Feverfew Lavender Compound by Herb Pharm

POSSIBLY EFFECTIVE

• Migraine headache. Oral feverfew seems to reduce the frequency of migraines and improve migraine-related symptoms. Details: Most clinical research shows that taking feverfew can reduce the frequency of migraine headaches and reduce symptoms of pain, nausea, vomiting, and sensitivity to light and noise (5080,6959,6960,6961,12384,13239,19358,90607). It may be more effective in patients with more frequent migraine attacks (12384). Combination products containing feverfew and other ingredients have also been evaluated, with promising results in most studies (12389,19357,19359,22602,96531,96532,103009,107473). However, some conflicting evidence exists (727,6938,12153,12384). These conflicting findings may reflect differences in the harvested feverfew plants or differences in the bioavailability of commercially prepared feverfew products (12153). Dosing regimens with evidence of benefit include feverfew powder 50-150 mg once daily for up to 4 months (6959,6960,6961,90607) and a carbon dioxide extract of feverfew (MIG-99, Schaper & Brümmer GmbH & Co) 2.08-18.75 mg three times daily for 3 to 4 months (12384,13239).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Prurigo nodularis. It is unclear if topical feverfew is beneficial for patients with this skin condition. Details: Preliminary clinical research in people with prurigo nodularis shows that applying a topical cream containing feverfew (Aveeno Ultra-Calming Cream, Johnson & Johnson) modestly improves pruritus in about 90% of affected patients. However, the cream does not appear to cause complete remission of skin lesions (22601).
• Psoriasis. Although there has been interest in using oral feverfew for psoriasis, there is insufficient reliable information about the clinical effects of feverfew for this purpose.
• Rheumatoid arthritis (RA). It is unclear if oral feverfew is beneficial for patients with RA. Details: Preliminary clinical research in a small number of women with RA shows that taking dried chopped feverfew 70-86 mg daily for 6 weeks does not seem to reduce the symptoms of RA, including pain, stiffness, or grip strength, when compared with placebo (6933).
• Tension headache. Oral feverfew has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Observational research in children and adolescents with tension headache has found that taking a specific combination supplement (Partena) containing feverfew dry extract 150 mg (standardized to 1.2 mg of parthenolides), magnesium 169 mg, coenzyme Q10 20 mg, riboflavin 4.8 mg, and andrographis 100 mg twice daily for 4 weeks and then once daily for 12 weeks is associated with reduced headache frequency, but not pain intensity, when compared to baseline (103009). More evidence is needed to rate feverfew for these uses.

(Read more about FEVERFEW)

POSSIBLY EFFECTIVE

• Anxiety. Orally, a specific lavender oil product (Silexan) seems to improve anxiety in some patients. Lavender oil aromatherapy and aromatherapy massage also seem to improve chronic and situational anxiety in some patients. Details: Most meta-analyses and clinical trials in patients with mild to severe anxiety show that taking capsules containing a specific lavender oil ingredient (Silexan, Dr Willmar Schwabe GmbH & Co. KG) 80-160 mg orally daily for 6-10 weeks improves anxiety when compared with placebo. However, heterogeneity and small sample sizes limit the validity of these findings (58077,58080,58098,95640,103061,103069). A meta-analysis of a subgroup of these clinical studies shows that taking Silexan 80 mg orally once daily for 10 weeks also reduces anxiety in patients with subthreshold anxiety disorders, which meet some but not all criteria for generalized anxiety disorder (97257). Limited research compares Silexan to the conventional medications paroxetine and lorazepam. One clinical study shows that taking Silexan 80 mg daily for 6 weeks improves anxiety and quality of sleep similarly to low-dose lorazepam (Ativan) 0.5 mg in adults with generalized anxiety disorder (58077). Another clinical study in adults with generalized anxiety disorder shows that taking Silexan 80-160 mg daily for 10 weeks reduces symptom severity similar to paroxetine 20 mg daily (93004). A network meta-analysis suggests that the higher dose of Silexan (160 mg) might be more effective when compared with paroxetine 20 mg or lorazepam 0.5 mg (103069). Limited research has assessed other oral formulations of lavender. A small clinical study in postmenopausal adults with mild to moderate anxiety shows that taking a dried lavender flower powder 500 mg twice daily for 8 weeks reduces anxiety by about 6% when compared with placebo, as measured on the State-Trait Anxiety Inventory Scale (97256). The clinical significance of this improvement is not clear. Meta-analyses of clinical trials in patients with chronic or situational anxiety show that inhalation aromatherapy or aromatherapy massage using lavender oil moderately reduces anxiety when compared with control. Most often, the control group received no intervention although occasionally they received standard or routine care. In some studies, plain water or diluted lemon juice were used as controls. Most treatments with lavender aromatherapy were given as single sessions of 1-30 minutes. However, occasionally multiple sessions were used (101720,103061,109974). Most other individual clinical trials of aromatherapy with lavender, alone or in combination with bergamot, are in agreement with these findings (58103,95637,97258,99713,101722,101724,108752,109854,109981), although some research does not support the use of lavender aromatherapy for anxiety (29504,58053,97258,101724,109853). The poor quality of most of the available research makes it difficult to determine which patients, if any, are most likely to benefit.
• Depression. Oral lavender, in the form of tea, tincture, powder, or a specific oil (Silexan), seems to reduce depressive symptoms in some patients. Early research also shows that lavender oil aromatherapy seems to improve symptoms of depression. Details: When used orally, lavender may be beneficial in some patients with depression. A meta-analysis of five clinical trials shows that oral lavender is moderately more beneficial than a control group for reducing symptoms of depression (109860). Most studies included in the analysis were low- to moderate-quality with variation in patient demographics. Studies in the analysis investigated the effects of oral lavender oil or powder in menopausal or postpartum patients, or in patients with major depression, and compared lavender with routine care, placebo, medication, or no intervention. Doses have included powdered lavender leaves 1-2 grams daily for 8 weeks, lavender tea made from 2 grams powder per teabag once or twice daily for 2 weeks, and a specific oral capsule containing lavender oil (Silexan, Dr. Willmar Schwabe GmbH & Co. KG) 80 mg daily for 70 days (103060,104433,109860). Other preliminary clinical research in patients with depressed mood shows that taking Silexan 80 mg daily for 6 weeks can improve depression scores by about 33% when compared to baseline (58098). Also, a small clinical study in patients with mild to moderate depression shows that drinking a tincture of lavender appears to be slightly less effective than imipramine; however, lavender might have some additive antidepressant effects when used in combination with imipramine (9792). The validity of these findings is limited by the lack of a placebo group and small study size. Lavender has also been taken in combination with other products. A small clinical study in patients with depression and anxious distress shows that taking 5 mL of a syrup containing lavender flower extract and Chinese dodder extract twice daily for 6 weeks seems to reduce depression to a similar degree as citalopram 20 mg daily (104437). It is unclear if the benefit is due to lavender, Chinese dodder, or the combination. Lavender oil aromatherapy has also been evaluated. A meta-analysis of nine clinical trials shows that lavender oil aromatherapy is moderately more beneficial than control for reducing symptoms of depression. Most studies included in the analysis were low- to moderate-quality with variation in patient demographics. Studies in the analysis investigated the effects of lavender oil aromatherapy in a variety of patient populations, and no studies were specific to patients with depression. Lavender aromatherapy was compared with no intervention, routine care, other aromatherapy oils, or distilled water (109860). However, in hospitalized patients undergoing microvascular breast reconstruction, lavender oil aromatherapy does not improve symptoms of perioperative depression when compared with coconut oil (109853). Lavender oil has also been studied in combination with other oils as aromatherapy. A small clinical study in community-dwelling older adults shows that inhalation or massage with lavender, sweet orange, and bergamot oils twice weekly for 8 weeks improves depressive symptoms in 55% to 65% of patients when compared with a control (98474). Another small clinical study in postmenopausal adults shows that a combination of aromatherapy with lavender and bergamot oils three times daily for 8 weeks along with routine care modestly improves symptoms of depression when compared with routine care alone (109981). It is unclear if any benefit is due to lavender, other ingredients, or the combination.
• Dysmenorrhea. Limited clinical research suggests that lavender oil aromatherapy might reduce dysmenorrhea symptoms. Details: A clinical study in young adults with dysmenorrhea shows that applying 3 drops of lavender oil to a piece of cotton and inhaling for 30 minutes daily for the first 3 days of menstruation modestly reduces pain when compared to inhaling the scent of diluted milk (95635). Another small clinical study in patients with dysmenorrhea shows that applying 3 drops of lavender oil to the hands and inhaling for 5 minutes every 6 hours for the first 3 days of menstruation seems to reduce abdominal pain and backache when compared with inhaling the scent of sesame oil (90510). Lavender oil has also been added to abdominal massage. A clinical crossover study in young females with dysmenorrhea shows that administering a gentle abdominal massage with lavender essential oil for 15 minutes moderately reduces pain immediately after treatment when compared with a massage with petrolatum (58106). It is unclear if the benefit persists after the end of the treatment. Additionally, because all available research has been conducted in the Middle East, it is unclear if these results can be extrapolated to other geographic locations.

POSSIBLY INEFFECTIVE

• Cancer-related pain. Using lavender oil for massage or as an aromatherapy diffusion does not seem to provide any additional pain relief in patients with advanced or terminal cancer. Details: Clinical research in patients with advanced or terminal cancer shows that diffusing lavender oil as aromatherapy or using lavender oil for massage does not improve pain scores when compared with control treatments without lavender oil (29504,58053).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alopecia areata. Topical lavender oil has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with alopecia areata shows that applying lavender oil in combination with essential oils from thyme, rosemary, and cedarwood daily for 7 months seems to improve hair growth in 44% of participants when compared with 15% of those using only carrier oils (5177). It is unclear if this effect is due to lavender oil, other oils, or the combination.
• Atopic dermatitis (eczema). Although there is interest in using topical lavender oil for eczema, there is insufficient reliable information about the clinical effects of lavender oil for this condition.
• Burns. It is unclear whether lavender oil aromatherapy is beneficial as adjunct treatment for reducing pain associated with dressing changes in children with burns. Details: Preliminary clinical research in young children with second-degree burns shows that lavender oil aromatherapy, provided as 0.5 mL dripped onto a gauze pad and placed 20 cm away from the child's nose for 15 minutes before a dressing change, modestly reduces pain severity at 1 and 30 minutes after the dressing change when compared with placebo aromatherapy with jojoba oil. Use of lavender oil aromatherapy also attenuated increases in heart and respiratory rates after the dressing change (109857).
• Canker sores. Topical lavender oil might improve canker sore healing and reduce swelling and pain. Details: A clinical study shows that applying 2 drops of lavender oil to canker sores three times daily might reduce redness, swelling, and pain when compared with placebo (58099).
• Colic. It is unclear whether lavender oil aromatherapy massage is beneficial for reducing colic symptoms in infants. Details: A small clinical trial shows that using lavender oil diluted with almond oil to massage the belly of infants for 5-15 minutes beginning at the onset of colic reduces average weekly crying times by about 7 hours when compared with infants not receiving aromatherapy massages (58096). It is unclear if this effect is due to lavender oil, massage, or the combination.
• Coronary artery bypass graft (CABG) surgery. Small clinical studies suggest that lavender aromatherapy might modestly improve sleep and reduce pain in patients who have undergone CABG surgery. Details: One small clinical study shows that placing three drops of lavender oil (Barich Essence Company) on the pillow every night for 5 nights modestly improves sleep quality, but not sleep latency, duration, or efficiency, when compared with placebo (109861). Another small clinical study shows that placing 2 drops of lavender oil on a cotton ball for overnight aromatherapy starting on the second evening after surgery modestly improves sleep quality on the second and third nights of use, but not the first night, when compared with distilled water (109856). Also, a small clinical study shows that applying 5 drops of lavender oil 20% to a gauze which is worn around the neck for 30 minutes after CABG surgery modestly reduces postoperative pain on the day of surgery and the day after surgery when compared with pre-aromatherapy pain levels. These changes were greater than those seen in patients inhaling distilled water (109850). However, one small clinical study shows that inhaling 2 drops of lavender oil 2% for 20 minutes on postoperative days 2 and 3 does not reduce mental stress when compared with placebo (93009).
• Coronavirus disease 2019 (COVID-19). It is unclear if oral lavender is beneficial for olfactory dysfunction in patients with COVID-19. Details: A small preliminary clinical trial in patients with olfactory dysfunction related to COVID-19 shows that taking lavender syrup 9 mL twice daily for 3 weeks in combination with routine treatments modestly reduces symptoms when compared with routine treatments alone. However, there was no change in symptom scores or the percentage of patients with complete improvement in olfactory or taste dysfunction. The lavender syrup was made by preparing a water extract of the dried aerial parts and mixing with honey and water (109864).
• Dementia. Small clinical studies suggest that diffused aromatherapy with lavender oil may modestly improve agitation symptoms in patients with dementia; however, lavender oil applied to the patient or the patient's clothes might not be beneficial. Details: Some small and heterogeneous clinical studies in patients with dementia show that applying lavender oil aromatherapy via a diffuser for either 20 minutes twice daily, 2 hours daily, or once nightly for up to 3 weeks seems to improve agitation when compared with baseline, water, or a sunflower oil placebo (16393,58052,95632). However, using aromatherapy that is applied to the person's clothes or arms does not seem to help. Small clinical studies in patients with moderate or advanced dementia show that applying lavender oil to a pad attached to a patient's shirt does not reduce agitation when compared with placebo (12213,99710). Another clinical study in nursing home residents with dementia and frequent agitated behavior shows that applying 1 mL of 30% lavender oil to each forearm does not reduce agitation or improve mood when compared with applying placebo oil (93014).
• Diabetic neuropathy. It is unclear if lavender aromatherapy massage is beneficial for diabetic neuropathy. Details: Preliminary clinical research in patients with neuropathic pain related to diabetes shows that a gentle foot massage with lavender essential oil 3% in sunflower oil for 10 minutes nightly for 1 month reduces neuropathic pain and improves quality of life when compared with a placebo sunflower oil massage or routine care alone (109858).
• Fall prevention. It is unclear if lavender aromatherapy prevents falls in elderly patients. Details: A clinical study in nursing home residents aged 65 years or older shows that attaching a patch with lavender oil (Aromaseal Lavender, Hakujuji Co.) onto the neckline of clothing once daily for one year seems to have a non-significant trend toward reduced fall incidence when compared with placebo (58101).
• Fatigue. Small clinical studies suggest that lavender aromatherapy may modestly reduce fatigue in patients with underlying medical conditions, such as kidney failure or heart disease. The effects of lavender for fatigue in otherwise healthy adults is unclear. Details: Most small clinical studies in adults with kidney failure show that receiving aromatherapy with lavender essential oil during hemodialysis sessions for 4 weeks reduces fatigue when compared with baseline, a control group, or a placebo group (98524,109867). However, one small clinical study in these patients shows that applying lavender oil for inhalation for 10 minutes during dialysis sessions for 4 weeks does not reduce fatigue when compared with control (95642). Lavender aromatherapy has also been tried in patients hospitalized with various forms of cardiac disease. A small clinical trial shows that placing 3 drops of lavender oil on a cotton ball and inhaling for 20 minutes nightly for 7 days improves fatigue scores by 21 points, compared with a 2-point improvement in those receiving placebo (107959). The validity of these findings is limited due to the short duration of treatment.
• Hypertension. Although there is interest in using lavender aromatherapy for hypertension, there is insufficient reliable information about the clinical effects of lavender for this condition.
• Insect repellent. Although there is interest in using topical lavender to repel insects, there is insufficient reliable information about the clinical effects of lavender for this condition.
• Insomnia. Inhalation aromatherapy or aromatherapy massage with lavender oil may improve some subjective measures of sleep, but results are conflicting and improvements appear minimal at best. Additionally, most small clinical studies suggest it does not improve sleep in hospitalized patients. Details: Lavender oil aromatherapy seems to improve sleep quality in some patients, although it is unclear which patient populations may be most likely to be benefit. A clinical study in healthy college students with self-reported sleep problems shows that wearing a patch containing lavender oil 55 mcL on the chest, in addition to practicing sleep hygiene, improves self-reported sleep quality, but not sleep quantity, when compared with wearing a placebo patch (93012). Another small clinical study in elderly patients that have trouble sleeping in nursing homes shows that placing 2 drops of lavender oil to a cotton pad on a nightstand at bedtime for 4 weeks moderately improves sleep quality and reduces fatigue when compared with control (103062). A meta-analysis of three clinical trials shows that lavender modestly improves postpartum sleep quality when compared with control, including placebo or no intervention. However, each trial used a different form of lavender, including a topical cream, a tea, and aromatherapy. Also, the individual trials included in the analysis show that only the cream and aromatherapy resulted in statistically significant improvements in sleep quality (109866). Conversely, a small clinical study in postmenopausal adults with insomnia who received sleep hygiene guidance shows that inhaling lavender oil 6% before bed nightly for 1 month does not improve sleep quality when compared with sunflower oil. The oil was inhaled from the bottle for two, two-minute sessions and then poured on a cotton ball and placed near the head while sleeping (109852). Lavender aromatherapy has also been evaluated for insomnia in patients with comorbid disease states. A clinical study in patients with insomnia and type 2 diabetes shows that lavender oil aromatherapy for 5 minutes at bedtime nightly for 4 weeks improves sleep when compared with almond oil (103065). Preliminary clinical research in adults with kidney failure shows that foot massage with lavender oil 1.5% for 3 weeks during hemodialysis modestly improves sleep quality when compared with routine care, but is no more effective than sweet orange oil (109859). Another preliminary clinical study in cancer patients shows that receiving aromatherapy as two drops of pure lavender oil applied to a cotton ball and attached to the collar for 20 minutes at bedtime for one week improves sleep when compared with baseline, but seems to be no better than using peppermint oil or a lavender oil 1% control (103063). The validity of this finding is limited because the lavender oil 1% control resulted in notable benefit and might have been an inadequate control treatment. Aromatherapy with lavender oil does not seem to improve sleep in most hospitalized patients, including patients in intermediate care units, hospitalized cardiac patients, and in patients undergoing microvascular breast reconstruction. Aromatherapy treatments have included lavender aromatherapy throughout hospitalization, placing 3 mL of lavender oil 3 feet away from the bed during sleep, and hand and lower leg massage with lavender essential oil 1.5% in sweet almond oil at bedtime (93013,101727,109853). However, studies have generally been small and did not use proper controls. Also, some small clinical studies suggest that lavender aromatherapy might have modest beneficial effects in patients undergoing coronary artery bypass graft (CABG) surgery (109856,109861).
• Kidney failure. Small clinical studies suggest that lavender aromatherapy may modestly reduce fatigue and improve sleep quality in adults receiving hemodialysis. Lavender oil massage may also modestly improve symptoms of restless leg syndrome (RLS) in these patients. Details: Multiple small studies have evaluated lavender aromatherapy, provided during hemodialysis sessions, for reducing fatigue. A small clinical study shows that applying 5% lavender essential oil (Barij Essence Pharmaceutical Company) to a cotton ball on the patient's collar for inhalation for 15-20 minutes twice daily during each session for 1 month reduces fatigue by an additional 44% and 40% when compared with baseline and control, respectively (98524). Another preliminary clinical trial shows that applying lavender oil 7% in sweet almond oil to a gauze pad placed 20 cm from the patient's nose for 2 minutes improves fatigue when compared with placebo aromatherapy. By the third week of four total weeks of treatment, most patients given lavender oil aromatherapy had only mild fatigue, compared with moderate or severe fatigue in the control group (109867). Also, a small clinical trial shows that aromatherapy or aromatherapy foot massage with lavender and sweet orange oil for 10-20 minutes during each session for 2 months reduces fatigue when compared with no treatment. Aromatherapy massage seems to be more effective than aromatherapy alone (103068). However, one small clinical study shows that applying the oil for inhalation for 10 minutes during each session for 1 month does not reduce fatigue when compared with control (95642). The difference in these findings might be due to study size, lavender oil concentration, or the frequency and duration of aromatherapy sessions. Lavender aromatherapy has also been evaluated for reducing insomnia in adults on hemodialysis. A small clinical study shows that foot massage with lavender oil 1.5% for 3 weeks during hemodialysis sessions modestly improves sleep quality when compared with routine care. However, it does not seem to be more effective than using sweet orange oil (109859). Some small clinical studies in patients undergoing hemodialysis show that massaging the feet or lower legs with lavender oil reduces the severity of RLS by up to 45% when compared with routine care, massage only, or baby oil as placebo (95638,103064,109865). However, massage with lavender oil does not seem to be more beneficial than glycerin oil 2% or sweet orange oil 1.5% for reducing RLS severity (103064,109859). Doses have included 10-15 mL of 1.5% or 5% lavender oil for 10- to 45-minutes during hemodialysis sessions for 3-4 weeks (95638,103064,109859,109865).
• Labor pain. Lavender aromatherapy may help to reduce pain during childbirth. Details: A meta-analysis of clinical trials in pregnant patients in Iran shows that lavender oil aromatherapy applied by various means, such as mask or massage, reduces labor pain when compared with control (104440). All available research has been conducted in Iran, so it is unclear if the benefit can be extrapolated to other geographic locations.
• Lice. Topical lavender oil has only been evaluated in combination with other essential oils; its effect when used alone is unclear. Details: Clinical studies in patients with head lice shows that applying lavender oil in combination with tea tree oil reduces the number of hatched and unhatched live lice when compared with control (19188,19189). When applied with tea tree oil three times weekly, lavender oils seems to improve lice eradication when compared with two weekly treatments of pyrethrin and piperonyl butoxide (19189). It is not known if these effects are due to tea tree oil, lavender, or the combination.
• Menopausal symptoms. It is unclear if lavender aromatherapy reduces menopausal symptoms such as hot flushes. Details: A meta-analysis and individual clinical studies in postmenopausal adults show that lavender aromatherapy for 4-12 weeks, alone or in combination with other essential oils, reduces menopausal symptoms such as hot flushes when compared with placebo (95634,99711,103067). However, heterogeneity and small sample sizes limit the validity of these findings. A small clinical study in postmenopausal adults shows that aromatherapy with lavender 2% oil for 20 minutes at bedtime every day for 1 month improves quality of life scores when compared to baseline (99711). Another small clinical study in menopausal adults shows that receiving aromatherapy with lavender oil and lemon oil for 5 minutes daily for 30 days seems to improve sleep and quality of life when compared with placebo (104439). However, a small clinical study in postmenopausal adults shows that a combination of lavender and bergamot oils administered via inhalation three times daily for 8 weeks with routine care does not improve sexual function when compared with routine care alone (109981).
• Migraine headache. It is unclear if lavender aromatherapy improves migraine symptoms. Details: A small clinical study in patients with migraine headaches shows that rubbing 2-3 drops of lavender oil on the upper lip for inhalation might reduce headache pain and associated symptoms such as nausea and photophobia. Of 129 headaches treated with lavender oil, 92 responded completely or partially, compared with 32 of 68 headaches in the placebo group (18209).
• Multiple sclerosis (MS). It is unclear if lavender aromatherapy can improve memory in patients with MS. Details: A small preliminary clinical trial in patients with MS shows that dripping 2 drops of lavender oil (Barij Essence Pharmaceutical Company) on a cotton ball for inhalation for 10 minutes twice daily for 2 weeks improves working memory by a small amount when compared with inhaling distilled water (109855).
• Multiple sclerosis-related fatigue. It is unclear if oral lavender is beneficial for reducing fatigue in adults with multiple sclerosis (MS). Details: A small clinical trial in patients with MS shows that taking lavender 600 mg three times daily for 60 days improves fatigue by a large amount when compared with placebo (109851).
• Neuropathic pain. Although there is interest in using topical lavender oil for neuropathic pain, there is insufficient reliable information about the clinical effects of lavender for this condition.
• Osteoarthritis. It is unclear if lavender aromatherapy with massage reduces osteoarthritis pain. Details: A small clinical study in patients with osteoarthritis shows that applying 5 mL of 3% lavender oil (Barij Essence Pharmaceutical Company) to the knee through self-administered massage three times weekly for 3 weeks can reduce pain by 23% when compared to massage with placebo oil and by 36% when compared with no treatment. However, any benefits of treatment begin to wear off after treatment completion (95645).
• Otitis media. Topical lavender oil has only been evaluated in combination with other essential oils; its effect when used alone is unclear. Details: A clinical study in children ages 5-18 years with otitis media and otalgia shows that administering ear drops containing lavender and other herbal extracts, alone or in combination with a topical anesthetic, improves ear pain when compared with baseline. However, it is possible that the pain is self-limited and any pain reduction is due to natural resolution (39500).
• Pain (acute). Small clinical studies suggest that lavender aromatherapy may modestly reduce acute pain from needle insertion or other procedures in infants and adults. Details: Two small clinical studies in patients having a needle inserted for hemodialysis shows that inhaling 10% lavender essence for 5 minutes or topically applying 0.3 mL of 100% lavender oil for 5 minutes prior to needle insertion modestly reduces pain when compared with using placebo oil or water (93008,93010). Lavender aromatherapy has also been tried for gynecological exam pain. A clinical study shows that inhaling 10% lavender oil from a heat lamp for 10-15 minutes prior to gynecological exams can reduce pain experienced during the exam up to three-fold when compared to those receiving no treatment (95639). Lavender oil aromatherapy may also reduce vaccination, needle stick, and heel-lancing pain in infants. One clinical study shows that inhaling the scent of lavender oil (Barij Essence Pharmaceutical Company) 0.5% drops for one minute before vaccination modestly reduces pain and decreases crying time by about 20 seconds when compared with sweet almond oil (109869). A small clinical study in term infants shows that being placed in an incubator with lavender essential oil scent overnight before receiving a blood draw modestly reduces overall pain scores when compared with no intervention, but seems to be no different than giving 2 mL of 30% glucose solution (103066). Another small clinical study in premature infants shows that inhaling the scent of 6 lavender oil drops on a cotton ball for 3 minutes before and 30 seconds after a heel-lancing procedure seems to reduce pain scores when compared with exposure to an unscented cotton ball (104442). Lavender oil aromatherapy may also reduce pain due to frenotomy in infants. Preliminary clinical research shows that applying a gauze pad containing one drop of lavender oil under the nose, starting 2 minutes before the frenotomy and continuing throughout the procedure, modestly reduces pain when compared with routine care, which includes swaddling, oral sucrose, and pre-frenotomy sucking. Post-frenotomy crying was also reduced by about 50%, or 10 seconds (109868). Lavender oil seems to be similarly effective to vanilla oil (109810).
• Postdural puncture headache. It is unclear if lavender aromatherapy improves postdural puncture headache severity. Details: A small clinical study in patients with postdural puncture headache shows that receiving lavender oil aromatherapy for 15 minutes modestly improves pain immediately after treatment when compared with placebo. However, the pain relief is not maintained at 30 minutes after treatment (104441).
• Postoperative nausea and vomiting (PONV). It is unclear if lavender aromatherapy reduces PONV. Details: A small clinical study in postoperative patients shows that inhaling the scent of 2 drops of lavender oil from a cotton pad for 5 minutes improves nausea scores in 83% of people, compared with 44% of those inhaling a placebo. There was no difference in vomiting scores between groups (99712). Another small clinical study in patients after percutaneous nephrolithotomy shows that inhaling the scent of 3 drops of lavender essential oil from a gauze for 5 minutes immediately after the operation, and again 3 and 6 hours later, does not improve nausea or vomiting when compared with a control group that was not receiving aromatherapy (103872).
• Postoperative pain. The evidence for the use of lavender aromatherapy for pain after various types of surgical procedures is preliminary and conflicting. Details: Some preliminary clinical research in patients post-Cesarean section shows that, when used in conjunction with standard analgesic therapy, applying 2 drops of lavender oil 2% to a face mask or applying 3 drops of lavender to a cotton ball for inhalation seems to reduce postoperative pain when compared with control (58093,101724). Additionally, preliminary clinical research in patients undergoing coronary artery bypass graft (CABG) surgery shows that applying lavender oil to a gauze which is worn around the neck may modestly reduce postoperative pain on the day of surgery and the day after surgery when compared with distilled water (109850). Also, a small clinical study in children aged 6-12 years post-tonsillectomy shows that rubbing lavender oil onto the palms and inhaling for 3 minutes every 6 hours as needed reduces the use of acetaminophen when compared with control (90513). However, aromatherapy with lavender throughout hospitalization does not seem to improve postoperative pain in patients undergoing microvascular breast reconstruction when compared with coconut oil (109853).
• Postpartum complications. It is unclear if topical or inhaled lavender reduces postpartum complications such as pain and swelling. Details: Some clinical research in patients receiving an episiotomy during childbirth shows that adding lavender oil to water or sitz baths for up to 10 days might reduce episiotomy redness and discomfort when compared with using no lavender and standard treatment, such as povidone-iodine. However, findings are mixed as to whether adding lavender oil to baths helps to reduce edema and analgesic use (58085,58092,58116,58121). Lavender aromatherapy has also been studied to improve wellbeing in postpartum patients. A small clinical study in postpartum patients immediately following a natural birth shows that inhaling lavender oil from a cotton ball for 10-15 minutes in the morning, 6 hours later, and at bedtime, improves perceived pain, fatigue, distress, and mood within 1 hour of treatment and also the next morning when compared with placebo (95631).
• Postpartum depression. Small clinical studies suggest that aromatherapy with lavender oil may modestly improve or prevent depressive symptoms in postpartum patients. Details: A clinical study in healthy postpartum patients shows that placing 3 drops of lavender essential oil on the palms three times daily for 4 weeks after delivery moderately reduces depressive symptoms and anxiety when compared with usual care only (95637). There is limited research on the benefits of lavender aromatherapy in patients diagnosed with postpartum depression. A small clinical trial in these patients shows that a combination of lavender and rose essential oils, administered via inhalation or aromatherapy massage using hand "M" technique for 15-minute sessions, twice weekly for 4 weeks, reduces depression scores when compared with no intervention (58103).
• Pre-procedural anxiety. It is unclear if lavender aromatherapy can reduce preoperative or preprocedural anxiety; results from clinical research are generally of low-quality and benefits are modest at best. Details: A meta-analysis of four small clinical studies in patients undergoing cardiac surgery shows that lavender aromatherapy modestly reduces preoperative anxiety when compared with control (103058). However, the included studies were conducted in the Middle East, and it is unknown if these results are generalizable to other geographic areas. There is conflicting clinical evidence regarding the effect of lavender aromatherapy on anxiety prior to a dental procedure (58078,101725,103059). Small clinical studies also show mixed results as to whether lavender oil aromatherapy applied to a gauze bandage or oxygen mask improves anxiety in patients waiting for breast surgery when compared with usual care. (95641,101729). Lavender aromatherapy might reduce anxiety prior to less risky and extensive procedures such as needle injections. Small clinical studies in adults receiving botulinum toxin type A injections or children receiving dental injections show that lavender oil aromatherapy reduces heart rate and cortisol levels when compared with placebo (58089,104438). Another clinical study in preoperative patients undergoing insertion of a peripheral venous cannula shows that inhalation of 1% lavender oil (Talya Herbal Products) from a gauze pad for 5 minutes modestly reduces pain and anxiety scores and improves patient satisfaction when compared with control (95636). However, a clinical study in patients undergoing a colonoscopy or esophagogastroduodenoscopy shows that inhaling lavender oil does not reduce anxiety, although it does improve patient satisfaction, when compared with placebo (58066). Reasons for conflicting findings are unclear but may relate to the severity of anxiety, the specific outcomes measured, and cultural differences occurring in different geographic locations.
• Psychological well-being. It is unclear if topical or inhaled lavender improves well-being. Details: A small clinical study in healthy females shows that adding 3 mL of a mixture containing 20% lavender oil and 80% grapeseed oil to daily baths modestly improves mood when compared with baths containing grapeseed oil alone (15534). However, lavender may not impact well-being in patients with cancer. Clinical research shows that that adding lavender oil for an aromatherapy massage in patients with advanced or terminal cancer does not improve well-being or quality of life when compared with no massage treatment or massage with inert oil (29504,58053).
• Restless legs syndrome (RLS). Most preliminary clinical research suggests that lavender oil aromatherapy massage is beneficial for RLS in patients undergoing hemodialysis. Its effect in other patient populations is unclear. Details: Some small clinical studies in patients undergoing hemodialysis show that massaging the feet or lower legs with lavender oil reduces the severity of RLS by up to 45% when compared with routine care, massage only, or baby oil as placebo (95638,103064,109865). However, massage with lavender oil does not seem to be more beneficial than glycerin oil 2% or sweet orange oil 1.5% for reducing RLS severity (103064,109859). Doses have included 10-15 mL of 1.5% or 5% lavender oil for 10 to 45 minutes during hemodialysis sessions for 3-4 weeks (95638,103064,109859,109865).
• Stress. Small studies suggest that inhaled lavender oil does not reduce stress in students under academic stress. Details: A meta-analysis of 21 moderate- to high-quality, small- to medium-sized studies shows that inhaling lavender oil modestly reduces stress when compared with control. Most studies included in the analysis have used lavender oil as aromatherapy; other studies have used a cream (109863). Also, inhaling lavender oil 3% in almond oil twice daily for 30 minutes during the exam period does not reduce academic stress or associated symptoms, including headache, blood pressure, or heart rate, in pharmacy students when compared with inhaling an odorless oil, although both were more effective than no intervention (101723).
• Toothache. Although there is interest in using topical lavender oil for toothache, there is insufficient reliable information about the clinical effects of lavender oil for this purpose. More evidence is needed to rate lavender for these uses.

(Read more about LAVENDER)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Headache. Although there has been interest in using oral meadowsweet for headache, there is insufficient reliable information about the clinical effects of meadowsweet for these conditions.
• Respiratory tract infections. Although there has been interest in using oral meadowsweet for respiratory tract infections, including cold, flu, bronchitis, and pneumonia, there is insufficient reliable information about the clinical effects of meadowsweet for these conditions. More evidence is needed to rate meadowsweet for these uses.

(Read more about MEADOWSWEET)

There is insufficient reliable information available about the effectiveness of periwinkle.

(Read more about PERIWINKLE)

LIKELY SAFE ...when used orally and appropriately, short-term. Feverfew has been used safely in studies lasting up to 4 months (6959,6960,6961,13239).

POSSIBLY UNSAFE ...when fresh feverfew leaves are chewed. Chewing raw or unprocessed feverfew leaves can cause oral inflammation, ulceration, swelling of the lips, and sometimes loss of taste (6959).

PREGNANCY: POSSIBLY UNSAFE
when used orally. Feverfew might cause uterine contractions and abortion (12); avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about FEVERFEW)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Lavender has Generally Recognized as Safe (GRAS) status for food use in the US (4912).

POSSIBLY SAFE ...when used orally and appropriately in medicinal amounts (9792). In clinical research, a specific product containing lavender oil (Silexan, Dr Willmar Schwabe GmbH & Co. KG) has been used safely at doses of 80-160 mg daily for up to 10 weeks (58077,58080,58098,97257). Powdered dried lavender flowers 500 mg twice daily has also been used with apparent safety for up to 8 weeks (97256). ...when used topically and appropriately. Lavender oil has been used safely for up to 7 months in adults (5177,109858,109865). ...when the essential oil is inhaled as a part of aromatherapy. Clinical studies have used lavender oil aromatherapy with apparent safety for up to 12 weeks (7107,12213,16393,16394,95634,103062,103063,103065,103068).

CHILDREN: POSSIBLY SAFE
when the essential oil is inhaled as a part of aromatherapy. Clinical studies have used lavender oil aromatherapy with apparent safety in single doses for up to 2 minutes (109868).

CHILDREN: POSSIBLY UNSAFE
when applied topically in males. Anecdotal reports suggest that applying topical products containing lavender oil to prepubertal males may result in gynecomastia in some cases (15254,95643). Products with a higher concentration of lavender oil and more frequent applications might be more likely to result in gynecomastia.

PREGNANCY AND LACTATION:
Insufficient reliable evidence available. Preliminary clinical research shows that lavender essential oil can be inhaled during labor, with no apparent adverse outcomes in the infants (95633). Although this study suggests safety, high quality assessment of safety has not been conducted.

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POSSIBLY SAFE ...when used orally and appropriately, short-term (12). Meadowsweet flower has been used with apparent safety at doses of 2.5-3.5 grams daily. Meadowsweet herb has been used with apparent safety at doses of 4-5 grams daily (12).

POSSIBLY UNSAFE ...when used in large amounts or for prolonged periods of time. Meadowsweet contains salicylates and high amounts of tannins (4).

PREGNANCY: LIKELY UNSAFE
when used orally. Some evidence suggests meadowsweet might stimulate uterine activity (4).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about MEADOWSWEET)

UNSAFE ...when used orally (2,17). Periwinkle contains pharmacologically active toxic alkaloids that can cause nerve, liver, and kidney damage (17).

PREGNANCY AND LACTATION: UNSAFE
when used orally (2,17); avoid using.

(Read more about PERIWINKLE)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, feverfew might have additive effects and increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.  Details Laboratory research suggests that feverfew may inhibit platelet aggregation (6935,6936,6942,6943,6944,6945,6951). Additionally, in one case report, a 36-year-old patient taking feverfew 2400 mg daily for 3 months experienced vaginal bleeding and a prolonged menstrual cycle, with a modest increase in partial thromboplastin time (PTT) and prothrombin time (PT) (107472).

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, feverfew might increase levels of drugs metabolized by CYP1A2.  Details Laboratory research shows that feverfew might inhibit CYP1A2 (12479). So far, this interaction has not been reported in humans.

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, feverfew might increase levels of drugs metabolized by CYP2C19.  Details Laboratory research shows that feverfew might inhibit CYP2C19 (12479). So far, this interaction has not been reported in humans.

CYTOCHROME P450 2C8 (CYP2C8) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, feverfew might increase levels of drugs metabolized by CYP2C8.  Details Laboratory research shows that feverfew might inhibit CYP2C8 (12479). So far, this interaction has not been reported in humans.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, feverfew might increase levels of drugs metabolized by CYP2C9.  Details Laboratory research shows that feverfew might inhibit CYP2C9 (12479). So far, this interaction has not been reported in humans.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, feverfew might increase levels of drugs metabolized by CYP2D6.  Details Laboratory research shows that feverfew might inhibit CYP2D6 (12479). So far, this interaction has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, feverfew might increase levels of drugs metabolized by CYP3A4.  Details Laboratory research shows that feverfew might inhibit CYP3A4 (12479,19361). So far, this interaction has not been reported in humans.

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CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Unlikely •  Level of Evidence = D Theoretically, lavender might potentiate the therapeutic effects and adverse effects of CNS depressants.  Details Laboratory research suggests that lavender has sedative effects (7). However, clinical studies in patients taking oral lavender oil (Silexan) 160 mg for 10 weeks or taking lavender flower powder 1 gram daily for 2 months have not reported side effects of drowsiness, sedation, or sleepiness (97256,103061). There is still some concern that higher doses or different preparations of lavender might have additive effects with CNS depressant medications.

(Read more about LAVENDER)

ASPIRIN Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, meadowsweet might have an additive effect with other salicylate-containing drugs, such as aspirin.  Details Meadowsweet contains salicin, a plant salicylate; however, salicin doesn't seem to have the antiplatelet effects of aspirin (12).

CHOLINE MAGNESIUM TRISALICYLATE (Trilisate) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, meadowsweet might have an additive effect with other salicylate-containing drugs, such as choline magnesium trisalicylate (12).  Details Meadowsweet contains salicin, a plant salicylate (12).

SALSALATE (Disalcid) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, meadowsweet might have an additive effect with other salicylate-containing drugs such as salsalate (12).  Details Meadowsweet contains salicin, a plant salicylate (12).

(Read more about MEADOWSWEET)

(Read more about PERIWINKLE)

General ...Orally, feverfew is generally well tolerated. Chewing fresh feverfew leaves is more likely to cause mouth ulceration and other adverse effects of the mouth, lips, and tongue when compared with commercial feverfew preparations.
Most Common Adverse Effects:
Orally: Abdominal pain, bloating, constipation, diarrhea, flatulence, heartburn, and nausea. Skin rash may occur in sensitive individuals.
Topically: Dermatitis in sensitive individuals.

Cardiovascular ...Orally, feverfew has been associated with palpitations in one patient in a clinical study (6959).

Dermatologic ...Orally, feverfew can cause skin rash (12383). Topically, allergic contact dermatitis can occur (6958,42856,42891). Allergic reactions to feverfew may be more likely in individuals sensitive to the Asteraceae/Compositae family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

Gastrointestinal ...Orally, feverfew can cause gastrointestinal symptoms such as heartburn, nausea, diarrhea, constipation, abdominal pain and bloating, and flatulence (6938,6959,12383,22602). Oral numbness has also been reported when feverfew has been taken sublingually in combination with ginger (22602). The traditional method of feverfew administration-chewing fresh feverfew leaves-can result in mouth ulceration, inflamed oral mucosa and tongue, swelling of the lips, and occasionally, loss of taste (6935,6959). Mouth ulceration might result from direct contact with feverfew leaves during chewing, possibly attributable to the sesquiterpene lactone constituent (6959). Some researchers suggest that mouth ulceration is a systemic effect, but one study using dried feverfew capsules reported a higher incidence of mouth ulcers in subjects taking placebo than feverfew (6935,6959,6960).

Genitourinary ...Orally, feverfew has been associated with menstrual changes in one patient in a clinical study (6959) and in one case report involving a 36-year-old patient taking 800 mg of feverfew three times daily for 3 months (107472).

Immunologic ...Orally and topically, feverfew may cause an allergic reaction in individuals sensitive to the Asteraceae/Compositae family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many other herbs.

Musculoskeletal ...Orally, feverfew has been associated with joint stiffness in two patients in a clinical study (6959). Discontinuation of oral feverfew after long-term use may cause "post-feverfew syndrome", which includes symptoms such as muscle and joint stiffness (6959,12153).

Neurologic/CNS ...Discontinuation of oral feverfew after long-term use may cause "post-feverfew syndrome", which includes symptoms such as anxiety, headaches, and insomnia (6959,12153).

Other ...Orally, feverfew may cause weight gain (12383).

(Read more about FEVERFEW)

General ...Orally, lavender is well tolerated in food amounts and seems to be well tolerated in larger amounts. Topically, lavender oil seems to be well tolerated.
Most Common Adverse Effects:
Orally: Breath odor, constipation, diarrhea, dyspepsia, eructation, headache, and nausea.
Topically: Allergic contact dermatitis (with lavender oil).
Serious Adverse Effects (Rare):
Topically: Cases of gynecomastia have been reported in prepubertal males using lavender oil.

Cardiovascular ...Orally, a specific lavender oil ingredient (Silexan) has been associated with palpitations (103061).

Endocrine ...Topical products containing lavender oil alone, including a product referred to as agua de violetas, or in combination with tea tree oil have been linked to at least six cases of gynecomastia when used in prepubertal males. In each case, gynecomastia resolved when the lavender oil products were discontinued. It is thought that the estrogenic and antiandrogenic activity of lavender oil and tea tree oil resulted in gynecomastia in these cases (15254,95643).

Gastrointestinal ...Orally, lavender oil, including a specific lavender oil ingredient KG), may cause gastrointestinal disturbance, including dyspepsia, diarrhea, breath odor, eructation, and nausea (58077,58080,58098,93004,103061). Tincture of lavender has been linked to cases of constipation and increased appetite; however, it is unknown if this occurred at a greater rate than with placebo (9792).

Immunologic ...Topically, use of lavender oil, such as in personal care products, might cause allergic contact dermatitis in some patients (6,101728). There have been numerous case reports of allergic contact dermatitis and eczema linked to lavender oil exposure from shampoos, lotions, fragrances, or direct application of oil to pillows (10031,58043,58109,58120,101728).

Neurologic/CNS ...Orally, lavender flower powder, tincture of lavender containing 50% alcohol, and a specific lavender oil ingredient (Silexan) have been linked to headache (9792,103061,109860). Headache has also been reported rarely following lavender oil aromatherapy (109860).

Pulmonary/Respiratory ...In one case report, a 34-year-old Japanese female presented with complaints of dyspnea, cough, and fever 2 weeks after initiating lavender essential oil therapy via humidifier. The patient had an oxygen saturation of 88% and was diagnosed with acute eosinophilic pneumonia. Symptoms improved after a course of corticosteroids and discontinuation of aromatherapy (109979).

(Read more about LAVENDER)

General ...Orally, meadowsweet seems to be well tolerated.

Dermatologic ...Meadowsweet contains salicylate constituents. There is insufficient reliable information available to know if the side effects and toxicity normally associated with salicylates could occur with meadowsweet use. Orally, adverse reactions associated with salicin include skin rashes (4).

Gastrointestinal ...Orally, large doses of meadowsweet can cause nausea and other stomach complaints (18).
Meadowsweet contains salicylate constituents. There is insufficient reliable information available to know if the side effects and toxicity normally associated with salicylates could occur with meadowsweet use. Adverse reactions associated with salicylates include gastric irritation, hematochezia, nausea, and vomiting (4).

Immunologic ...Meadowsweet contains salicylate constituents. There is insufficient reliable information available to know if the side effects and toxicity normally associated with salicylates could occur with meadowsweet use. Orally, salicylates can cause hypersensitivity in sensitive individuals (4).

Ocular/Otic ...Meadowsweet contains salicylate constituents. There is insufficient reliable information available to know if the side effects and toxicity normally associated with salicylates could occur with meadowsweet use. Orally, adverse reactions with salicylates include tinnitus (4).

Pulmonary/Respiratory ...Orally, large doses of meadowsweet can cause bronchospastic activity (4).

Renal ...Meadowsweet contains salicylate constituents. There is insufficient reliable information available to know if the side effects and toxicity normally associated with salicylates could occur with the use of meadowsweet. Orally, adverse reactions with salicylates include renal irritation (4).

(Read more about MEADOWSWEET)

General ...Periwinkle is generally regarded as unsafe for use. Orally, periwinkle can cause cytotoxic, neurologic, liver, and kidney damage due to its vinca alkaloid constituents (17). Periwinkle has also been reported to cause gastrointestinal complaints, skin flushing, and hypotension (18).

Cardiovascular ...Orally, large amounts of periwinkle can cause a severe drop in blood pressure (18).

Dermatologic ...Orally, periwinkle can cause skin flushing (18).

Gastrointestinal ...Orally, periwinkle can cause gastrointestinal complaints (18).

Hepatic ...Orally, periwinkle can cause liver damage due to its vinca alkaloid constituents (17).

Neurologic/CNS ...Orally, periwinkle can cause neurologic damage due to its vinca alkaloid constituents (17).

Renal ...Orally, periwinkle can cause kidney damage due to its vinca alkaloid constituents (17).

(Read more about PERIWINKLE)