timing at which the animal remained rubbing the injected area. To assess the hepatotoxic effect, mice were chronically treated for 25 days with saline, carbamazepine and hydroalcoholic extract. The animals were euthanized and the liver weighed, followed by a differential count of leukocytes and measurement of alanine transaminase and alkaline phosphatase. RESULTS: The evaluation of analgesic activity in phase 1 reduced the time of rubbing compared to the control by 86% 0.05 mL/10 g and 76% 0.10 mL/10 g. In phase 2, the extracts reduced rubbing time by 94% and 85%, respectively. In the evaluation of alkaline phosphatase, the groups treated with extracts at doses of 0.05 mL/10 g and 0.1 mL/10 g increased by 16.1% and 9.5% compared to the control group and a reduction of 8.5% and 9.1% in the evaluation of alanine transaminase respectively. It was demonstrated that in the differential counts showed an increase in eosinophils in the treated group with 0.05 mL/10 g. CONCLUSIONS: The use of hydroalcoholic extract of the associated plants reduced the orofacial formalin-induced pain with better results than carbamazepine, at both the neural conductor level of pain phase 1 and in inflammatory or later pain phase 2 without presenting hepatotoxicity. The observed eosinophilia is suggestive of a phenomenon called hormesis...

Comparation of Total Iridoids in Valerian from Different Habitats / 医药导报

Objective To determine and compare the contents of total iridoids in valerian from different origins.Methods The total iridoids in valerian was detected by reaction with alkaline hydroxylamine-perchloric acid iron reagent,and the absorbance was measured at 522 nm by spectrophotometry. Results The content of valepotriate and its absorption were linear within the range of 0. 05-1. 40 mg·mL-1 . The average recovery was 98. 50%,and RSD was 1. 02%. There was significant difference between the contents of iridoid in valerian from different habitats. Conclusion This method is accurate and reliable for evaluating the quality of valerianand. The contents of valeriana is related to its habitats.

Evaluation of the acute and subchronic oral toxicity of ethanol extract from Valeriana pavonii species in Wistar rats / Evaluación de la toxicidad oral aguda y sub-crónica del extracto etanólico de la especie Valeriana pavonii en ratas Wistar

Introduction: One of the most frequent problems found in medicinal plants is the absence of clinical, toxicological, and pharmacological studies. Valeriana pavonii is one of the species used in Colombia as an anxiolytic. Further study of this specie is rendered to add information in the toxicological area. Objective: The acute and subchronic oral toxicity of V. pavonii ethanolic extract was evaluated in Wistar rats of both sexes. Materials and methods: The rats were distributed into four groups: the control group received the vehicle (0.5 mL/100 g of corporal weight) and the other three groups received increasing levels of the dosage for 90 days to evaluate characteristics like physical exam, laboratory test (blood chemistry and haematology), and anatomopathological findings. Results: This study reveals that there were no signs of toxicity, mortality, or significant alterations attributable to the ethanolic extract of V. pavonii. Conclusions: The Not Observed Adverse Effect Levels (NOAEL) of V. pavonii ethanolic extract were 2000 and 1000 mg/kg of body weight for the acute and subchronic toxicity studies, respectively.

Introducción: Uno de los problemas más frecuentes asociados con el uso de plantas medicinales es la ausencia de evidencias farmacológicas, toxicológicas y clínicas. Valeriana pavonii es una de las especies más utilizadas popularmente en Colombia con fines ansiolíticos. Es necesario avanzar en el estudio de esta especie para aportar información en el campo toxicológico. Objetivos: Evaluar la toxicidad oral aguda y sub-crónica del extracto etanólico de V. pavonii en ratas Wistar de ambos sexos. Materiales y métodos: En cada uno de los estudios se distribuyeron ratas en cuatro grupos; un grupo control que recibió únicamente vehículo (0.5 ml/100 g de peso corporal) y tres grupos correspondientes a niveles crecientes de dosis, así: para el estudio de toxicidad aguda se administraron en dosis única 20, 200 y 2000 mg/kg con un período de observación de 14 días y para el de toxicidad sub-crónica, dosis diarias de 250, 500 y 1000 mg/kg durante 90 días. Se evaluaron los parámetros de examen físico, los exámenes de laboratorio (química sanguínea y hematología) y el estudio anatomopatológico. Resultados: No se presentaron signos de toxicidad, letalidad ni alteraciones significativas atribuibles al consumo del extracto etanólico de V. pavonii, según el examen físico, el examen anatomopatológico y el análisis de las pruebas de química sanguínea y hematología. Conclusiones: Los valores de nivel sin efectos adversos observados (NOAEL) del extracto etanólico de V. pavonii, fueron 2000 y 1000 mg/kg de peso corporal para los estudios de toxicidad aguda y sub-crónica, respectivamente. No se encontraron valores de nivel más bajo de efecto adverso observado (LOAEL).

Valeriana en el tratamiento a largo plazo del insomnio / Use of Valerian in the Long-Term Treatment of Insomnia

Introducción: La valeriana se ha utilizado desde la antigua Grecia y China para inducir el sueño, debido a sus propiedades ansiolíticas. Hoy en día, aun cuando no es un producto aprobado por la Agencia de Administración de Drogas y Alimentos de Estados Unidos (FDA) para el tratamiento del insomnio, se utiliza en diferentes países con esta finalidad. Objetivo: Llevar a cabo una revisión que permita determinar la eficacia de la valeriana en el tratamiento a largo plazo del insomnio y considerarla una alternativa terapéutica posible a las benzodiazepinas y los agonistas benzodiazepínicos. Resultados: Son pocos los estudios controlados realizados con valeriana; no obstante, los resultados disponibles sugieren que su empleo facilita la reestructuración de la arquitectura del sueño después de varias semanas de tratamiento y consigue así mejorar su calidad. También hay indicios que señalan que desempeña un papel importante en la disminución del estrés y la ansiedad en aquellos pacientes donde esta condición interfi ere con el inicio y mantenimiento del sueño, así como en el tratamiento coadyuvante en la discontinuación del uso prolongado de benzodiazepinas. Conclusiones: El principal punto a favor de la valeriana es su capacidad para disminuir la latencia del sueño de ondas lentas y aumentar su porcentaje, sin provocar efectos secundarios de importancia ni dependencia; sin embargo, aún no se dispone de suficientes estudios controlados a largo plazo que permitan establecer conclusiones definitivas.

Introduction: Valerian has been used for centuries to induce drowsiness due to its anxiolytic properties. It was fi rst described being used in ancient cultures, i.e., Greece and China. Nowadays, even though it is not officially approved by the US Food and Drug Administration Agency (FDA) as a treatment for insomnia, it is widely used in different latitudes for such a purpose. Objective: To carry out an extensive review in order to establish the levels of effectiveness of valerian in the long term treatment of patients suffering from sleeplessness and consider it an alternative to the use of benzodiazepines and benzodiazepinic agonists. Results: There are very few controlled studies on the effects of valerian. Nonetheless, the available data might indicate that the use of valerian helps to restructure sleep architecture after several weeks of treatment and helps to improve sleep quality. There are also papers suggesting that valerian plays a key role in diminishing stress and anxiety in cases where these conditions disturb normal sleep patterns and is useful in discontinuing long treatments based on benzodiazepines. Conclusions: The key advantage of valerian is its capability to reduce the slow wave sleep latency and increase its percentage without causing relevant secondary effects or dependence. Still, we do not have sufficient data from long term controlled studies in order to support conclusive results.

Potenciais interações entre fármacos e produtos à base de valeriana ou alho / Potential interactions between drugs and valerian or garlic herbal medicines

Atualmente, as potenciais interações entre fármacos e plantas medicinais e/ou medicamentos fitoterápicos são objetos de inúmeros estudos. Tais estudos são motivados pelo fato de que a fitoterapia é amplamente utilizada em associação com diversos fármacos. Nesta revisão, as informações sobre as principais interações entre produtos elaborados com valeriana ou alho foram localizadas, avaliadas e sistematizadas. Verificou-se que tais plantas podem alterar os perfis farmacocinéticos e/ou farmacodinâmicos de diversos fármacos, podendo provocar conseqüências graves aos pacientes. A valeriana pode aumentar os efeitos adversos dos benzodiazepínicos, reduzir a biodisponibilidade dos fármacos metabolizados pelo sistema P450-CYP3A4 e provocar hemorragias graves quando utilizada juntamente com anticoagulantes orais e antiplaquetários. O alho pode aumentar a biodisponibilidade dos relaxantes musculares, potencializar os efeitos terapêuticos e adversos dos hipoglicemiantes, provocar hemorragias quando administrado juntamente com anticoagulantes orais e antiplaquetários e reduzir a biodisponibilidade dos anti-retrovirais inibidores de protease. Porém, tais potenciais interações não são consensos na literatura, visto que há limitações metodológicas e diferenças significativas entre os estudos localizados. Mesmo assim, o uso de produtos à base de valeriana ou alho, associado com determinados fármacos, deve ser adequadamente monitorado por um profissional da área da saúde.

At present, potential herbal-drug interactions are subject of great interest, because herbal medicines are often administered in combination with synthetic drugs. The aim of this paper was to review the literature in order to identify reported interactions between valerian or garlic herbal medicines and drugs, as well as to evaluate and summarize this information. Valerian or garlic herbal medicines could modify pharmacokinetics and/or pharmacodynamic profiles of several drugs and might lead to serious clinical consequences. Valerian could increase the adverse effects of benzodiazepines and could decrease the bioavailability of drugs metabolized by CYP3A4. Furthermore, valerian could cause severe bleeding when taken with oral anticoagulants and/or antiplatelet agents. Garlic could increase the bioavailability of muscle relaxants, could increase the therapeutic and adverse effects of hypoglycemic agents, could cause bleeding when taken with oral anticoagulants and/or antiplatelet agents, and could decrease the area under the plasma concentration curve of protease inhibitors. However, such potential herbal drug interactions are not consensual, because the reported studies present several limitations and significant differences among them. Therefore, concomitant use of herbal medicines and drugs has to be properly monitored by health care professionals.

QOL Improving Effects of Herbal Teas-A Preliminary Pilot Study on the Quality of Sleep- / 日本補完代替医療学会誌

The sleep-inducing effect and safety of an herbal tea containing valerian and lemon balm were subject to a preliminary open pilot study. Subjects were 14 female volunteers (age 35 ± 11, BMI 21 ± 3 kg/m²) who complained of poor sleep. After obtaining informed consent, subjects took daily 2 cups of herbal teas containing valerian and lemon balm for 1 week, followed by a control week, during which they had two cups of hot water. OSA sleep questionnaires and VAS scales were recorded every day. Sleep quality increased at the 2^nd day after starting the tea, and sleep induction and sleep maintenance were improved in particular. Those whose complaints were severe experienced greater relief than those who complaint a little. Some cases reported transient sleepiness and gastrointestinal complaints. However, these symptoms disappeared spontaneously. The safety and effectiveness of this sleep-inducing herbal tea was ascertained.<br>

Supercritical CO_2 extraction of essential oil from Valeriana officinalis by orthogonal design / 中成药

AIM:To study the parameters of supercritical CO_2 extraction of essential oil from valeriana efficinalis by orthogonal design. METHODS: Four factors,such as extraction pressure,extraction temperature,extraction time and separation temperature were chosen by the observation of orthogonal design,each factor was assigned to three levels.Bornyl acetate content was selected as a marker in a position to determine optimal extraction. RESULTS: Pressure and temperature were the main factors in effecting the extraction of bornyl acetate,extraction time was minor factor relatively. CONCLUSION: The optimal extraction is as follow,parameters were extraction pressure:12 MPa,extraction temperature:45 ℃,extraction time:1 hour,separation temperature:35 ℃,it gave the best recoveries of essential oils and bornylacetate.