Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction

Abstract

BackgroundAnxiety symptoms are frequently observed in dental patients, whether they are undergoing simple or more invasive procedures such as surgery. This research aimed to compare the effects of Passiflora incarnata and midazolam for the control of anxiety in patients undergoing mandibular third molar extraction.Material and MethodsForty volunteers underwent bilateral extraction of their mandibular third molars in a randomized, controlled, double-blind, crossover clinical trial. Passiflora incarnata (260 mg) or midazolam (15 mg) were orally administered 30 minutes before surgery. The anxiety level of participants was evaluated by questionnaires and measurement of physical parameters, including heart rate (HR), blood pressure (BP), and oxygen saturation (SpO2).ResultsConsidering each procedure independently, there were no significant differences between the protocols in BP, HR, and SpO2. Over 70% of the volunteers responded that they felt quiet or a little anxious under both protocols. With midazolam, 20% of the participants reported amnesia (not remembering anything at all), while Passiflora showed little or no ability to interfere with memory formation.ConclusionsPassiflora incarnata showed an anxiolytic effect similar to midazolam, and was safe and effective for conscious sedation in adult patients who underwent extraction of their mandibular third molars. Key words:Passiflora incarnata, midazolam, anxiety, oral surgery.

GABA‐modulating phytomedicines for anxiety: A systematic review of preclinical and clinical evidence

“…Seven studies involving human populations were found; four examined effects on preoperative anxiety in RCTs (Aslanargun, Cuvas, Dikmen, Aslan, & Yuksel, ; Dantas, de Oliveira‐Ribeiro, de Almeida‐Souza, & Groppo, ; Kaviani, Tavakoli, Tabanmehr, & Havaei, ; Movafegh, Alizadeh, Hajimohamadi, Esfehani, & Nejatfar, ) all reporting significant benefits from P .incarnata treatment in comparison to placebo conditions and/or non‐inferiority to BDZ comparators. Most recently, this effect was observed in a double‐blind RCT of 40 dental surgery patients (Dantas et al, ), showing 260 mg of P. incarnata orally administered 30 min before dental surgery reduced subjective anxiety along with physiological indicators (i.e., blood pressure and heart rate) to the same extent as midazolam, with fewer cognitively‐impairing side effects.…”

“…Akhondzadeh et al (); Aslanargun et al (), Dantas et al (); Kaviani et al (); Mori et al (); Movafegh et al ().…”

“…used anxiolytic and sedative paradigms (EPM, hole board and horizontal wire) in male CF1 mice to examine the constituent chrysin (5,7-dihydroxyflavone) with a diazepam comparator, reporting no significant differences in anxiolytic effect, but an increase to head-dipping and myo-relaxant properties via horizontal wire test in the BDZ group. Finally, a recent study (Aman et al, 2016) observed anxiolytic and sedative effects of P. incarnata in staircase and open field tests, with BALB/c mice and female Sprague Dawley rats, which were antagonised by pentylenetetrazole, indicating the behavioural effects of P. incarnata occurred through GABA-ergic mechanisms; however, precise mechanisms were again unclear.Seven studies involving human populations were found; four examined effects on preoperative anxiety in RCTs(Aslanargun, Cuvas, Dikmen, Aslan, & Yuksel, 2012;Dantas, de Oliveira-Ribeiro, de Almeida-Souza, & Groppo, 2017;Kaviani, Tavakoli, Tabanmehr, & Havaei, 2013;Movafegh, Alizadeh, Hajimohamadi, Esfehani, & Nejatfar, 2008) all reporting significant benefits from P .incarnata treatment in comparison to placebo conditions and/or non-inferiority to BDZ comparators. Most recently, this effect was observed in a double-blind RCT of 40 dental surgery patients(Dantas et al, 2017),…”

Herbal medicines in the treatment of psychiatric disorders: 10‐year updated review

“…An initial Iranian RCT using passionflower extract in a sample of participants with GAD ( n = 36) showed that the plant was as effective (with less side effects) as oxazepam (30 mg/day) in reducing anxiety (Akhondzadeh et al, ). Since then, six studies involving human populations were found; four examined effects on pre‐operative anxiety via RCT designs (Aslanargun, Cuvas, Dikmen, Aslan, & Yuksel, ; Dantas, De Oliveira‐Ribeiro, De Almeida‐Souza, & Groppo, ; Kaviani, Tavakoli, Tabanmehr, & Havaei, ; Movafegh, Alizadeh, Hajimohamadi, Esfehani, & Nejatfar, ), all reporting significant benefits from passionflower in comparison with placebo and non‐inferiority to pharmaceutical comparators.…”

“…Since then, six studies involving human populations were found; four examined effects on pre-operative anxiety via RCT designs (Aslanargun, Cuvas, Dikmen, Aslan, & Yuksel, 2012;Dantas, De Oliveira-Ribeiro, De Almeida-Souza, & Groppo, 2017;Kaviani, Tavakoli, Tabanmehr, & Havaei, 2013;Movafegh, Alizadeh, Hajimohamadi, Esfehani, & Nejatfar, 2008), all reporting significant benefits from passionflower in comparison with placebo and non-inferiority to pharmaceutical comparators.…”