GERMAN CHAMOMILE -- Chamomilla recutita syn. Matricaria recutita

HERBAL

MEDICINAL

-CHAMOMILE-

GERMAN CHAMOMILE

Chamomilla recutita syn. Matricaria recutita

by 

Rettodwikart Thenu

CHAMOMILE

(ka’muh-meel)

German Chamomile (Medical Economics Company. 2000)

Chamomilla recutita syn. Matricaria recutita

TRADE NAMES

Chamomile Flowers (available from numerous manufacturers),

Standardized Chamomile Extract,  Wild Chamomile, Kid Chamomile

HISTORICAL NOTE (Braun, L and Cohen, M. 2010)

Chamomiles have been used as medicines since antiquity and traditionally grouped in botanical texts under the same general heading. They were probably used interchangeably. Roman chamomile was reportedly used to embalm the Egyptian Pharaoh, Ramses II, and is thought to have been introduced into Britain by the Romans during their conquests. The Anglo-Saxons used chamomile, presumably the Roman chamomile, as one of their nine sacred herbs. Culpeper lists numerous ailments for which chamomile was used, such as jaundice, fevers, kidney stones, colic, retention of urine and inflammation of the bowel (Culpeper 1995).

It was also widely used to treat common conditions in children, including colic in infants, teething pains and fever (Grieve 1976). It is used in the treatment of gout and to reduce the severity of sciatic pain, either taken internally or applied as a poultice externally (Culpeper 1995). Today, chamomile tea is one of the most popular herbal teas in Australia and New Zealand, and extracts are also used in cosmetics, as bath preparations, in hair dye for blonde hair, shampoos, mouthwashes and preparations to prevent sunburn (Foster & Leung 1996).

 

Figure 1. German chamomile (Matricaria recutita)     Figure 2. German chamomile – dried drug substance (flowerhead)

DESCRIPTION (Medical Economics Company, Inc. 2000)

Medicinal Parts: The medicinal parts consist of the entire flowering herb or only the flowers.

Flower and Fruit: The flower heads are terminal and longpedicled. The flower is white with a yellow center. The margin flowers are obtuse with a tunicate margin. The ray florets are white, linguiform, female and 3-toothed. The disc florets are tubular, androgynous, 5-toothed, with a hollow receptacle.

Leaves, Stem and Root: The plant is a 20 to 40 cm high herb with an erect, glabrous stem, which is branched above. The leaves are 2 to 3 pinnatisect and have a narrow thorny tip.

Characteristic: The receptacle of the compound head of German Chamomile is hollow which distinguishes it from other types of chamomile.

Habitat: German Chamomile is indigenous to Europe and northwest Asia, naturalized in North America and elsewhere.

Production: German Chamomile consists of the fresh or dried flower heads of Matricaria recutita and their preparations.

Other Names: Pin Heads, Chamomilla. Chamomile, Single Chamomile, Hungarian Chamomile

ORIGIN (Linda, S-R. 2007)

Chamomile is a perennial found in Europe.

USES (Linda, S-R. 2007)

Chamomile is used as an antiinfl ammatory and to treat insomnia, anxiety, and spasms. It is commonly used to treat digestive conditions such as irritable bowel syndrome, indigestion, colitis, and Crohn’s disease. Chamomile is used as a topical treatment to promote wound healing.

INVESTIGATIONAL USES (Linda, S-R. 2007)

Studies are underway to determine the effectiveness of chamomile as an antioxidant and as a treatment for menopausal symptoms.

PLANT PARTS USED (Braun, L and Cohen, M. 2010)

Flower heads, gathered in summer when they are dry, and carefully dried at low temperatures. Essential oil extracted by steam distillation of the flower heads.

PHARMACOPOEIAL AND OTHER MONOGRAPHS (Barnes, J et al., 2007)

BHC 1992(G6)

BHP 1996(G9)

BP 2007 (Matricaria Flower)(G84)

Complete German Commission E (G3)

ESCOP 2003(G76)

Martindale 35th edition(G85)

Ph Eur 2007 (Matricaria Flower)(G81)

USP29/NF24(G86)

WHO volume 1 1999(G63)

LEGAL CATEGORY (LICENSED PRODUCTS) (Barnes, J et al., 2007)

GSL(G37)

CONSTITUENTS (Barnes, J et al., 2007)

The following is compiled from several sources, including General References G2, G6 and G52. Coumarins Umbelliferone and its methyl ether, heniarin.

Flavonoids Apigenin, apigetrin, apiin, luteolin, quercetin, quercimeritrin and rutin.

Volatile oils 0.24–1.9%. Pharmacopoeial standard not less than 4 mg/kg blue oil.(G84) Main components are (_)-a-bisabolol (up to 50%)(1) and chamazulene (1–15%).(2) Others include (_)-abisabolol oxide A and B, (_)-a-bisabolone oxide A, spiroethers (e.g. cis- and trans-en-yn-dicycloether), sesquiterpenes (e.g. anthecotulid), cadinene, farnesene, furfural, spathulenol and proazulenes (e.g. matricarin and matricin). Chamazulene is formed from matricin during steam distillation of the oil. It varies in yield depending on the origin and age of the flowers.(2)

Other constituents Amino acids, anthemic acid (bitter), choline, polysaccharide, plant and fatty acids, tannin and triterpene hydrocarbons (e.g. triacontane).

ESSENTIAL OIL (Braun, L and Cohen, M. 2010)

Chamomile extract produced by a cold extraction process is yellow; steam distillation produces the blue essential oil. This is derived from matricin, also known as proazulene or prochamazulene, a precursor

of chamazulene. Chamazulene (1–15%), farnesene, alpha-bisabolol and bisabolol oxides A and B (up to 50% of

the essential oil; proportions vary depending on the chemotype), bisabolone oxide, chamazulene (from matricin on distillation), matricin, chamaviolin, spathulenol and cis- and trans-enyne dicyclo ethers (spiroether, polyacetylenes). German chamomile has four chemotypes (variations of the plant product according to chemical composition). These relate to slight variations in the bisabolol oxide content of the essential oil (Gasic et al 1986). Chemotypes, which contain highest levels of alpha-bisabolol (known as C and D chemotypes), should be sourced when an essential oil is required for antiphlogistic or spasmolytic properties.

CLINICAL NOTE — THE DIFFERENCE BETWEEN GERMAN AND ROMAN CHAMOMILE

(Braun, L and Cohen, M. 2010)

Chamomilla recutita is widely distributed in wastelands and in the neglected fields of Europe, particularly in Croatia and Hungary. Selected varieties are cultivated (Bruneton 1995). Many plants are referred to as chamomile or have the word ‘chamomile’ as part of their common name. Of the large number of species of chamomile growing in Europe, North Africa and the temperate region of Asia, five grow wild in the United Kingdom and Europe. Wild varieties are German chamomile (C. recutita), Roman chamomile (C. nobile (L.)), foetid or stinking mayweed (Anthemis cotula), corn chamomile (Anthemis arvensis), and yellow chamomile (Grieve 1976). Roman chamomile, or Chamaemelum nobile (L.) (Anthemis nobile L.) is the ‘chamomile’ often referred to in English herbals. It has similar uses to the German chamomile, such as an aromatic bitter for digestive conditions, antispasmodic agent, mild sedative, and topically for its anti-inflammatory and mild analgesic properties.

FOOD USE (Barnes, J et al., 2007)

German chamomile is listed by the Council of Europe as a natural source of food flavouring (category N2). This category indicates that chamomile can be added to foodstuffs in small quantities, with a possible limitation of an active principle (as yet unspecified) in the final product.(G16) German chamomile is commonly used in herbal teas. Previously, German chamomile has been listed as GRAS (Generally Recognised As Safe).(G41)

HERBAL USE (BARNES, J et al., 2007)

German chamomile is stated to possess carminative, antispasmodic, mild sedative, anti-inflammatory, antiseptic and anticatarrhal properties.(G2, G4, G6, G7, G8, G43, G52, G64) It has been used for flatulent nervous dyspepsia, travel sickness, nasal catarrh, nervous diarrhoea, restlessness and specifically for gastrointestinal disturbance with associated nervous irritability in children. It has been used topically for haemorrhoids, mastitis and leg ulcers. German Commission E approved use for gastrointestinal spasms and inflammatory diseases of the gastrointestinal tract and externally for skin and mucous membrane inflammation and bacterial skin diseases including oral cavity and gums. It is also approved for inflammations and irritations of the respiratory tract (by inhalation) and ano-genital inflammation (baths and irrigation).(G3)

APPROVED BY COMMISSION E: (Medical Economics Company, Inc. 2000)

• Cough/bronchitis

• Fevers and colds

• Inflammation of the skin

• Inflammation of the mouth and pharynx

• Tendency to infection

• Wounds and burns

Chamomile is used internally for inflammatory diseases of the gastrointestinal tract associated with gastrointestinal spasms, irritation of the oral pharygeal mucous membrane and upper respiratory tract. Externally, the drug is used for skin and mucous membrane inflammations, pulpitis, gingivitis, respiratory catarrh, and ano-genital inflammation.

Unproven Uses: In Folk medicine, the herb is used internally for diarrhea and flatulence. The herb is used externally for furuncles, hemorrhoids, abscesses, and acne.

Homeopathic Uses: The herb is used for inflammation and cramps in the gastrointestinal tract, teething symptoms, severe pain, inflammation of the upper respiratory tract, and dysmenorrhea.

MAIN ACTIONS (Braun, L and Cohen, M. 2010)

Anti-inflammatory Chamomile extract and various isolated constituents within chamomile have demonstrated antiinflammatory activity in a variety of tests. Chamomile extract showed anti-inflammatory effects when applied topically in animal models of inflammation (Al-Hindawi et al 1989, Plevova 1999, Shipochliev et al 1981). In a comparative trial, hydro-alcoholic extracts of chamomile produced anti-inflammatory actions when applied topically in the croton ear test in the mouse. The hydro-alcoholic extract reduced oedema in a dose-dependent manner and was equivalent in effectiveness to benzydamine at twice the usual clinical dose, but hydrocortisone was found to be the most effective treatment (Tubaro et al 1984). Another comparative study investigated the antiinflammatory effects of an extract prepared from dried flowers, an extract based on fresh flowers, and the volatile oil, in croton oil-induced dermatitis of mouse ear. The activity of fresh chamomile equaled the activity of the reference drug (benzydamine). The anti-inflammatory activity of the herb appears to be due to several different constituents, chiefly apigenin, matricin, chamazulene and alphabisabolol, although others may also exist. The previous study determined that apigenin exerts the strongest anti-inflammatory action, which is 10 times greater than matricin, which is 10 times greater than chamazulene (Della Loggia et al 1990). Another study evaluated the effects of apigenin on the lipopolysaccharide-induced proinflammatory cytokines IL6 and TNF-alpha in vitro and in vivo (Smolinski & Pestka 2003). Apigenin reduced IL6, but not TNF-alpha in vitro. Pretreatment with the flavone (50 mg/kg) reduced IL6 by 35% and TNF-alpha by 33% in vivo as compared with control animals. Alphabisabolol has demonstrated anti-inflammatory and analgesic effects in a number of experimental inflammatory models: rat paw oedema, adjuvant arthritis of the rat, ultraviolet erythema of the guinea pig, and yeast fever of the rat (Jakovlev et al 1979). Sodium azulene sulphate, a water-soluble derivative of azulene, has demonstrated the ability to reduce plasma exudation in a recently developed model of capsaicin-induced pharyngitis (Sakai et al 2005). Most studies have investigated the effects of topically applied chamomile or isolated constituents; however, one study using the carrageenan inflammation test on rat paws showed that orally administered matricin produces anti-inflammatory activity that was greater than chamazulene and almost as effective as (-)-alpha-bisabolol (Jakovlev et al 1979, Shipochliev 1981a). Chamazulene has been found to inhibit leukotriene B4 formation and blocks chemical peroxidation of arachidonic acid (Safayhi et al 1994).

Antipuritic An ethyl acetate extract and essential oil of chamomile have both shown antipuritic activity after a single dose in vivo (Kobayashi et al 2005). Additionally, the antipuritic effects of the antihistamine H1 antagonists, oxatomide and fexofenadine, were significantly increased by the ethyl acetate extract.

Antispasmodic  Chamomile extract and several constituents demonstrate a dose-dependent antispasmodic effect in vitro. The major activity is related to bisabolol, spiroethers and apigenin. (-)-alpha-bisabolol has an effect equal to papaverine; apigenin was the most potent flavonoid, being significantly more potent than papaverine. The extract of chamomile also has a good spasmolytic activity (Achterrath-Tuckermann et al 1980).

Sedative  Shinomiya et al found that 300 mg/kg of chamomile extract significantly decreased sleep latency in a sleep-disturbed rat model, demonstrating benzodiazepine-like activity (Shinomiya et al 2005). Extracts of chamomile showed sedative activity on the mouse CNS (Della Loggia et al 1981), and extracts of chamomile, as well as isolated apigenin, have been shown to bind to benzodiazepine receptors in vitro. Apigenin showed antianxiety and sedative activity with intraperitoneal injection in mice (Viola et al 1995). Ovariectomised rats given inhalations of chamomile oil showed decreased levels of stress-induced ACTH levels compared with controls; the experiment suggested an activity similar to benzodiazepine agonists (Yamada et al 1996).

Antimicrobial   According to in vitro studies, the essential oil has bactericidal and fungicidal activities against gram-positive bacteria (Bacillus subtilis, Staphylococcus aureus) and Candida albicans in concentrations above 0.05% v/v, but has no effect against the gram-negative bacteria Escherichia coli, Pseudomonas aeruginosa (Aggag & Yousef 1972) and Salmonella typhimurium (Gomes-Carneiro et al 2005). In contrast, extracts of chamomile have demonstrated antimicrobial activity against E. coli (Ceska et al 1992). The growth of S. aureus, Streptococcus mutans and group B streptococcus was inhibited by chamomile extract at concentrations of 10 mg/mL (Cinco et al 1983), whilst a very low concentration of the essential oil (0.0075% v/v) effectively inhibited Helicobacter pylori (Weseler et al 2005). Extracts of chamomile may also inhibit Herpes simplex virus (HSV). One study found that a semipurified extract of chamomile was effective in inhibiting HSV in vitro (Suganda et al 1983), whilst another found the essential oil to have significant virucidal activity against HSV type 2 (Koch et al 2008). In vitro tests using apigenin have identified inhibitory activity against HIV activation, possibly by affecting viral transcription (Critchfield et al 1997, Trovato et al 2000).

Anti-ulcer  Chamomile extract protected rats from developing experimentally induced ulcers. Bisabolol (and extracts of chamomile) prevented the formation of ulcers in experimental animals exposed to indomethacin (NSAID) stress, and alcohol; and reduced the healing time of ulcers induced by chemical stress (acetic acid) or by heat coagulation.

Wound healing  Alpha-bisabolol promotes granulation and tissue regeneration in burns and ulcers, and protects against their formation (Szelenyi et al 1979). Oral administration of an aqueous extract of chamomile (120 mg/kg/day) significantly decreased healing time for excision, incision and dead space wounds in vivo (Nayak et al 2007). Another study evaluated the topical application of chamomile in vivo and found that it significantly improved healing time for second degree burns (Jarrahi 2008).

OTHER ACTIONS (Braun, L and Cohen, M. 2010)

Immune enhancement Chamomile extract increased T-lymphocyte rosette formation in vitro in blood samples taken from ear, nose and throat patients with immunodeficiency (Kliachko et al 1994). The polysaccharides (heteroglycans) showed significant immunostimulating activities according to the granulocytes and carbon clearance tests (Wagner et al 1985).

Antioxidant Chamazulene is a potent antioxidant. It inhibits lipid peroxidation in vitro (Goeters et al 2001) in a dose–concentration- and time-dependent manner (Rekka et al 1996).

Choleretic Chamomile increases the production of bile by the liver (Pasechnik 1966).

Drug dependence Chamomile extract was shown to inhibit the development of morphine dependence and expression of abstinence syndrome in rats. Chamomile reduced frequencies of behaviours associated with withdrawal (paw tremor, rearing, teeth chattering, body shakes, ptosis, diarrhoea and urination) and weight loss (Gomaa et al 2003).

Anticarcinogenic Apigenin inhibits carcinogenesis in a number of in vitro and animal studies (Aguilera et al 2000, Ali-Shtayeh et al 2000, Birt et al 1986, 1997, Lepley & Pelling 1997, Lepley et al 1996, Panes et al 1996, Patel et al 2007, Srivastava & Gupta 2007, Umezu 1999, Wei et al 1990).

Uterine effects Water extracts of chamomile increased uterine tonus in isolated rabbit and guinea pig uterine horn (Shipochliev 1981b).

Pigmentation Chamomile extract has been found to decrease UV-induced pigmentation as well as the hyperpigmentation found in lentigo senilis (aged or liver spots). Endothelin-1 is a cytokine responsible for stimulating melanocyte function leading to hyperpigmentation. Chamomile has been shown to interrupt the endothelin-1-induced signalling, there by reducing the ability of melanocytes to proliferate and to synthesise melanin (Ichihashi et al 1999).

CLINICAL USE (Braun, L and Cohen, M. 2010)

Chamomile is most widely taken as a tea, often after meals or as an alternative to caffeine-containing beverages. In clinical practice, the oral dose form most often used is a concentrated extract, in order to produce stronger therapeutic effects. It is also used as a topical treatment in some indications.

Skin conditions Chamomile is used topically for a variety of dermatological conditions. The most tested topical product is commercially known as Kamillosan. Wound healing According to a double-blind trial, external application of a chamomile extract improves wound healing. In the study, chamomile extract significantly decreased weeping and improved wound healing after dermabrasion of tattoos (Glowania et al 1987). Eczema In one comparative study, 161 patients with eczema on the arms and lower legs were treated with 0.25% hydrocortisone, 5% bufexamac (NSAID), 0.75% fluocortin (glucocorticoid) or a chamomile cream commercially known as Kamillosan. The chamomile cream was as effective as hydrocortisone and was superior to the other two treatments (Aertgeerts et al 1985). (Kamillosan is reportedly made from a high bisabolol-containing chemotype of chamomile.) Dermatitis A study involving experimentally induced toxic dermatitis found that chamomile ointment (Kamillosan) produced a more soothing effect on human skin than a chamomile ointment base or hydrocortisone ointment 0.1% (Nissen et al 1988). (Note: the hydrocortisone cream used in this study was quite weak compared with the usual strength of 0.5–2.5%.) Chamomile cream helped to protect against skin radiation damage in breast cancer patients receiving radiation (Maiche et al 1991). Chamomile cream (Kamillosan) has been shown to be slightly less effective than 0.25% hydrocortisone, but superior to fluocortin butyl ester and 5% bufexamac in relieving inflammation associated with dermatoses (Aertgeerts 1984, Aertgeerts et al 1985). Commission E approves the external use of chamomile for inflammation of the skin and mucous membranes, as well as for bacterial skin diseases, including those of the oral cavity and gums (Blumenthal et al 2000).

Sedation Both oral dose forms and the essential oil of chamomile are used for this indication. A placebo-controlled study involving 22 volunteers found that inhalation of chamomile oil produced sedative effects and improved mood (Roberts & Williams 1992). Chamomile tea (two teabags in 175 mL of hot water) given to 12 patients during cardiac catheterisation induced a deep sleep in 10 patients, even though the procedure usually causes pain and anxiety (Gould et al 1973).

Gastrointestinal conditions Chamomile is widely used to relieve stomach cramping, dyspepsia and flatulence. The herb’s antispasmodic and relaxant effects provide a theoretical basis for its use in these conditions. In an open, multicentre study, 104 patients with gastrointestinal complaints, including gastritis, flatulence and minor spasms of the intestines, were treated for 6 weeks with 5 mL/day of an oral chamomile preparation (standardised to contain 50 mg alpha-bisabolol and 150–300 mg apigenin-7-glucoside per 100 g). By self-evaluation, all patients improved with 44.2% becoming symptom free (Stiegelmeyer 1978).

Diarrhoea in children In Europe, chamomile is widely used to treat a variety of paediatric complaints. A prospective, double-blind, randomised trial was used to document the efficacy of a preparation containing chamomile extract and pectin (Diarrhoesan) in children aged 6 months–5.5 years with uncomplicated diarrhoea. The chamomile preparation reduced the duration and severity significantly faster than placebo (de la Motte et al 1997). A larger multicenter, double-blind, RCT involving 255 patients was designed to further evaluate the apple pectin and chamomile preparation for acute diarrhoea in children aged between 6 months and 6 years (Becker et al 2006). Stool frequency was significantly reduced in the treatment group as compared to placebo. Commission E approves chamomile for gastrointestinal spasms and inflammatory diseases of the gastrointestinal tract.

Antibacterial preparations A phase III, double-blind, placebo-controlled clinical trial of 164 patients assessed the efficacy of chamomile mouthwash in preventing 5-fluorouracil- induced stomatitis and found no difference between chamomile and placebo (Fidler et al 1996).

ACTIONS (Linda, S-R. 2010)

Chamomile is a widely recognized herb in Western culture. The medicinal use dates back many centuries. Chamomile is calming, carminative, and antispasmotic (Altern Med Rev, 2008).

Antianxiety Action One of the fl avonoid components of chamomile, apigenin, has shown an affi nity for benzodiazepine receptors, which accounts for the antianxiety and sedative qualities of this herb (Viola et al, 1995; Medina et al, 1998). Two other studies have shown a mild hypnotic effect in laboratory animals as a result of the fl avonoid component (Berry, 1995; Mills, Bone, 1991). Multiple studies have documented the ability of chamomile to decrease anxiety and promote relaxation and sleep.

Antidiabetes Action Evidence has demonstrated that two fl avonoids in chamomile, glucoside and chamaemeloside, produce hypoglycemic effects (Konig, 1998). However, the current recommended dose for humans of 0.05% to 0.1% is too low to have any signifi cant effect on glucose levels.

Phytoestrogen Action One study evaluated the effi cacy of 13 isofl avonoids, fl avonoids, and lignans, plus several phytoestrogens, in the treatment of estrogen-dependent tumors. Apigenin, a fl avonoid present in chamomile, exerted a signifi cant effect on DNA synthesis in  estrogen-dependent and estrogen-independent human breast cancer cells (Wang et al, 1997). Further studies are necessary to clarify the possible cancer preventative effects of these chemical components.

Antispasmodic Action in the Gastrointestinal Tract Studies have shown the antispasmodic action of chamomile on the gastrointestinal tract. In one study, infant colic was signifi cantly reduced when chamomile tea was given to 69 infants with colic symptoms (Weizman et al, 1993). However, this was a study of short duration (7 days).

OTHER USES (Braun, L and Cohen, M. 2010)

The British Herbal Pharmacopoeia (1983) recommends chamomile for flatulent nervous dyspepsia, travel sickness, nasal catarrh, nervous diarrhoea and restlessness. Externally, chamomile is recommended for haemorrhoids, mastitis and leg ulcers. The specific indication is for gastrointestinal disturbance with nervous irritability in children and for teething and colic in infants. Commission E approves the use of inhalations for inflammation and irritation of the respiratory tract and baths and irrigations for anogenital inflammation (Blumenthal et al 2000).

Oral mucositis/recurrent aphthous stomatitis Methotrexate-induced oral mucositis in a 76-year old woman was successfully treated by chamomile mouthwash in a recently reported case study (Mazokopakis et al 2005). The mouthwash consisted of 8 g of flower heads steeped in 1000 mL of boiling water for 15 min and then used as a gargle four times daily. The fluid extract of chamomile appears to exert an analgesic effect on the oral mucosa. Thirty-four patients applied chamomile extract directly to their mouth ulcer(s) and then repeated this process at intervals of 5, 10 and 15 min in an unblinded, uncontrolled clinical trial. The effect was rated as excellent by 82% and good by 18% of participants using an Analogical Visual Scale (Ramos-e-Silva et al 2006).

Preventing postoperative sore throat Chamomile extract spray administered before intubation was not able to prevent postoperative sore throat and hoarseness compared with saline spray in a randomised, double-blind study (Chan et al 2003).

Haemorrhagic cystitis Chamomile extract decreased the symptoms of haemorrhagic cystitis. Thirty-two patients were randomly assigned to receive either the antibiotic cotrimoxazole (trimethoprim/sulfamethoxazole) alone or with a chamomile extract administered on day one as a bladder instillation, followed by daily hipbath use. Symptoms were evaluated after 10 days and indicated that the chamomile group experienced more rapid alleviation of symptoms than the group treated with only cotrimoxazole. The product used was Kamillenextrakt, an ethanolic extract of chamomile flowers (Barsom et al 1993).

DOSAGE (Medical Economics Company. Inc. 2000)

Mode of Administration: Liquid and solid preparations are available for external and internal application.

How Supplied:

Ø  Capsule — 125 mg, 350 mg, 354 mg

Ø  Liquid — 1:4

Ø  Oil — 100%

Preparation: An infusion for internal use is prepared by pouring boiling water (150 ml) over 3 gm of chamomile, cover for 5 to 10 minutes and strain. (1 teaspoonful = 1 gm drug). An infusion for external poultice application is prepared by pouring one and one-half cups of hot water over 2 dessertspoons of the drug, cover, leave to draw for 15 minutes and then strain. Ointments and gels are available in strengths of 3 to 10%.

Daily Dosage: An internal single dose is approximately 3 gm as an infusion. Liquid extract 1-4 ml or 1 cup of freshly made tea is administered 3-4 times daily. Externally as a bath additive, 50 gm is added to 1 Liter of water or 6 gm of drug for a steam bath. Washes and gargles may be administered several times a day.

Homeopathic Dosage: Internally, the herb is given as 5-10 drops, 1 tablet, or 5-10 globules. Externally, dilute 1 dessert spoon with 250 ml water and use 2-3 times daily in poutices or washes (HAB1).

DOSAGE (Barnes, J et al., 2007)

Dosages for oral administration (adults) for traditional uses recommended in standard herbal reference texts are given below.  Dried flowerheads 2–8 g as an infusion three times daily.(G7)

Liquid extract 1–4mL (1 : 1 in 45% alcohol) three times daily.(G7)

PRODUCT AVAILABILITY (Linda, S-R. 2010)

Capsules: 360 mg; cream; fl uid extract; lotion; shampoo and conditioner; tea; tincture; various cosmetics

DOSAGES (Linda, S-R. 2010)

v  Adult PO capsules: 300-400 mg, standardized to 1% apigenin and 0.5% essential oil, as often as 6 times/day (Foster, 1998)

v  Adult PO fl uid extract: 1-2 ml tid (1:1, 45% ethanol) (Smith, 1999)

v  Adult PO tea: 2-4 oz prn (Moore, 1996)

v  Adult PO tincture: 3-10 ml tid (1:5, 45% ethanol) (Bradley, 1992)

v  Adult topical: 11⁄2 cups water mixed with 2 tsp dried fl owers, cover, let stand 10-15 min, strain, apply as a compress

v  Child PO tea: 1⁄2-4 cups daily (Romm, 2000)

v  Child PO tincture: 1⁄4-1 tsp as often as qid (Romm, 2000)

v  Child topical: as a wash or cream, apply prn to treat infl ammation (Romm, 2000)

DOSAGE RANGE (Braun, L and Cohen, M. 2010)

Internal use

German chamomile is used either as a tea made from the dried flower heads, or as an extract.

v  Dried flower heads: 2–8 g three times daily by infusion.

v  Fluid extract (1:2): 3–6 mL/day.

v  Tincture (1:5): 3–10 mL three times daily.

The quality of chamomile varies greatly. For maximum efficacy, use high-grade chamomile (high in alpha-bisabolol). Standardised extracts are usually standardised to either bisabolol or apigenin.

External use

The dried flowers can also be made into a poultice with the addition of hot water and applied directly to the skin, or the tea can be used to bathe inflamed skin and eyes.

v  Essential oil (external use): Five drops per 100 mL of oil, or per 100 g of cream or ointment.

v  In baths and water for compresses, the dose should not exceed 10 drops.

v  Inhalation: Five drops of essential oil in 1 L hot water.

DOSAGE (Gladstar, R. 2012)

Chamomile flowers have rich amounts of azulene, a volatile oil with a whole range of active principles that serve as antiinfl ammatory and antifever agents, making it useful for treating arthritis and other inflammatory conditions. In one clinical study, 10 out of 12 people who drank chamomile tea instead of taking their regular

pain medication at bedtime (for relieving general aches and pains, headaches, or arthritic pain) went into a deep, restful sleep within 10 minutes of retiring.

CALMING CHAMOMILE TEA

Nothing could be simpler than making a cup of chamomile tea, whether with fresh or dried fl owers, and few things are more calming and peaceful.

To make the tea:

Prepare an infusion of the fl owers, following the instructions on page 29. Use 1 teaspoon of dried fl owers or 2 teaspoons fresh fl owers per cup of water, or 1 ounce of dried fl owers or 2 ounces fresh fl owers per quart of water. Let steep, covered, for 15 to 20 minutes. Chamomile contains bitters; the longer it steeps, the stronger the bitters. For a better-tasting, less bitter infusion, steep less.

To use:

Drink 2 to 3 cups daily, or as often as needed. This herb has lasting effects if used over a period of several weeks. It is nice to blend with other herbs that support the nervous system, such as lemon balm and rose petals, and it is excellent for infants and children as well as adults.

CHAMOMILE EYE PACKS

These eye packs will help relieve eye stress and strain, dark circles, and puffiness.

To make the packs:

Place two chamomile tea bags in hot water and let sit for a couple of minutes, or until thoroughly saturated. Remove and let cool to a tolerable temperature.

To use:

Place a tea bag directly over each eye. Lie back and relax, leaving on the chamomile packs for 15 to 20 minutes.

CALMING HERBAL BATH FOR DE-STRESSING

Immersing yourself in an herbal bath is much like stepping into a giant cup of tea: your pores open up, absorbing the healing properties of the herbs, and the warm water relaxes while it cleanses. It’s healing at its fi nest.

To prepare the bath:

Mix together a handful each of dried chamomile blossoms, lemon balm leaves, and rose petals. Place the mixture in a large muslin bag, an extra-large tea strainer, or even an old nylon stocking. Attach directly to the faucet of the tub. Let hot water (the hottest possible) run through the herbs for a few minutes. Then adjust the water temperature to a comfortable level and fill the tub.

To use:

Dim the lights, light a candle, and immerse yourself in the calming essence of herbs. You might even want to enhance the relaxing effects on your nervous system by drinking a cup of warm chamomile tea.

DOSAGE AND SENSIBLE USE (Chevallier, A. 2018)

As with all medicines, getting the dosage right is essential. Too much and you risk overdosing, too little and the remedy may not work. Follow the guidelines on these pages to ensure that you use herbal remedies safely and appropriately.

ADULT DOSAGES Each of the remedies listed in the A–Z of Herbal Remedies has a letter indicating its adult dosage—how much of the herb to take per day or per week.

To take an example, passion flower (Passiflora incarnata) on p.173 has C for its dosage. Looking at the dosage guide (right), it can be seen that C = 2–4g a day or 30g a week. Passion flower should therefore be taken at these recommended dosages.

As another example, hawthorn leaf (Crataegus spp.) has M and C for its dosage. M applies to manufactured products: take prepackaged hawthorn products, such as standardized tablets and capsules, at the manufacturer’s recommended dosage. C applies to dried hawthorn leaf or berry: take at the recommended daily or weekly dosage, i.e. 2–4g a day or 30g a week.  Similarly, each of the other letters gives specific recommendations on how to use the herb.

Teas and decoctions The dosages given in the guide apply when making teas and decoctions from dried herb material—bark, leaves, roots, etc. For fresh herb material you can use 11⁄2–2 times the quantity of dried material.

Tinctures It is not possible to give clear guidelines for tinctures owing to the wide variation in their strength. Ask advice on dosage when purchasing a tincture. In general, the dosage range for a 1:3 tincture is the same (in milliliters not grams) as the above dosages, i.e. for A, the dosage of a 1:3 tincture is 5–15ml a day.

ADULT DOSAGE GUIDE

Recommended ADULT dosage as given in the key information boxes (see opposite page). For children and people over 70, see below and opposite.

Ø  A = 5–15g a day, or max. 100g (31⁄2 oz) per week

Ø  B = 3–7.5g a day, or max. 50g (2 oz) per week

Ø  C = 2–4g a day, or max. 30g (1 oz) per week

Ø  D = 1–2g a day, or max. 15g (1⁄2 oz) per week

Ø  M = Take product at manufacturer’s recommended dosage.

Ø  T = Topical application on the skin only (Note: preparations made specifically for topical use should not be taken internally.)

Powders Take the minimum recommended daily dosage only.

Tablets and capsules Take at the manufacturer’s recommended dosage.

CHILDREN’S DOSAGES Do not give babies under 6 months any medication without professional advice. You may need to adjust dosage levels for children who are particularly small or large for their age.

§  From 6 months to 1 year: give 1⁄10 the minimum adult dose

§  From 1 to 6 years: give 1⁄3 the minimum adult dose

§  From 7 to 11 years: give 1⁄2 the minimum adult dose

§  From 12 to 16 years: give the low adult dose.

DOSAGES FOR OVER 70s As we age, our bodies become less efficient at breaking down drugs, including herbs. From the age of about 70 onward it is advisable to take slightly lower doses: 80 percent of the standard adult dose is normally recommended. In very old and frail people the dosage may need to be as low as 50 percent of the standard adult dosage.

GENERAL CAUTIONS

v  Do not take essential oils internally unless on advice of a suitably qualified health care professional.

v  Do not give herbs to babies under 6 months old.

v  Do not exceed the recommended dosage levels.

v  If you are taking drugs prescribed by your doctor or hospital, check with them, or with a registered herbal or naturopathic practitioner, before taking a herbal remedy.

v  People known to have allergies should start by taking a low dose and, if this is fine, then increase the dose.

Contact allergy can occur on handling fresh or dried herbs. Where such allergy occurs, do not take the remedy internally. Some people are allergic to specific plant families, for example the daisy (Asteraceae) family. Several herbs listed in this book, including chamomile (Chamomilla recutita), echinacea (Echinacea spp.), and feverfew (Tanacetum parthenium), belong to this family and are known to cause contact allergy in sensitive individuals.

KEY INFORMATION (Chevallier, A. 2018)

Every remedy in the A–Z features a key information box that provides essential data on the herb. At the top, each herb is rated using a 5-star rating system, with 5 black stars = most. This gives some idea of the herb’s:

v  overall safety record (Safety)

v  long-standing use in traditional medicine (Traditional use)

v  evidence of effectiveness, as supported by scientific research (Research).

On the line below (Best taken as), suitable types of preparation are recommended; for example, yarrow (Achillea millefolium) is best taken as a tea, which gets 3 checks. Dosage information is provided on the following line. Some entries include an “Often used with” recommendation. The last and most important section lists known cautions for the remedy, and should be read carefully, especially before taking a remedy.

     

                 Figure 3. Example  Key Information Used Herbal                    Figure 4. Key Information Chamomile Used

ADVERSE REACTIONS (Braun, L and Cohen, M. 2010)

Allergic Reactions

Occasional rare cases of allergic skin reactions have been reported. However, a bibliographic review of 50 reports of ‘chamomile’ sensitivity revealed that in only five papers was the botanical identification of the plant material correlated with Chamomilla recutita. In the majority of other instances, the effects were caused by species of the genus Anthemis, frequently also called chamomile. Experimental studies on pigs using a rigorous testing technique proved that C. recutita possesses low sensitising capacity. The suspected allergen is the sesquiterpene lactone, anthecotulide, found in Anthemis cotula L. (stinking mayweed), which only occurs in trace amounts in the bisabolol oxide B-chemotype of genuine chamomile (Hausen et al 1984). Allergic conjunctivitis has been reported with the use of chamomile tea eyewashes, and the pollens contained in the teas

have been identified as the allergens responsible. The reaction occurred after first exposure and was thought to be due to cross-reactivity to Artemesia pollen (Subiza et al 1989). Pollens are not likely to be present or active in aqueous alcohol extracts of chamomile.  German chamomile is thought to be less allergenic than Roman chamomile, but any variety of chamomile can potentially cause allergic reactions. An enema made from German chamomile (Kamillosan) given during labour to a 35-year-old woman with no history of atopy resulted in life-threatening anaphylaxis and fatal asphyxia of the newborn (Jensen-Jarolim et al 1998). Chamomile enemas are not a usual form of administration.

SIGNIFICANT INTERACTIONS (Braun, L and Cohen, M. 2010)

Controlled studies are not available; therefore, interactions are based on evidence of activity and are largely theoretical and speculative.

Benzodiazepines  Theoretically, an additive CNS depressant and antispasmodic effect can occur with concurrent use. Observe patients taking this combination, although the combination may be clinically useful when used under supervision.

Warfarin  A case of multiple internal haemorrhage in a 70-year-old woman using topical and oral chamomile products in conjunction with warfarin has been described (Segal et al 2006). Observe.

Drugs metabolised by CYP3A4  Chamomile has been shown to inhibit cytochrome 3A4 enzymes in vitro (Budzinski et al 2000, Ganzera et al 2006, Gomes-Carneiro et al 2005). The clinical significance of this is unknown; however, drugs that are metabolised by these enzymes could theoretically be affected. Until this can be confirmed or refuted in a clinical study, observe for interactions.

NSAIDS Chamomile extract protected test animals from experimentally induced ulcers — beneficial interaction.

CONTRAINDICATIONS AND PRECAUTIONS (Braun, L and Cohen, M. 2010)

Chamomile is contraindicated in hypersensitivity or known allergy to chamomile or other members of the Asteraceae family (e.g. yarrow, tansy, feverfew, daisy, ragweed). A recent investigation found that 7.5% of the 200 samples evaluated were contaminated with Clostridium botulinum spores (Bianco et al 2008). This could be potentially dangerous for infants. The investigators found that the presence of these spores was significantly higher in bulk chamomile sold by weight as opposed to packaged tea (P = 0.005). Caution is advised when giving chamomile to children aged less than 12 months.

PREGNANCY USE  Safety has not been established scientifically; however, no teratogenic effects have been observed in vivo.

CONTRAINDICATIONS (Linda, S-R. 2010)

German chamomile: Pregnancy category is 1; breastfeeding category is 2A. German chamomile (Matricaria chamomilla) may be given to children. Roman chamomile (Chamaemelum nobile) is a known abortifacient and should not be used during pregnancy and breastfeeding, but it may be given to children. Persons with asthma should not use this herb. Cross-hypersensitivity may result from allergy to sunfl owers, ragweed, or members of the aster family (echinacea, feverfew, milk thistle).

CONTRA-INDICATIONS, WARNINGS (Barnes, J et al., 2007)

In view of the documented allergic reactions and crosssensitivities, German chamomile should be avoided by individuals with a known hypersensitivity to any members of the Asteraceae/ Compositae family. In addition, German chamomile may precipitate an allergic reaction or exacerbate existing symptoms in susceptible individuals (e.g. asthmatics). The use of chamomile preparations for teething babies is not recommended.

Drug interactions None documented. However the potential for preparations of German chamomile to interact with other medicines administered concurrently, particularly those with similar or opposing effects, should be considered (particularly where oral preparations of German chamomile are used). Coumarin compounds detected so far in German chamomile do not possess the minimum structural requirements (a C-4 hydroxyl substituent and a C-3 non-polar carbon substituent)(G87) for anticoagulant activity.

Pregnancy and lactation German chamomile is reputed to affect the menstrual cycle(G30) and extracts are reported to be uterotonic.(2, 11) Teratogenicity studies in rats, rabbits and dogs have been documented for (_)-a-bisabolol, with the oral toxic dose stated as 1–3 mL/kg.(22) A dose of 3 mL/kg was found to increase the number of fetuses reabsorbed and reduce the body weight of live offspring.(22) (_)-a-Bisabolol administered orally (250 and 500 mg/kg) to pregnant rats has been reported to have no effect on the fetus.(1) There are insufficient data on the use of German chamomile preparations during pregnancy and breastfeasting, and excessive use (particularly oral preparations) should be avoided during these periods.

SIDE EFFECTS/ADVERSE REACTIONS (Linda, S-R. 2010)

EENT: Burning of the face, eyes, mucous membranes (topical)

SYST: Hypersensitivity

Interactions

Drug

Alcohol: Chamomile may increase the effects of alcohol (theoretical).

Anticoagulants: Chamomile (C. nobile) may interfere with the actions of anticoagulants; avoid concurrent use.

CNS depressants: Chamomile may increase the effects of other sedatives; avoid concurrent use (Jellin et al, 2008).

SIDE-EFFECTS, TOXICITY (Barnes, J et al., 2007)

There is a lack of clinical safety data and toxicity data for German chamomile and further investigation of these aspects is required. Reports of allergic reactions to chamomile are common, although in the majority of cases the plant species is not specified.(15) Patients with an existing hypersensitivity to German chamomile have demonstrated cross-sensitivities to other members of the family Asteraceae/Compositae(16, G51) and also to celery (family Umbelliferae).(G51) There are reports of anaphylactic reactions to chamomile (species unspecified)(17, 18) and in both cases the individuals concerned had an existing hypersensitivity to ragweed (member of Asteraceae/Compositae). The symptoms they experienced included abdominal cramps, thickness of the tongue and a tight sensation in the throat,(18) angioedema of the lips and eyes, diffuse pruritus, a full sensation of the ears, generalised urticaria, upper airway obstruction, and pharyngeal oedema.(17) Both patients made a full recovery following medical treatment. Allergic skin reactions have been documented following external contact with German chamomile.(2, 19, G51) Consumption of chamomile tea may exacerbate existing allergic conditions and the use of a chamomile enema has been documented to cause asthma and urticaria.(G51) The allergenic properties documented for chamomile have been attributed to anthecotulid, a sesquiterpene lactone present in low concentrations,(15) and to matricarin, a proazulene which has produced positive patch tests in patients with an existing sesquiterpene lactone hypersensitivity.(G51) Sesquiterpene lactones have been implicated in the allergenic activity of many plants, especially those belonging to the Asteraceae/Compositae family (see Feverfew). The prerequisite for allergenic activity is thought to be an exocyclic a-methylene group.(20) The flowerheads contain anthemic acid, which is reported to act as an emetic in large doses.(G22) The acute toxicity of chamomile oil (German and Roman) is reported to be low.(21) Oral and dermal LD50 values in rabbits have been documented as greater than 5 g/kg,(21) and the application of undiluted oil to the hairless backs of mice, to rabbit skin, and to human skinwas not found to produce any observable irritation.(21) An LD50 value (mouse, by mouth) for German chamomile oil has been documented as 2.5 mL/kg.(13) The acute oral toxicity of (_)- a-bisabolol in mice and rats is reported to be low at approximately 15 mL/kg.(22) The subacute oral toxicity of (_)-abisabolol has been estimated to be between 1.0 and 2.0 mL/kg in rats and dogs.(22) An LD50 value (mouse, intraperitoneal injection) for cis-spiroether has been stated as 670 mg/kg.(6)

CLIENT CONSIDERATIONS (Linda, S-R. 2010)

Assess

v  Determine whether the client is using chamomile for insomnia.

v  Assess the client’s sleeping patterns: ability to fall asleep and stay asleep, hours of sleep.

v  Assess for the use of alcohol, anticoagulants, and sedatives (see Interactions).

Administer

v  Instruct the client to store chamomile in a cool, dry place, away from heat and moisture.

Teach Client/Family

v  Caution the client not to use C. nobile during pregnancy; it is a known abortifacient.

v  Instruct the client to avoid using chamomile concurrently with other sedatives or alcohol; chamomile may increase their effects.

PRACTICE POINTS/PATIENT COUNSELLING (Braun, L and Cohen, M. 2010)

v  German chamomile has demonstrated antiinflammatory, antispasmodic, sedative and antimicrobial activity.

v  It is taken orally either as a tea or tincture, used externally as a poultice, cream or ointment or inhaled as an essential oil.

v  Internally, it is used to relieve flatulence, gastrointestinal spasm, dyspepsia and induce a sense of relaxation. It is also used for infants with teething pain and colic.

v  Externally, chamomile preparations are used to treat dermatitis, enhance wound healing, nappy rash and soothe irritated skin. Comparative studies show that it has an anti-inflammatory effect equivalent to low-dose hydrocortisone preparations.

v  There is some evidence from clinical trials to support the use of chamomile in the treatment of wounds, eczema, dermatitis, nervousness and tension, diarrhoea in children and for the symptoms of haemorrhagic cystitis (in association with antibiotic therapy).

PATIENTS’ FAQs (Braun, L and Cohen, M. 2010)

What will this herb do for me? Chamomile is taken to relieve stomach spasms and flatulence, to induce relaxation and promote sleep. It is also popular for children with teething pain and digestive complaints such as colic or diarrhoea. Applied externally as a cream, ointment or poultice, it is used to reduce skin irritation and inflammation.

When will it start to work? Chamomile relieves gastrointestinal symptoms quickly, within several minutes. For more chronic problems, it may need to be used long term.

Are there any safety issues? Chamomile is considered a very safe herb. While there have been reports of allergic reactions, the majority have been due to adulteration with other herbs. Chamomile tea is more likely to cause allergic reactions than either extracts or essential oil. Chamomile should not be used by persons with hypersensitivity or known allergy to chamomile or other members of Asteraceae family (e.g. yarrow, tansy, feverfew, wormwood).

REFERENCE

Barnes, J., Anderson, L. A., and Phillipson, J. D.  2007.  Herbal Medicines Third Edition. Pharmaceutical Press. Auckland and London.

Braun, L and Cohen, M. 2010. Hebs and Natural Supplements An Evidence Based Guide 3R D Edition. Elsevier Australia. Australia.

Chevallier, A. 2018. Herbal Remedies Handbook. DK Publishing. New York.

Gladstar, R. 2012. Rosemary Gladstar’s Medicinal Herbs : A Beginner’s Guide. 210 MASS MoCA. Way North Adams, MA 01247 www.storey.com

Linda S-Roth. 2010. Mosby’s Handbook Of Herbs & Natural Supplements, Fourth Edition. Mosby Elsevier. USA.

Medical Economics Company, Inc. 2000. PDR for Herbal Medicines". Medical Economics Company, Inc. at Montvale, NJ 07645-1742.