Dr. Miller explains that she is somewhat familiar with valerian and danshen and wants to check whether there is any evidence that they might pose risks for Mrs. Thompson, cause adverse effects or interact with her medicine.
Turning to her computer, Dr. Miller checks online at The Cochrane Library and the Natural Medicines Comprehensive Database (NCMD).
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• Used orally for insomnia and dyssomnia, anxiety, and sleeping disorders related to anxiety.4,5
• Considered "possibly effective" for sleep problems. Most evidence suggests it reduces sleep latency and improves subjective sleep quality. Some evidence suggests it is no more effective than a placebo.5
• Insufficient reliable evidence to rate the effectiveness of valerian for anxiety; evidence is contradictory.5
• Components of valerian may have sedative-hypnotic, anxiolytic, antidepressant, anticonvulsant and antispasmodic effects.5
• Appropriate oral use for medical purposes is considered "possibly safe," on the basis of clinical trials lasting up to four weeks. U.S. FDA lists valerian as "generally recognized as safe" as a food additive.5
• Authors of the Cochrane review article found one study eligible for inclusion: a randomized, controlled pilot study with 36 patients, comparing valerian with diazepam and placebo. No significant difference in symptom reduction between valerian and diazepam, or between valerian and placebo. No side effects reported by patients in the valerian group. Authors conclude there is insufficient evidence about the efficacy and safety of valerian compared to diazepam or placebo for anxiety.4
• Valerian should not be used in combination with alcohol (due to theoretical additive sedative effect), with alprazolam (because it seems to increase alprazolam levels), or with benzodiazepines or CNS depressants (due to theoretical additive therapeutic and adverse effects). 5
• Patients taking cytochrome P450 3A4 substrates should use valerian cautiously or not at all due to preliminary evidence that valerian might inhibit CYP3A4.5
• Concurrent use of valerian and other sedative herbs or supplements might enhance therapeutic and adverse effects.5
• Oral doses of valerian up to 1,800 mg do not appear to affect psychomotor performance significantly. However, dose-dependent impairment might occur and would likely peak within the first few hours after administration, so patients should be cautioned not to drive or operate dangerous machinery after taking valerian.5
• Used orally for cardiovascular and circulatory problems, including for its possible hypotensive, positive inotropic and vasodilator effects.6,8
• Insufficient reliable evidence to rate the effectiveness of danshen.8
• Components of danshen may inhibit platelet aggregation and decrease clotting and may increase the anticoagulant effect of warfarin and the risk of bleeding.6,7,8
• When used concurrently with warfarin, danshen increases INR values and prothrombin time (PT).6,8
• Has properties similar to cardiac glycosides and might increase the cardiovascular effects and side effects of digoxin if used concurrently. It can interfere with some serum digoxin measurements.8
• Dosage of warfarin may need to be modified if danshen is taken concurrently.7
• Patients who start taking danshen concurrently with warfarin should be monitored by checking INR and PT frequently until these values stabilize and routinely thereafter. Further, such patients should be counseled to watch for increased bruising, petechia, purpura and bleeding, and if these occur, to discontinue danshen and contact the physician.6
• Patients should avoid using danshen and Coumadin concurrently due to possible herb-drug interaction ("Interaction Rating=Major," "Severity=High," "Occurrence=Probable," "Level of Evidence=D").8
• Patients should avoid using danshen and digoxin concurrently due to possible herb-drug interaction ("Interaction Rating=Major," "Severity=High," "Occurrence=Probable," "Level of Evidence=D").8