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Lavender

Scientific Name(s): Lavandula angustifolia Mill., Lavandula dentata, Lavandula latifolia Medik., Lavandula luisieri (Rozeira) Rivas Mart., Lavandula officinalis, Lavandula pubescens Decne., Lavandula stoechas L.
Common Name(s): Aspic, Buckwheat herb (Turkey), Common lavender, English lavender, Garden lavender, Lavandin, Lavender, Ostokhoddous (Persian), Pink lavender, Spike lavender, True lavender, White lavender

Clinical Overview

See also: Basaglar

Use

Lavender has been used for anxiety and anxiety-related conditions such as restlessness, insomnia, anxiety, and GI distress. However, trials often included healthy volunteers, and most were considered to be of poor quality and displayed inconsistent results. Limited clinical trials support therapeutic use of lavender for pain, hot flushes, and postnatal perineal discomfort.

Dosing

A single to several drops of lavender essential oil (20 mg to 120 mg) diluted in a base or carrier oil, or added to hot water in a diffuser or humidifier, infiltrated on a cotton pad, or dripped in a jar for inhalation has been described for aromatherapy. For consumption as a tea, 1 to 2 tsp (5 to 10 mL) of lavender herb can be steeped in 1 cup of boiling water. A proprietary oral product, Silexan, is usually dosed at 80 or 160 mg/day for use in anxiety.

Contraindications

Contraindications have not been identified. Cautious use or avoidance is warranted in patients with known allergy/hypersensitivity to lavender.

Pregnancy/Lactation

Information regarding safety and efficacy in pregnancy and lactation is limited. Lavender may possess emmenagogic properties, and excessive internal use should be avoided in pregnancy. Lavender aromatherapy has been used in limited studies during and after labor, with no reported adverse effects.

Interactions

CNS depressants and anticonvulsants may increase or potentiate narcotic and sedative effects when given in combination with lavender-containing products. Anticoagulants may increase the risk of bleeding when given concomitantly with lavender. Lavender may also cause additive cholesterol-lowering effects when given with other drugs that lower cholesterol (eg, statins, nicotinic acid, fibric acid derivatives).

Adverse Reactions

Lavender may cause allergic contact dermatitis and photosensitization. Additionally, several case reports suggest a possible association between topical application of lavender and tea tree oils and prepubertal gynecomastia. GI complaints have been reported with oral use.

Toxicology

A case report describes an accidental ingestion of lavandin resulting in CNS depression in an 18-month-old child. The child's neurological state normalized within 6 hours of ingestion. Consumption of tea made from L. stoechas resulted in supraventricular tachycardia in a 46-year-old woman.

Botany

Lavender plants are aromatic evergreen subshrubs that grow to approximately 1 m in height.Leung 1980 The plants are native to the Mediterranean region, the Arabian peninsula, Russia, and Africa. Additionally, lavender is cultivated in the United States, the United Kingdom, southern Europe, and Australia.Denner 2009 The many species readily hybridize with each other. Fresh flowering tops are collected, and the essential oil is distilled or extracts are obtained by solvent extraction.Leung 1980 The plant has small blue or purple flowers. The narrow leaves are fuzzy and gray when young and turn green as they mature.Weiss 1988 Lavender is cultivated extensively for use as a perfume, potpourri, and as an ornamental plant. Lavender grows in a wide range of environments but grows best in full sun exposure. To obtain high yields of oils from lavender, it is necessary to prune the woody stocks each year in order to cause the shoots to bloom.Woronuk 2011 A synonym is L. officinalis Chaix.

History

Lavender has a long history of use as an analgesic, antibacterial agent, antifungal agent, antidepressant, antispasmodic, carminative, cicatrizant, and sedative.Denner 2009 Extracts have been used to treat conditions ranging from acne to migraines.Leung 1980 The term "lavandula" comes from the Latin word "lavare," which means "to wash," suggesting its use as an antiseptic and disinfectant.Denner 2009 Lavender was used in India and Tibet to treat psychiatric conditions. It was also used by ancient Egyptians as part of the mummification process. In 16th-century Europe, lavender skullcaps were thought to increase intelligence.Denner 2009

Although the plant has been known to increase bile flow output and flow into the intestine, it is not significantly used or valued for the treatment of biliary conditions.Weiss 1988 Lavender has been used extensively as an antidiabetic agent in Spain and is included in some commercial herbal antidiabetic preparations.Gámez 1987 Fresh leaves and flowers are applied to the forehead to relieve headaches and to joints to treat rheumatic pain. The vapors of steamed flowers have been used as a cold remedy.Abulafatih 1987 In Chile, the tea is used to induce or increase menstrual flow.San Martín 1983 Since 2009, a patented lavender flower extract, known as Silexan, has been registered as a medicinal product in Germany for the treatment of restlessness related to anxious mood.Kasper 2016

Lavender has traditionally been administered in the form of an infusion, decoction, or oil, and either taken internally or applied topically for relief of a variety of conditions. Today, lavender oil and extracts are used as pharmaceutical fragrances and are found in cosmetics. Spike lavender oil, though of lower quality than true lavender oil, is often used in toiletry soaps because it is inexpensive. Lavandin oil, lavender absolute (an extract), and spike lavender oil are used in concentrations of up to 1.2% in perfumes.Leung 1980 Small amounts (0.002% to 0.004%) of the oil are used to flavor food. Lavender is also used in other bath and shower products, hair care products, and detergents.Lamparsky 1986

Chemistry

Chemical component analysis is important, as different constituents can exhibit different therapeutic properties. Although L. angustifolia has relaxing properties, L. latifolia is considered stimulating.Lillehei 2014 Lavender flowers contain between 1% and 3% essential oil.Bisset 1994 The essential oil contains mixtures of mono- and sesquiterpenoid alcohols, esters, oxides, and ketones, the most abundant of which are linaloyl acetate (30% to 55%), linalool (20% to 35%), cineole, camphor, beta-ocimene, limonene, caproic acid, caryophyllene oxide, and tannins (5% to 10%).Bisset 1994, Leung 1980, Woronuk 2011 However, the relative amounts of these compounds can vary widely among species.Martin Mesonero 1974, Nyiredy 1985 Lavandin hybrids contain a higher volatile oil content, but their composition is extremely variable. Additionally, lavandin oils are not typically used for cosmetic or therapeutic purposes because they contain high levels of camphor.Woronuk 2011 Perillyl alcohol, a constituent of L. angustifolia, has been shown to exert anticancer effects.Jones 1998 Several articles on lavender are available, discussing analysis methods,Boelens 1986, Ikechukwu Ezennia 1997, Kustrak 1975 enantiomeric purity and distinctiveness,Kreis 1993, Mizrahi 1970, Ognyanov 1973 variety deviation,Ahmed 1980, Agnel 1984, Djarmati 1987, Prager 1981 essential oil quality,Denny 1969, Rouzet 1984 gas chromatography retention indices,Nyiredy 1985 and lavender content in perfumes.Cabo 1982

Uses and Pharmacology

Antimicrobial effects

Animal and in vitro data

In vitro studies have demonstrated antibacterial effects of lavender, particularly against gram-negative microorganisms.Lodhia 2009 Growth inhibition of methicillin-sensitive and -resistant Staphylococcus aureus (MSSA and MRSA) with the use of lavender oils (L. angustifolia, L. luisieri, L. latifolia, and L. stoechas) was observed, with larger inhibition zones noted when L. luisieri was combined with L. stoechas and L. angustifolia. However, exposure to the vapor phase of lavender did not inhibit MSSA and MRSA growth.Roller 2009 Strong and rapid antiparasitic effects against Giardia duodenalis and Trichomonas vaginalis have been documented,Moon 2006 as well as both fungistatic and fungicidal effects against Candida albicans.D'Auria 2005 Bacterial infection is the most important local factor responsible for delayed healing and repair of aphthous ulceration. In rabbits with induced recurrent aphthous ulceration, 90% of animals in the lavender group showed complete healing by day 3, while redness, ulcer, and pus were still evident in the placebo group. Histological examination revealed evidence of healing, with near-normal appearance of tissue with application of topical lavender oil compared with the edematous and heavy infiltration of acute and chronic inflammatory cells observed with placebo.Altaei 2012

Clinical data

A double-blind, randomized, placebo-controlled study assessed the effects of topically applied 2% lavender oil on pain, healing, and safety in 115 patients with recurrent aphthous ulceration. Within 4 days of the 5-day trial, 100% of the lavender group experienced complete healing, whereas the placebo group still experienced ulceration and pain (P<0.0001). Additionally, the time for symptoms (ie, erythema, edema, pain) to resolve was significantly less with lavender than placebo (P<0.001 for each). No adverse events or intolerance were reported. Antibacterial mean inhibition zones with lavender oil ranged from 17 to 24 mm against S. aureus, Escherichia coli, alpha-hemolytic Streptococcus, and Bacteroides compared to 12 to 22 mm for the reference control, streptomycin.Altaei 2012

Cancer chemoprevention

Perillyl alcohol, a compound distilled from lavender but also found in cherries, mint, and celery seeds, possesses anticancer activities.Jones 1998 This monocyclic monoterpene is being tested in clinical trials to study its role in cancer chemoprevention and therapy.Gould 1997 Suggested mechanisms of action of perillyl alcohol include inhibition of posttranslational isoprenylation of cell growth–regulatory proteins (eg, Ras) by monoterpenes,Crowell 1996 as well as altered Ras protein synthesisHohl 1996, Ren 1997 and promotion of apoptosis by perillyl alcohol.Jones 1998, Mills 1995, Stayrook 1997

Animal and in vitro data

In an in vitro model, data suggest that lavender oil is cytotoxic to human skin cells (ie, endothelial cells, fibroblasts).Prashar 2004 Monoterpene used to treat rat mammary tumors resulted in remodeling/redifferentiation to more benign phenotypes.Tsang 2010 However, one study in rats found perillyl alcohol 0.5% and 1% to weakly promote the growth of esophageal tumors.Liston 2003

Cardiovascular

Clinical data

In a study of 19 healthy medical personnel, the effect of inhaled lavender oil on endothelial function following night shift work was assessed. Flow-mediated dilation (FMD) of the brachial artery was lower after night shift work, and improved with lavender inhalation.Shimada 2011 In 30 healthy men, inhalation of lavender was associated with an increase in coronary flow velocity reserve (3.8±0.87 to 4.7±0.9; P<0.001) following aromatherapy, an effect that was not noted among the control group.Shiina 2008

CNS effects

It has been suggested that lavender possesses similar action to the benzodiazepines by affecting gamma-aminobutyric acid (GABA) receptors Generoso 2017, Woronuk 2011; inhibition of presynaptic calcium channels has also been described.Generoso 2017 Lavender electroencephalogram studies have shown various alpha wave responses to different odors and have been used for psychophysiological response evaluation.Lee 1994 The aroma hedonics of lavender's scent, such as intensity and pleasantness, have also been observed to play a role in its effectiveness. However, expectancy due to suggestive priming may also play a role in lavender's effectiveness, which confounds studies of less robust methodology.Chamine 2016

Anticonvulsant effects

Animal data

In rats, inhaled lavender oil vapor was associated with anticonvulsive effects on pentetrazol-, nicotine-, and electroshock-induced convulsions but not strychnine-induced convulsions.Yamada 1994

Anxiety

Animal data

In a systematic review of aromatherapy in animal models, 4 of 5 studies identified positive anxiolytic effects with the use of lavender oil in 3 species of rodents. The effects were not limited to a particular species, dosage method, or animal model.Tsang 2010 Additionally, lavender oil caused a reduction in hyperactivity following injection of caffeine in mice.Buchbauer 1991

Clinical data

A systematic review of randomized controlled trials (published between 1995 and 2010) evaluating any type of lavender preparation (ie, oral, topical, olfactory) for the treatment of anxiety (with or without clinical diagnosis) identified 15 studies (N=1,565) that met inclusion criteria. The studies were mostly of poor quality; only 2 trials had a Jadad score of 4, whereas the other 13 trials were rated as poor (0 to 2). A meta-analysis was not possible due to clinical and statistical heterogeneity. Approximately 50% of the studies were conducted in healthy volunteers subjected to experimentally induced anxiety, while the other 7 studies included patients with cancer-related anxiety and depression, preprocedural anxiety, anxiety due to a stay in the intensive care unit, generalized anxiety disorder (GAD), and subsyndromal anxiety disorder. Most studies (n=8) used L. angustifolia and employed aromatherapy, 3 studies used oral capsules, and the others used aromatherapy massage, bathing, and oil-dripping administration methods. Half of the studies employing lavender inhalation reported positive effects for at least one anxiety outcome measure, whereas the other 4 studies demonstrated no effect. Aromatherapy massage, dripping oil, and bathing in lavender produced limited to no beneficial effects, and results were often generated with confounding methodological issues. The 2 highest-quality trials used oral Silexan and reported statistically significant benefit with treatment compared with placebo, an effect that was comparable with lorazepam. Only 5 of the 15 studies reported information regarding adverse events; lavender was well tolerated.Perry 2012 In a study of 30 healthy men, inhalation of lavender was associated with a reduction in serum cortisol levels (8.4±3.6 mg/dL to 6.3±3.3 mg/dL; P<0.05) following aromatherapy.Shiina 2008 A case series of 8 adults with major depressive disorder (MDD) found that oral lavender supplementation (lavendula oil 80 to 160 mg/day) added to usual treatment (antidepressants, psychotherapy) reduced sleep disturbances and some anxiety-related symptoms while reducing psychomotor agitation.Fißler 2014

A 2017 systematic review and meta-analysis of published controlled trials assessing oral Silexan for treatment of anxiety reported data from 5 studies (N=1,165). Overall, pooled data suggested a statistically significant benefit of oral Silexan 80 or 160 mg compared with placebo in ameliorating anxiety symptoms, regardless of diagnosis (GAD, mixed-anxiety depression, anxiety-related restlessness, subsyndromal anxiety), with clinical effects comparable with lorazepam and favoring a diagnosis of GAD. However, the presence of significant heterogeneity, lack of blinding, small sample sizes, and small number of studies (4 of which were by the same author) limit extrapolation of the results.Generoso 2017 In other studies, Silexan demonstrated superior efficacy in reducing anxiety scores in patients with GAD compared to placebo.Kasper 2014, Kasper 2017 In a 10-week randomized, double-blind, double-dummy, multicenter trial in German psychiatric practices, all evaluated GAD patient groups (N=539) experienced a reduction in total Hamilton Anxiety Rating Scale (HAMA) scores, with the most pronounced effect observed with Silexan (160 mg/day or 80 mg/day), followed by paroxetine (20 mg/day), and then placebo. Average HAMA score reductions were 14.1, 12.8, and 11.3 points, respectively, compared to placebo (9.5 points) (P<0.001, P=0.002, and P=0.096, respectively). Adverse events were reported in 25%, 34.8%, 40.9%, and 30.9% for the Silexan 160 mg/day, Silexan 80 mg/day, paroxetine, and placebo groups, respectively; an increased rate of GI disorders was observed with Silexan (greater than 3% increase compared to placebo).Kasper 2014 After 10 weeks, the Silexan 160 mg daily dose had demonstrated superior efficacy over placebo for all outcomes, with a safety profile not significantly different from placebo. Silexan 80 mg/day was effective in many outcomes and may represent the lower end of the effective dose range.Kasper 2017

In a triple-blind, randomized controlled trial comparing effects of lavender and bitter orange on anxiety in 156 postmenopausal women, Spielberger's State-Trait Anxiety Inventory scores were statistically significantly improved with administration of lavender compared to placebo, but were not significantly different compared to bitter orange. Lavender capsules contained 500 mg of whole dried herb (linalool 36.12%, linalyl acetate 26.32%, caryophyllene 7.55%), did not contain volatile oils, and were taken twice daily. At week 8, greater reductions in adjusted mean state-anxiety and trait-anxiety scores were observed with lavender (by 6% and 5%, respectively) compared to controls. Palpitations occurred at a higher incidence with lavender than placebo (4.4% vs 2.1%).Farshbaf-Khalili 2018

Lavender demonstrated no benefit compared with controls on stress levels in children in a perianesthesia setting,Nord 2009 on salivary stress markers (ie, cortisol, chromogranin A) of students who completed serial stress tasks,Toda 2008 or on stress markers (eg, salivary cortisol, blood pressure, pulse rate) in women undergoing urodynamic examination.Seol 2013 In another study in post–coronary artery bypass graft patients, no benefits on subjective stress measures or vital signs were observed between lavender and control 2-day inhalation therapy, except for higher blood pressure in the lavender group on the second day of therapy.Birkmoradi 2015 Lavender also tended to increase blood pressure following single-dose inhalation in a study of women undergoing urodynamic examination.Seol 2013

Various forms of lavender aromatherapy have produced reductions in measures of anxiety and/or pain in patients undergoing gynecological examinations, otolaryngology procedures, intravenous catheter insertion, and peripheral venous cannulation.Bikmoradi 2017, Karaman 2016, Tugut 2017, Wotman 2017

Depression

Clinical data

A systematic review of prospective trials (published through 2009) investigating herbal medicines other than St. John's wort for treatment of mild to moderate depression identified 1 trial using lavender (N=45). Significant improvements in mean Hamilton Rating Scale for Depression (HAM-D) scores were observed after 4 weeks of lavender monotherapy, imipramine monotherapy, and lavender plus imipramine, with the greatest improvement observed with imipramine only.Dwyer 2011

The safety and efficacy of Silexan 80 mg daily each morning in adults with mixed anxiety and depressive disorder (MADD) were investigated in a double-blind, randomized, placebo-controlled, multicenter trial (N=318). A statistically significant anxiolytic and antidepressant benefit was observed with Silexan compared with placebo, which began at week 4 and continued through the end of the 10-week trial. Clinically, the severity of MADD improved in 35.5% of patients receiving Silexan and 17.5% receiving placebo (P<0.01). Treatment group difference between adjusted mean Montgomery-Asberg Depression Rating Scale (MADRS) total score values was 3.25 points (P<0.001, one-sided) favoring Silexan. In contrast to anxiety scores, a significant number of patients achieved remission of depressive symptoms (MADRS total score less than 10) at the end of treatment. Patients with the biggest improvement were those with the lowest baseline scores. Eructation was the only adverse event that occurred at a substantially higher incidence with Silexan (16% vs 0%, respectively).Kasper 2016

The Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of MDD in adults (2016) recommend lavender as third-line adjunctive therapy for mild to moderate MDD (level 3 evidence).Ravindran 2016

Dementia

Clinical data

In a meta-analysis of 7 studies of 428 patients with dementia of any type and severity, data were equivocal regarding effects of lavender aromatherapy on agitation, behavioral symptoms, and other measurements.Forrester 2014 In one study, patients with moderate to severe dementia were randomized to receive lavender aromatherapy 3 times daily for 1 hour after meals or placebo for 4 weeks. Neuropsychiatric Inventory scores significantly improved from baseline with lavender therapy (from 31±10 to 18±12; P<0.01), and no significant changes were noted in the control group (32±11 to 27±12).Fujii 2008 In a randomized crossover study, 70 Chinese adults with dementia were assigned to receive lavender inhalation for 3 weeks followed by control for 3 weeks or vice versa. Agitation, aggressive behavior, irritability, and night-time behaviors were improved with lavender therapy.Lin 2007

In a randomized, single-blind, controlled crossover trial conducted in elderly patients with moderate to severe dementia residing in nursing facilities, no differences in affect or behavior were observed between topical lavender oil or placebo (jojoba oil).O'Connor 2013

Falls

Clinical data

In a randomized, double-blind, placebo-controlled trial, lavender aromatherapy patches applied daily for 1 year to clothing of 145 residents in nursing homes (at least 65 years of age) led to a statistically significant reduction in falls (hazard ratio [HR], 0.57; 95% CI, 0.34 to 0.95) and in fall incidence rate (incidence rate ratio, 0.51; 95% CI, 0.3 to 0.88) compared with placebo when adjusted for covariates (eg, age, Mini-Mental State Exam [MMSE] score, fall history). No adverse events were reported.Sakamoto 2012

Fatigue

Clinical data

Lavender aromatherapy has been utilized to increase mental capacity and diminish fatigue,Leshchinskaia 1983 and one study found lavender useful for maintaining attention spans during long-term tasksShimizu 2008; however, results are equivocal. In a randomized controlled trial conducted in 59 hemodialysis patients, no effect on fatigue was observed in those exposed to 5% lavender aromatherapy for 10 minutes 3 times a week for 4 weeks compared with those receiving routine care.Bagheri-Nesami 2016

Insomnia

Animal data

In mice, lavender oil exhibits CNS depressant activity, characterized by anticonvulsant activity and potentiation of chloral hydrate–induced sleep. Another report on aromatherapy found time-dependent decreases in motility in mice after inhalation of lavender fragrance, helping to confirm folk use of remedies such as herbal pillows to facilitate rest or minimize stress.Buchbauer 1991

Clinical data

The German Commission E Monographs list treatment of restlessness and difficulties in sleeping among lavender's uses.Kreis 1993 A systematic review exploring effects of inhaled essential oils on sleep identified 8 studies (published between 1995 and 2012) using lavender oil as a single ingredient. The sample sizes ranged from 10 to 67 and participants included healthy adults, midlife women, coronary care unit inpatients, and those with insomnia. In 6 of the studies, lavender demonstrated statistically significant benefits, including improvements in sleepiness, deep sleep period time and rapid eye movement, and relaxation, as well as reduced arousal and wakening.Lillehei 2014

The effects of lavender oil aromatherapy for insomnia are documented to be comparable with hypnotics or tranquilizers.Hardy 1995 A study of percutaneous absorption of lavender oil in massage found that within 5 minutes of application, the main constituents of the oil were detected in blood. After this rapid absorption, most of the lavender oil was excreted within 90 minutes.Jäger 1992 A case series of 8 adults with MDD found that oral lavender supplementation (lavendula oil 80 to 160 mg/day) added to usual treatment (antidepressants, psychotherapy) reduced sleep disturbances.Fißler 2014 A double-blind, randomized, controlled trial conducted in 79 college students with self-reported sleep problems reported significantly improved sleep quality with lavender (L. angustifolia) patches plus sleep hygiene (sleep practices based on National Institutes of Health recommendations) compared with sleep hygiene alone (P≤0.01). Additionally, less daytime fatigue and "waking feeling refreshed" were significantly more likely in the lavender group (P≤0.02 and P=0.01, respectively). The effect persisted for 2 weeks following the 5-day treatment. Lillehei 2015

In contrast, no positive effects on sleep patterns occurred with lavender oil aromatherapy massage in 12 patients with autismWilliams 2006 or with lavender oil aromatherapy (3 mL) in an intermediate care unit in a randomized controlled pilot study (N=50). In another study however, blood pressure scores were decreased with lavender compared with control, with a significant difference between the 2 groups (P=0.03).Lytle 2014 One study found the expectation of effect to be a more relevant factor than the aroma in determining relaxation results.Howard 2008

Dysmenorrhea

Clinical data

In a double-blind, randomized, controlled trial of 96 Iranian girls 18 to 28 years of age, lavender aromatherapy provided statistically significant relief in symptoms of primary dysmenorrhea (ie, abdominal pain, backache, headache, tiredness, mood change, faint, nausea, vomiting) compared with placebo (P<0.001). However, binary logistic regression failed to show any benefit on amount of bleeding or presence of blood clots.Raisi Dekhordi 2014

GI disorders

Animal and in vitro data

In an in vitro model, L. angustifolia inhibited the growth of organisms such as Bacteriodes fragilis, C. albicans, and Clostridium spp. while sparing species of Lactobacillusi and Bifidobacterium, suggesting a possible role in the treatment of intestinal dysbiosis.Hawrelak 2009 Spike lavender oil has a spasmolytic effect on animal smooth muscleBuchbauer 1991 and has demonstrated protection against acute ethanol-induced gastric ulceration, but not against indomethacin-induced gastric ulceration.Barocelli 2004 These effects are consistent with the pharmacologic activities of many other common volatile oils.Buchbauer 1991

Two lavender extracts, L. dentata and L. stoechas, demonstrated anti-inflammatory effects in an in vivo rat model of colitis, supporting anti-inflammatory findings from in vitro research. A variety of mechanisms were involved in these effects, including improvement of the intestinal epithelium, down-regulation of proinflammatory cytokines, antioxidant action, and increased expression of anti-inflammatory cytokines.Algieri 2016

Clinical data

A Bulgarian report discusses choleretic and cholagogic action of Bulgarian lavender oil.Gruncharov 1973 Many volatile oils may also share these common actions. One of lavender's uses listed in the German Commission E Monographs is treatment of functional disorders of the upper abdomen with irritable stomach and intestinal disorders of nervous origin. Lavender demonstrates both calming and antiflatulent effects.Bisset 1994

Hypoglycemic effects

Animal data

The infusion and suspension of L. stoechas causes hypoglycemia in normoglycemic rats, reaching maximum activity 30 minutes after administration.Gámez 1987 Further studies with L. dentata and L. latifolia have shown the active hypoglycemic components to be partially water soluble. Furthermore, the extracts were not active in rats with alloxan-induced diabetes, indicating the need for intact pancreatic cells for a pharmacologic effect. The active components have not been chemically identified.Gamez 1988 In another report,L. stoechas essential oil showed benefit in glucose levels in rats with alloxan-induced diabetes. Additionally, protective effects in diabetes-associated kidney and liver damage and mitigation of negative effects on lipid metabolism were observed.Sebai 2013

Insect repellent

Extracts of lavender are used in Europe as insect repellents. This effect appears to be related to compounds in the volatile oil.Secoy 1983 Findings from one study suggest that L. angustifolia is an effective method of controlling ticks.Pirali-Kheirabadi 2010

Menopause

Clinical data

In a double-blind, randomized, placebo-controlled, crossover trial in 100 menopausal women, a significant improvement in number of weekly hot flushes with use of lavender aromatherapy was observed compared with placebo. Lavender aromatherapy was administered twice a week for 20 minutes over the 12-week period, with a 4-week washout prior to the crossover. After 12 weeks of aromatherapy, mean hot flush numbers decreased from approximately 21 to 11 per week with lavender (P<0.001).Kazemzadeh 2016

Pain perception

Clinical data

While not causing a direct analgesic effect, inhalational lavender was associated with less pain intensity and pain unpleasantness, as noted by a patient report in a model of experimentally induced pain.Gedney 2004 Several randomized, controlled trials ranging in size from 34 to 115 patients have demonstrated statistically significant beneficial effects on perception of pain in favor of lavender compared with placebo and/or no treatment.Altaei 2012, Bagheri-Nesami 2014, Ghods 2015, Irmak Sapmaz 2015, Kim 2007, Nasiri 2016 Aromatherapy or topically applied essential oils of lavender produced lower pain scores than controls in hemodialysis patients,Bagheri-Nesami 2014, Ghods 2015 and led to use of fewer analgesics (46% vs 82%, respectively) and lower opioid doses (2.38 mg vs 4.26 mg, respectively) in laparoscopic patients undergoing gastric banding.Kim 2007 Similarly, pain scores were statistically significantly lower in patients with osteoarthritis of the knee,Nasiri 2016 recurrent aphthous ulcers,Altaei 2012 and renal colicIrmak Sapmaz 2015 when treated with lavender oil. Although significant reductions in headache severity were observed in both the treatment and placebo groups in a single-blind, randomized study (N=47) comprising migraine patients, headache severity, percentage of responders, time interval between treatment and headache reduction, and associated symptoms were significantly improved with aromatic lavender (P<0.0001 for each) compared with control.Sassanejad 2012 Very low–quality evidence suggests aromatic lavender essential oil applied by acupressure may reduce low back pain intensity compared with no treatment.Oltean 2014

Benefit of lavender has also been documented in randomized controlled trials (N=60 to 200) when used during and after labor, as well as postcesarean.Hadi 2011, Sheikan 2012, Yazdkhasti 2016 Pain scores were statistically significantly less (P=0.001) with lavender versus control postepisiotomy,Sheikan 2012 during labor at different dilations (P=0.001),Yazdkhasti 2016 and during all 3 stages postcesarean (P<0.001).Hadi 2011 Analgesic use (30% vs 67%; P=0.007) was also observed to be significantly less with lavender compared with controls.Sheikan 2012

Postnatal perineal discomfort

Clinical data

A report evaluated the role of lavender oil as a bath additive to relieve perineal discomfort after childbirth. Compared with controls, daily discomfort scores were lower between days 3 and 5 with true lavender oil use.Dale 1994, Sheikan 2012 In an unblinded, randomized controlled trial (N=60), pain intensity at 4 hours and 5 days (P≤0.001 each), but not 12 hours, postepisiotomy, as well as total Redness-Edema-Ecchymosis-Discharge-Approximation (REEDA) score (P=0) were significantly improved with the addition of lavender oil essence to a Betadine sitz bath compared to the Betadine sitz bath only. The percentage of women not taking analgesics (70% vs 33%) within the first 4 days was also significantly higher with lavender versus control, respectively (P=0.007).Sheikan 2012 In another comparison trial (N=120) of postepisiotomy care with povidone-iodine versus lavender oil added to a sitz bath, women using lavender had significantly decreased redness at 10 days (P=0.001), but no differences in edema or wound dehiscence. "No pain" was reported more often in the lavender group, but the difference was not significant (P=0.063).Vakilian 2011

Dosing

Anxiety

Silexan 80 to 160 mg/day for 10 weeks has been used for anxiety regardless of diagnosis, but particularly for GAD.Generoso 2017, Kasper 2017

Bath aromatherapy

6 drops (120 mg) added to 20 L of bath waterBasch 2004, Denner 2009, Perry 2012; 20 to 100 g of the dried herb in 20 L of bath water.Blumenthal 1998, van Wyk 2004

Inhalation aromatherapy

2 to 5 drops in 10 to 710 mL of boiling water, in an aromatic diffuser, humidifier, infiltrated onto filter paper or on a cotton pad, or dripped in a jar for inhalation.Basch 2004, Denner 2009, Perry 2012

Massage aromatherapy

1 to 4 drops per tablespoon (15 mL) of base or carrier oil; may mix with other essential oils.Basch 2004, Denner 2009 For management of psychological stress, lavender oil diluted to 1% has been used for massage for at least 30 minutes.Perry 2012

Oil for ingestion

1 to 4 drops (20 mg to 80 mg), often given on a sugar cube.Blumenthal 1998

Sitz bath

Sitz bath containing 10 mL of betadine 10% plus 0.25 mL of 0.96% lavender oil essence (2.4 mg) in 5 L of water for soaking (30 minutes twice daily for 5 days) has been used for postnatal perineal discomfort.Sheikan 2012

Tea

1 to 2 tsp (5 to 10 mL) of lavender herb steeped in 1 cup of boiling water.Basch 2004, Blumenthal 1998

Pregnancy / Lactation

Use of lavender aromatherapy (10% used at 1:10 dilution) has been used in limited studies during and after labor, with no reported adverse effects.Sheikan 2012, Yazdkhasti 2016 Lavender is believed to possess emmenagogic properties, and excessive internal use should be avoided in pregnancy.Basch 2004

Interactions

CNS depressants and anticonvulsants: May increase or potentiate narcotic and sedative effects when given in combination with lavender-containing products.Denner 2009

Anticoagulants: May increase the risk of bleeding when given concomitantly with lavender.Denner 2009

Cholesterol-lowering agents (eg, statins, nicotinic acid, fibric acid derivatives): Lavender may cause additive cholesterol-lowering effects when given concomitantly with other drugs that lower cholesterol parameters.Basch 2004

Adverse Reactions

Lavender and lavandin oil have been reported to be nonirritating and nonsensitizing to human skin.Leung 1980 However, case reports of allergic contact dermatitis, allergic eczema, and facial dermatitis from lavender oil and fragrance exist.Brandão 1986, Brown 2016, Posadzki 2012, Rademaker 1994, Schaller 1995 Examples are limited, probably because the oil is used in small quantities in foods and cosmetics and has not been associated with major toxicity during normal use. The German Commission E Monographs lists no known adverse reactions or contraindications to lavender use.Bisset 1994

Several case reports describe the development of prepubertal gynecomastia following topical application of colognes, balms, styling gels, shampoos, soaps, and lotions containing lavender and tea tree oils, including in a 14-month-old exposed to high amounts of lavender daily via lavender baby wipes, shampoo, body wash, moisturizing cream, and lotion. The symptoms resolved within several months upon discontinuation. Investigators have found that lavender and tea tree oils demonstrate estrogenic and antiandrogenic effects on human cells lines.Diaz 2016, Henley 2007, Linklater 2015

The proprietary lavender oil preparation for oral administration Silexan was associated with a higher rate of GI disorders compared with placebo in one study.Kasper 2014 Eructation occurred at a substantially higher incidence with Silexan versus placebo (16% vs 0%, respectively).Kasper 2016

Toxicology

Though not standardized in the United States, the US Food and Drug Administration has assigned lavender "generally recognized as safe" (GRAS) status for consumption.FDA 2010 Lavender oil has exhibited a low order of toxicity when administered subcutaneously to animals. Toxicity studies in mice identified 6.5 g/kg as a lethal dose, with deaths occurring within 24 to 72 hours after dosing.Altaei 2012

A case report describes toxicity occurring in an 18-month-old boy who unintentionally ingested homemade lavandin extract. Three hours later, he went into a state of confusion and presented to the hospital with CNS depression and a strong odor of lavender on his breath. An electroencephalogram found fast rhythm disorders. Six hours following the ingestion, his neurological state normalized. Headspace-gas chromatography-mass spectrometry confirmed linalyl acetate, linalyl formate, and acetone in the child's urine and blood.Landelle 2008 Similarly, a 46-year-old woman experienced palpitations, shortness of breath, headache, dizziness, nausea, epigastric pain, and fever within an hour of consuming tea made from L. stoechas. She was admitted to the emergency department with supraventricular tachycardia that eventually resolved following carotid sinus massage.Acikalin 2012

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