Interactions of Valeriana officinalis L. and Passiflora incarnata L. in a patient treated with lorazepam

Abstract

There is an increasing interest in the health risks related to the use of herbal remedies. Although most consumers think that phytomedicines are safe and without side effects, interactions between complementary alternative and conventional medicines are being described. The aim of this clinical case report is to highlight the importance of the safe use of herbal remedies by providing a clinical interaction study between pharmaceutical medicines and herbal medicinal products. The case of a patient self-medicated with Valeriana officinalis L. and Passiflora incarnata L. while he was on lorazepam treatment is described. Handshaking, dizziness, throbbing and muscular fatigue were reported within the 32 h before clinical diagnosis. The analysis of family medical history ruled out essential tremor, Parkinson's disease, Wilson's disease and other symptom-related pathologies. His medical history revealed a generalized anxiety disorder and medicinal plant consumption but no neurological disorder. Appropriate physical examination was carried out. An additive or synergistic effect is suspected to have produced these symptoms. The active principles of Valerian and passionflower might increase the inhibitory activity of benzodiazepines binding to the GABA receptors, causing severe secondary effects. Due to the increase in herbal product self-medication, the use of herbal remedies should be registered while taking the personal clinical history. Multidisciplinary teams should be created to raise studies on medicinal plants with impact on medical praxis.

Guidelines for Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures: Update 2016

“…[293][294][295] Valerian may itself produce sedation that apparently is mediated through the modulation of γ-aminobutyric acid neurotransmission and receptor function. 291,[296][297][298][299] Drugs such as erythromycin, cimetidine, and others may also inhibit the cytochrome P450 system, resulting in prolonged sedation with midazolam as well as other medications competing for the same enzyme systems. [300][301][302][303][304] Medications used to treat HIV infection, some anticonvulsants, immunosuppressive drugs, and some psychotropic medications (often used to treat children with autism spectrum disorder) may also produce clinically important drugdrug interactions.…”

Evaluation of macro and microminerals in crude drugs and infusions of five herbs widely used as sedatives

“…Although many of these herbs or supplements appear to be safe, World Health Organization (WHO) has stressed the need to set up quality standards for medicinal drugs of plant origin, given the marked increase in consumption that has taken place in recent decades (Yeh et al, 2002), the large number of species involved, and the potential side effects or interact both with standard pharmaceuticals and other supplements (Carrasco et al, 2009;Ernst, 2002;Murphy et al, 2005;WHO, 2004). The consumers are not informed about the possible toxicity of these products, and toxicity itself depends on the level of product contamination, as well as on the route of administration, quantity, frequency and duration of intake.…”

Valerian: No evidence for Clinically Relevant interactions

“…Also the case reports are by no means convincing [55,56]. At present therefore a relevant risk of pharmacodynamic interactions is not proven by valid clinical observations.…”

“…On the third day he took, instead of the infusion, three tablets containing a combination of valerian root extract (300 mg) and passion flower root and herb extracts (350 mg; no further information available) before bedtime. He thereafter suffered from transient mild handshaking and drowsiness [55]. It was suspected that these symptoms were caused by an interaction between the herbal drugs and lorazepam, as they ceased after stopping herbal treatment.…”