Chamomile
CAM (antiinflammatory, reduces prostaglandins, neuroprotective)
- Generalized Anxiety4
- Hypnotic (safe in elderly, deepens sleep)3
- Sexual dysfunction in postmenopause (vaginal cream)3
Features
Dosing
Anxiety: start 220 mg at night, raise to 220 mg twice a day after 1 week. Can titrate up to 500 mg tid.
Sleep: 400 mg qhs, can raise to 400 mg bid.
Sexual dysfunction: Chamomile vaginal gel 5%, apply 1 gram to vagina every night for 2 weeks, then apply only 2 nights per week (the lubricants are usually edible; we don’t have a recommended product for lubricant though).
INTERACTIONS: May reduce efficacy of oral contraceptives and tamoxifen (through estrogen-like effects). Raises drug levels by inhibiting CYP3A4, CYP1A2, CYP2C9, and CYP2D6.
Management
It is unclear if this really works in anxiety. For sleep, it mainly improved sleep quality.
TOLERABILITY: fatigue, GI distress.
RISKS: Allergic skin reactions (mild, more likely if allergy to ragweed or sunflowers). Avoid in pregnancy (miscarriage risk).
EMR Text
Insomnia
Chamomile use based on randomized controlled trials in insomnia (Hieu TH et al, Phytother Res 2019;33(6):1604-1615).
Chamomile side effects and drug interactions reviewed with patient.
Anxiety
Chamomile use based on randomized controlled trials in anxiety (Amsterdam JD et al, J Clin Psychopharmacol. 2009;29(4):378-82).
Chamomile side effects and drug interactions reviewed with patient.
Female sexual dysfunction (postmenopause)
Chamomile use based on a randomized controlled trials for sexual dysfunction in women (Bosak Z et al, J Sex Med. 2022;19(6):983-994).
Chamomile side effects and drug interactions reviewed with patient.