Medication Guide App

Chamomile

Scientific Name(s): Matricaria recutita L., Family: Asteraceae (daisy). Synonyms: Chamomilla , Chamomilla recutita , Matricaria chamomilla , Matricaria suavoelens , and Chamaemelum nobile (L.) All. Family: Asteraceae (daisy). Synonym: Anthemis nobilis L.

Common Name(s): Matricaria recutita is known as German , Hungarian , wild , or genuine chamomile. Chamaemelum nobile is commonly called English , Roman , Scotch , garden , lawn , sweet , true , or common chamomile.

Uses

Chamomile is used topically in skin and mucous membrane inflammations and skin diseases. It can be inhaled for respiratory tract inflammations or irritations; used in baths as irrigation for anogenital inflammation; and used internally for GI spasms and inflammatory diseases. However, clinical trials supporting any use of chamomile are limited.

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Dosing

Chamomile has been used as a tea for various conditions and as a topical cream. Typical oral doses are 9 to 15 g/day. Gargles made from 8 g chamomile flowers in 1,000 mL of water have been used in clinical trials.

Contraindications

The use of chamomile-containing preparations is contraindicated in persons with hypersensitivity to ragweed pollens.

Pregnancy/Lactation

Unreferenced adverse reactions have been cited. Avoid use during pregnancy. No clinical data are available on use during lactation.

Interactions

Possible interactions have been reported with warfarin or cyclosporine. Because warfarin and cyclosporine have a narrow therapeutic index, patients taking either of these medications in other than modest amounts should avoid concurrent use of chamomile.

Adverse Reactions

Use of the tea and essential oil has resulted in anaphylaxis, contact dermatitis, and other severe hypersensitivity reactions. Cross-reactivity to asters, chrysanthemums, ragweed, and other members of the Asteraceae family exists.

Toxicology

Animal studies report low toxicity with oral ingestion of chamomile.

Botany

M. recutita grows as an erect annual, and Chamaemelum nobilis is a slow-growing perennial. The fragrant flowering heads of both plants are collected and dried for use as teas and extracts. 1 , 2

History

Known since Roman times for their medicinal properties, both plants have been used as antispasmodics and sedatives in the treatment of digestive and rheumatic disorders. Teas have been used to treat parasitic worm infections, and as hair tints and conditioners. The volatile oil has been used to flavor cigarette tobacco.

Chamomile has been used as a skin wash to cleanse wounds and ulcers, and to increase the sloughing of necrotic tissue and promote granulation and epithelialization. Chamomile is also reported to have antibacterial, anti-inflammatory, astringent, and deodorant properties. Various formulations of chamomile have been used to treat colic, cystitis, fever, flatulence, and vomiting. 3 , 4

Chemistry

Both plants contain similar chemical compounds. Chamomile tea contains 10% to 15% of the plant's essential oil. The blue-colored volatile oil is a complex mixture of sesquiterpenes (alpha-bisabolol, bisbolol-oxides A and B, and farnesene), sesquiterpenelactones (including the blue compound chamazulene), and acetylene derivatives. 2

Phenolic compounds found in the flowers include hydroxycinnamic acid derivatives, caffeic acid, and flavonoids (apigenin, luteolin, and chamaemeloside). 4 , 5 A nonpeptide, tachykinin NK1 receptor antagonist has been identified in Matricaria flowers. 6 Coumarin has also been identified in chamomile. 7 , 8

Uses and Pharmacology

German chamomile flower is approved by the German Commission E for use as an inhalant in skin and mucous membrane inflammations, bacterial skin diseases, including those of the oral cavity and gums, and respiratory tract inflammations and irritations. The flower has been approved for use in baths, as irrigation for anogenital inflammation, and for use internally to treat GI spasms and inflammatory diseases. 9

Anti-inflammatory

Chamomile has purported anti-inflammatory effects, but there are no published clinical trials supporting the findings of animal experiments. Chemical constituents of chamomile, such as bisabolol, chamazulene, and the flavonoids apigenin and luteolin, possess anti-inflammatory properties. 10 , 11 , 12 , 13

Antispasmodic/antidiarrheal

Chamomile infusions have been used traditionally as GI antispasmodics despite the lack of rigorous trials to support this use. A small trial of a tea containing chamomile and other herbs was effective in treating infantile colic, but the volume of tea required for effect limited its usefulness. 14 Chemical components in chamomile (bisabolol and flavonoids) have demonstrated antispasmodic effects in animal experiments. 15 , 16

The use of a chamomile preparation in children with acute, noncomplicated diarrhea reduced the duration of the diarrheal episode compared with placebo, 17 and reduced stool frequency. 18

Skin: Eczema

Commercial preparations of chamomile-containing creams are widely available despite the lack of trials to support their use.

In a study designed to evaluate the effect of massage with chamomile essential oil versus massage only, no difference was found for the 2 study arms. Additionally, further use of the essential oil after the study period showed a decline in eczema severity, suggesting possible sensitization to the oils over time. 19

In another trial, chamomile cream was as effective as hydrocortisone 0.25% cream in the treatment of atopic eczema. 9 A more recent trial using a nonallergenic chamomile extract showed that chamomile extract was slightly superior to hydrocortisone 0.5%, but only marginally better than placebo. 20

Skin: Radiation dermatitis

In a study designed to investigate the efficacy of chamomile cream in acute radiation dermatitis, no difference was found between chamomile and almond creams. 21 Furthermore, review of the data did not reveal any additional trials; therefore, the use of chamomile cream for this condition is discouraged. 22

Estrogenic activity

Chamomile tea is reportedly among the most common herbs used for morning sickness (as a tea made from the flowers). However, there are no reports on the safety of chamomile during pregnancy. 23 Chamomile also is commonly used in menopause with a perceived high efficacy rate and few perceived adverse reactions. 24

An ethanolic extract of chamomile containing primarily apigenin demonstrated weak estrogenic and progestational activity in an in vitro tissue system. 25

An aqueous extract of chamomile demonstrated antiestrogenic activity on breast cell tissue and demonstrated a nonproliferative effect on cervical cancer cells in a study designed to measure the stimulatory effect of chamomile on bone osteoblasts. 26

CNS/sensory effects

No clinical trials have been published to support the use of chamomile as an anxiolytic. Although apigenin extracted from chamomile demonstrated inhibition of benzodiazepine binding in rat brain membranes, it did not display anxiolytic effects in whole rat models, indicating that its CNS activity is not mediated through this mechanism. 27

In a small, blind, crossover, placebo-controlled study, aromatized chamomile oil demonstrated a sedative effect as well as a positive effect on mood. 13 Changes in alpha wave activity during chamomile oil inhalation were demonstrated using electroencephalogram mapping. 28 Diminished withdrawal symptoms were achieved when chamomile was coadministered with morphine. 29 In a study investigating the efficacy of essential oils in reducing maternal anxiety during labor, the use of chamomile aromatherapy resulted in a reduction in opioid use, with less than 1% reporting minimal adverse reactions. 30

Mouth (mucositis)

Use of chamomile in radiation- and chemotherapy-induced mucositis have been studied in several trials with conflicting results. Prophylactic use of chamomile gargles or mouth rinses prevented the occurrence, delayed the onset, and reduced the intensity of mucositis in 2 trials 31 , 32 ; in another trial, chamomile was no more effective than placebo. 33

Dosage

Chamomile has been used as a tea for various conditions and as a topical cream. Typical oral doses are 9 to 15 g/day. Gargles made from 8 g chamomile flowers in 1,000 mL water have been used in trials. 31

Pregnancy/Lactation

Poorly documented adverse reactions have been reported (eg, abortifacient effects, menstrual cycle irregularities, uterine stimulation with excessive use). 23 , 34 As extracts of chamomile have demonstrated weak estrogenic activity, 25 , 26 use during pregnancy is best avoided.

No clinical data are available on the use of chamomile during lactation.

Interactions

A patient on a stable drug regimen including warfarin experienced multiple internal hemorrhages after using chamomile. 7 Elevated cyclosporine trough concentrations occurred in a patient after drinking 1 to 1.5 L/day of chamomile tea. 35 When the tea was stopped, cyclosporine concentrations deceased to the initial range. Because warfarin and cyclosporine have a narrow therapeutic index, patients taking either of these medications in other than modest amounts should avoid concurrent use of chamomile. Chamomile also has inhibited the CYP-450 isoenzyme IA2, but this is of questionable clinical importance.

No interactions caused by sedative effects or antispasmodic properties of chamomile have been reported. 27

Adverse Reactions

Allergic reactions to chamomile are commonly reported. Hypersensitivity reactions include anaphylaxis, dermatitis, GI upset, lacrimation, and sneezing. 36 , 37 , 38 In large amounts, the dried flowering heads are reported to be emetogenic. 39 Anaphylaxis resulting from chamomile-containing enemas has been documented, 40 as well as allergic conjunctivitis caused by chamomile-containing eye drops. 41

Manifestations of allergy are suggested to be dependent on the route of ingestion. Asthma, bowel cramps, diarrhea, and vomiting related to oral intake via tea have been reported; inhalation of the essential oil predominantly manifests as asthma. 42

Cross-reactivity is reported among people allergic to ragweed, asters, chrysanthemums, and other members of the Asteraceae family. 43

Toxicology

The toxicity of bisabolol was low following oral administration in animals, with acute LD 50 approximately 15 mL/kg in rats and mice. In a 4-week subacute toxicity study, the administration of bisabolol (1 to 2 mL/kg body weight) to rats did not cause toxicity. No teratogenic or developmental abnormalities were noted in rats and rabbits after chronic administration of bisabolol 1 mL/kg. 44

Bibliography

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38. Jensen-Jarolim E , Reider N , Fritsch R , Breiteneder H . Fatal outcome of anaphylaxis to camomile-containing enema during labor: a case study . J Allergy C!in Immunol . 1998;102:1041-1042.
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42. Reider N , Sepp N , Fritsch P , Weinlich G , Jensen-Jarolim E . Anaphylaxis to camomile: clinical features and allergen cross-reactivity . Clin Exp Allergy . 2000;30:1436-1443.
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