Chamomile

• How It Works

  Chamomile may benefit those with anxiety disorder and insomnia, but more study is needed.

  Chamomile has been used as a medicinal herb to treat various conditions including anxiety, sleeplessness, and gastrointestinal problems. It is also used topically for inflammatory skin conditions.

  Laboratory studies show that substances in chamomile can kill bacteria, reduce inflammation, and calm muscle spasms. It has also been shown to inhibit the growth of polio and herpes viruses as well as ulcers. Several chemicals in chamomile leaves might help to prevent inflammation. Apigenin, a compound isolated from chamomile, binds to brain cells in the same areas as well-known depressant drugs, which could explain chamomile’s sedative effects.

  Small clinical trials show that chamomile may have a modest effect on generalized anxiety disorder, insomnia, and in healing skin lesions after colostomy, a surgical procedure that brings one end of the large intestine out through the abdominal wall. Studies on whether chamomile mouth rinse can heal or prevent mouth sores from cancer treatment have been mixed. More study is needed to determine whether it can be helpful for this condition.

• Purported Uses
  • To relieve generalized anxiety disorder (GAD)
    Chamomile may have modest benefits for those with mild to moderate GAD.
  • Insomnia
    It has long been thought that chamomile tea can induce relaxation. However, clinical data are lacking.
  • As a mouthwash, to treat mucositis associated with radiation therapy and chemotherapy
    Clinical trials show conflicting results for this use. A more recent trial did not find benefit with an oral solution that contained chamomile as well as propolis, aloe vera, and calendula. More research is needed.
  • Topically, as an antiseptic and to treat skin ulcers
    Studies in animals show that substances in chamomile can kill bacteria and viruses, reduce inflammation, and prevent the growth of ulcers. Clinical trials have not been conducted.
  • Topically, to reduce the inflammation of hemorrhoids
    Animal studies show that substances in chamomile can reduce inflammation. Human data are lacking.
• Do Not Take If
  • You are allergic to ragweed or flowers in the Compositae family.
  • You take warfarin or other blood thinners: Chamomile may increase the risk of bruising or bleeding.
  • You use sedatives: Chamomile may have additive effects.
  • You are taking cytochrome P450 substrate drugs: Lab studies suggest that chamomile may increase the risk of side effects of these drugs. Therefore, discuss use of this supplement with your treating physician.
  • You are taking cyclosporine: Chamomile may increase the risk of side effects.
• Side Effects
  • Hypersensitivity allergic reactions, ranging from redness and swelling of the skin to anaphylactic shock

  Case reports

  • Constriction of a small blood vessel that is important for circulation in the developing fetus: Following consumption of chamomile tea by the mother during pregnancy.
  • Life-threatening allergic reaction: In a 38-year-old Caucasian man, 1 hour after consuming chamomile tea. Symptoms improved followed emergency treatment with an intravenous antihistamine.
  • Multiple internal hemorrhages: In a 70-year-old woman following use of chamomile products along with warfarin. Her symptoms resolved after treatment with intravenous heparin.
  • Occupational allergic rhinoconjunctivitis: Runny nose, sneezing, itching of the nose and eyes, and watery eyes caused by inhalation of chamomile dried flowers.
  • Increased breast milk production and breast tension: In a lactating woman after consuming chamomile.
• Scientific Name

  Matricaria recutita, Chamomilla recutita, Matricaria chamomilla

• Clinical Summary

  Chamomile, an aromatic annual herb, has a long history of use in traditional medicine to treat muscle spasms, menstrual disorders, insomnia, ulcers, wounds, stomach disorders, rheumatic pain, hay fever, and hemorrhoids. It is widely used in teas for its relaxing and calming effects. In vitro and animal studies indicate that chamomile extracts have anti-inflammatory ⁽¹¹⁾, anti-hyperglycemic ⁽¹²⁾, antigenotoxic ⁽¹³⁾, and anticancer ⁽¹⁴⁾ properties. Apigenin, a flavone present in chamomile, has chemopreventive effects ⁽¹⁵⁾. Bisabololoxide A, another constituent, had additive inhibitory effects in some instances when used with 5-fluorouracil against leukemic cells ⁽¹⁹⁾.

  Clinical data suggest modest benefits with oral chamomile in chronic insomnia ^(20) (41) or for moderate cyclic mastalgia ⁽⁴²⁾. Chamomile tea had positive effects on glycemic control in patients with diabetes ⁽³³⁾. Several studies have reported that chamomile extracts are effective against mild-to-moderate ⁽¹⁶⁾ and moderate-to-severe generalized anxiety disorder ^(37) (38), and may have antidepressant effects as well ⁽³⁰⁾. Data also show that chamomile can improve biological markers of stress in people with chronic anxiety ⁽⁴⁰⁾. In other controlled trials, application of a chamomile compress was effective and superior to hydrocortisone ointment in facilitating healing of peristomal skin lesions following colostomy ⁽²¹⁾; and a chamomile oleogel affected pain relief in patients who had migraine without aura ⁽⁴³⁾.

  In an animal study, chamomile extract showed some protective effects against radiation‐induced intestinal mucositis ⁽¹⁾. A chamomile mouthwash reduced 5-fluorouracil-induced mucositis in hamsters ⁽¹⁷⁾, but data from human studies are conflicting ^(8) (9). More recently, an aqueous solution of propolis, aloe vera, calendula, and chamomile did not prevent mucositis during chemoradiotherapy for head and neck cancer ⁽²⁾.

• Purported Uses
  • Anxiety
  • Depression
  • GI disorders
  • Hemorrhoids
  • Infections
  • Inflammation
  • Insomnia
  • Mucositis
• Mechanism of Action

  The anti-inflammatory activity of chamomile involves the release of LPS-induced prostaglandin E(2) in RAW 264.7 macrophages via inhibition of COX-2 enzyme activity ⁽¹¹⁾. Methanol extracts of chamomile exert anti-allergic effects by inhibiting histamine release from mast cells ⁽²³⁾. Neuroprotective activity has occurred via decreased lipid peroxidation and increased superoxide dismutase, catalase, glutathione, and total thiol levels ⁽²⁴⁾.

  Topical chamomile reduced the tissue levels of IL-1β and TNF-α in hamsters with oral mucositis ⁽³⁴⁾. In another study, a chamomile extract provided gastroprotection against ethanol-induced ulceration by increasing glutathione levels ⁽²⁵⁾. In an animal model of radiation‐induced intestinal mucositis, apoptotic effects from chamomile occurred via increases in cytosolic cytochrome c, caspase‐3, and depletion of mitochondrial B‐cell lymphoma‐2/ Bax ratio ⁽¹⁾.

  Apigenin, a flavone component of chamomile, interacts with GABA(A)-benzodiazepine receptors in vitro and inhibits locomotor behavior in rats ⁽⁵⁾. It also affected alternative splicing of key mRNAs by inhibiting dimerization of hnRNPA2, a factor associated with many cellular malignancies and in mRNA metabolism and splicing ⁽³²⁾.

• Contraindications

  Individuals allergic to ragweed or members of the Compositae family, such as chrysanthemums, should avoid this product.

• Adverse Reactions

  Hypersensitivity reactions including asthma, contact dermatitis, and anaphylaxis can occur following exposure to chamomile ^(26) (27).

  Case reports
  Premature constriction of fetal ductus arteriosus: Following consumption of chamomile tea by the mother during pregnancy ⁽³¹⁾.
  Severe anaphylaxis with generalized urticaria, angioedema, and severe dyspnea: In a 38-year-old Caucasian man, 1 hour after consuming chamomile tea. Symptoms improved following treatment with an intravenous antihistamine ⁽¹⁸⁾.
  Multiple internal hemorrhages: In a 70-year-old woman following concurrent use of chamomile products and warfarin. Her symptoms resolved after treatment with intravenous heparin ⁽²⁸⁾.
  Occupational allergic rhinoconjunctivitis: From the inhalation of chamomile dried flowers ⁽³⁶⁾.
  Increased lactogenesis and breast tension: In a lactating woman, a few hours after consuming chamomile ⁽³⁹⁾.

• Herb-Drug Interactions

  Anticoagulants / Antiplatelets: Chamomile may increase the anticoagulant effects and inhibit platelet activity due to its coumarin content ⁽²⁸⁾.
  Sedatives: Chamomile may increase the effects of sedatives  ⁽⁴⁾.
  Cytochrome P450 substrates: In vitro, chamomile inhibits CYP1A2, CYP2C9, CYP2D6, and CYP3A4, and may affect the intracellular concentration of drugs metabolized by these enzymes ⁽²⁹⁾. The clinical relevance has yet to be determined.
  Cyclosporine: Concurrent use resulted in increased serum levels of cyclosporine ⁽³⁵⁾.

• References

  1. Khayyal MT, Kreuter MH, Kemmler M, et al. Effect of a chamomile extract in protecting against radiation-induced intestinal mucositis. Phytother Res. Jan 10 2019.

  2. Marucci L, Farneti A, Di Ridolfi P, et al. Double-blind randomized phase III study comparing a mixture of natural agents versus placebo in the prevention of acute mucositis during chemoradiotherapy for head and neck cancer. Head Neck. Sep 2017;39(9):1761-1769.

  3. Tyler, V. Herbs of Choice, the Therapeutical Use of Phytomedicinals. Binghamton: Pharmaceutical Press; 1994.

  4. Brinker F. Herb Contraindications and Drug Interactions, 3^rd ed. Sandy (OR): Eclectic Medical; 2001.

  5. Avallone R, et al. Pharmacological profile of apigenin, a flavonoid isolated from Matricaria chamomilla. Biochem Pharmacol 2000;59:1387-94.

  6. Kyokong O, et al. Efficacy of chamomile-extract spray for prevention of post-operative sore throat. J Med Assoc Thai 2002;85(suppl):S180-5.

  7. Budzinski JW, et al. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82.

  8. Fidler P, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 1996;77: 522-5.

  9. Carl W, et al. Management of oral mucositis during local radiation and systemic chemotherapy: a study of 98 patients. J Prosthet Dent 1991;30:395-6.

  10. Segal R, et al. Warfarin interaction with Matricaria chamomilla. CMAJ. 2006 Apr 25;174(9):1281-2.

  11. Srivastava JK, Pandey M, Gupta S. Chamomile, a novel and selective COX-2 inhibitor with anti-inflammatory activity. Life Sci. 2009 Nov 4;85(19-20):663-9.

  12. Cemek M, Kaða S, Simþek N, Büyükokuroðlu ME, Konuk M. Antihyperglycemic and antioxidative potential of Matricaria chamomilla L. in streptozotocin-induced diabetic rats. J Nat Med. 2008 Jul;62(3):284-93.

  13. Hernández-Ceruelos A, Madrigal-Bujaidar E, de la Cruz C. Inhibitory effect of chamomile essential oil on the sister chromatid exchanges induced by daunorubicin and methyl methanesulfonate in mouse bone marrow. Toxicol Lett. 2002 Sep 5;135(1-2):103-110.

  14. Srivastava JK, Gupta S. Antiproliferative and apoptotic effects of chamomile extract in various human cancer cells. J Agric Food Chem. 2007 Nov 14;55(23):9470-8.

  15. Patel D, Shukla S, Gupta S. Apigenin and cancer chemoprevention: progress, potential and promise (review). Int J Oncol. 2007 Jan;30(1):233-45.

  16. Amsterdam JD, Li Y, Soeller I, et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009 Aug;29(4):378-82.

  17. Pavesi VC, Lopez TC, Martins MA, et al. Healing action of topical chamomile on 5-fluouracil induced oral mucositis in hamster. Support Care Cancer. 2011 May;19(5):639-46.

  18. Andres C, Chen WC, Ollert M, et al. Anaphylactic reaction to camomile tea. Allergol Int. 2009 Mar;58(1):135-6.

  19. Ogata-Ikeda I, Seo H, Kawanai T, Hashimoto E, Oyama Y. Cytotoxic action of bisabololoxide A of German chamomile on human leukemia K562 cells in combination with 5-fluorouracil. Phytomedicine. 2011 Mar 15;18(5):362-5.

  20. Zick SM, Wright BD, Sen A, Arnedt JT. Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study. BMC Complement Altern Med. 2011 Sep 22;11:78.

  21. Charousaei F, Dabirian A, Mojab F. Using chamomile solution or a 1% topical hydrocortisone ointment in the management of peristomal skin lesions in colostomy patients: results of a controlled clinical study. Ostomy Wound Manage. 2011 May;57(5):28-36.

  22. Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Report. 2010 Nov 1;3(6):895-901.

  23. Chandrashekhar VM, Halagali KS, Nidavani RB, et al. Anti-allergic activity of German chamomile (Matricaria recutita L.) in mast cell mediated allergy model. J Ethnopharmacol. 2011 Sep 1;137(1):336-40.

  24. Ranpariya VL, Parmar SK, Sheth NR, Chandrashekhar VM. Neuroprotective activity of Matricaria recutita against fluoride-induced stress in rats. Pharm Biol. 2011 Jul;49(7):696-701.

  25. Al-Hashem FH. Gastroprotective effects of aqueous extract of Chamomilla recutita against ethanol-induced gastric ulcers. Saudi Med J. 2010 Nov;31(11):1211-6.

  26. Vandenplas O, Pirson F, D’Alpaos V, et al. Occupational asthma caused by chamomile. Allergy. 2008 Aug;63(8):1090-2.

  27. Jacob SE, Hsu JW. Reactions to Aquaphor: is bisabolol the culprit? Pediatr Dermatol. 2010 Jan-Feb;27(1):103-4.

  28. Segal R, et al. Warfarin interaction with Matricaria chamomilla. CMAJ. 2006 Apr 25;174(9):1281-2.

  29. Ganzera M, Schneider P, Stuppner H. Inhibitory effects of the essential oil of chamomile (Matricaria recutita L.) and its major constituents on human cytochrome P450 enzymes. Life Sci. 2006 Jan 18;78(8):856-61.

  30. Amsterdam JD, Shults J, Soeller I, et al. Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: an exploratory study. Altern Ther Health Med. 2012 Sep-Oct;18(5):44-9.

  31. Sridharan S, Archer N, Manning N. Premature constriction of the fetal ductus arteriosus following the maternal consumption of camomile herbal tea.Ultrasound Obstet Gynecol. 2009 Sep;34(3):358-9.

  32. Arango D, Morohashi K, Yilmaz A, et al. Molecular basis for the action of a dietary flavonoid revealed by the comprehensive identification of apigenin human targets. Proc Natl Acad Sci U S A. 2013 Jun 11;110(24):E2153-62.

  33. Rafraf M, Zemestani M, Asghari-Jafarabadi M. Effectiveness of chamomile tea on glycemic control and serum lipid profile in patients with type 2 diabetes.J Endocrinol Invest. 2014 Sep 7. [Epub ahead of print]

  34. Curra M, Martins MA, Lauxen IS, et al. Effect of topical chamomile on immunohistochemical levels of IL-1β and TNF-α in 5-fluorouracil-induced oral mucositis in hamsters Cancer Chemother Pharmacol. 2013 Feb;71(2):293-9.

  35. Colombo D, Lunardon L, Bellia G. Cyclosporine and herbal supplement interactions. J Toxicol. 2014;2014:145325.

  36. Benito P, Rodríguez-Perez R, García F, Juste S, Moneo I, Caballero ML. Occupational allergic rhinoconjunctivitis induced by Matricaria chamomilla with tolerance of chamomile tea. J Investig Allergol Clin Immunol. 2014;24(5):369-70.

  37. Keefe JR, Mao JJ, Soeller I, Li QS, Amsterdam JD. Short-term open-label chamomile (Matricaria chamomilla L.) therapy of moderate to severe generalized anxiety disorder.  Phytomedicine. 2016 Dec 15;23(14):1699-1705.

  38. Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine. 2016 Dec 15;23(14):1735-1742.

  39. Silva FV, Dias F, Costa G, Campos MDG. Chamomile reveals to be a potent galactogogue: the unexpected effect.J Matern Fetal Neonatal Med. 2018 Jan;31(1):116-118.

  40. Keefe JR, Guo W, Li QS, Amsterdam JD, Mao JJ. An exploratory study of salivary cortisol changes during chamomile extract therapy of moderate to severe generalized anxiety disorder. J Psychiatr Res. 2018 Jan;96:189-195.

  41. Adib-Hajbaghery M, Mousavi SN. The effects of chamomile extract on sleep quality among elderly people: A clinical trial.Complement Ther Med. 2017 Dec;35:109-114.

  42. Saghafi N, Rhkhshandeh H, Pourmoghadam N, et al. Effectiveness of Matricaria chamomilla (chamomile) extract on pain control of cyclic mastalgia: a double-blind randomised controlled trial. J Obstet Gynaecol. 2018 Jan;38(1):81-84.

  43. Zargaran A, Borhani-Haghighi A, Salehi-Marzijarani M, et al. Evaluation of the effect of topical chamomile (Matricaria chamomilla L.) oleogel as pain relief in migraine without aura: a randomized, double-blind, placebo-controlled, crossover study. Neurol Sci. 2018 Aug;39(8):1345-1353.