Chamomile (Matricaria recutita, Chamaemelum nobile)

Category

Herbs & Supplements

Synonyms

Anthemis arvensis, Anthemis cotula, Anthemis nobile, Anthemis nobilis, Anthemis xylopoda, apigenin, Asteraceae/Compositae (family), baboonig, babuna, babunah, babunah camomile, babunj, bunga kamil, camamila, camamilla, camomile, camomile sauvage, camomilla, Camomille Allemande, Campomilla, chamaemeloside, Chamaemelum nobile L., chamomile flowers, Chamomilla, Chamomilla recutita, chamomillae ramane flos, chamomille commune, classic chamomile, common chamomile, double chamomile, Echte Kamille (Dutch), English chamomile, feldkamille (German), fleur de chamomile (French), fleurs de petite camomille (French), Flores Anthemidis, flos chamomillae, garden chamomile, German chamomile, Grosse Kamille, Grote Kamille, ground apple, Hungarian chamomile, Kamille, Kamillen, kamitsure, kamiture, Kleine, kleme kamille, lawn chamomile, low chamomile, manzanilla, manzanilla chiquita, manzilla comun, manzanilla dulce, matricaire, Matricaria chamomilla, Matricaria maritime (L.), Matricaria recutita, Matricaria suaveolens, matricariae flos, matricariae flowers, may-then, Nervine, pin heads, rauschert, Romaine, romaine manzanilla, Roman chamomile, Romische Kamille, single chamomile, STW 5 (containing Iberis, peppermint, chamomile), sweet chamomile, sweet false chamomile, sweet feverfew, true chamomile, whig-plant, wild chamomile.

Background

Chamomile has been used medicinally for thousands of years and is widely used in Europe. It is a popular treatment for numerous ailments, including sleep disorders, anxiety, digestion/intestinal conditions, skin infections/inflammation (including eczema), wound healing, infantile colic, teething pains, and diaper rash. In the United States, chamomile is best known as an ingredient in herbal tea preparations advertised for mild sedating effects.

German chamomile (Matricaria recutita) and Roman chamomile (Chamaemelum nobile) are the two major types of chamomile used for health conditions. They are believed to have similar effects on the body, although German chamomile may be slightly stronger. Most research has used German chamomile, which is more commonly used everywhere except for England, where Roman chamomile is more common.

Although chamomile is widely used, there is not enough reliable research in humans to support its use for any condition. Despite its reputation as a gentle medicinal plant, there are many reports of allergic reactions in people after eating or coming into contact with chamomile preparations, including life-threatening anaphylaxis.

Evidence

DISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Cardiovascular conditions: Chamomile is not well-known for its cardiac effects, and there is little research in this area. Large, well-designed randomized controlled trials are needed before a firm conclusion can be made.
Grade: C

Common cold: In early study, inhaling steam with chamomile extract has been reported to help common cold symptoms. Further research is needed to confirm these results.
Grade: C

Diarrhea in children: Preliminary study reports that chamomile with apple pectin may reduce the length of time that children experience diarrhea. Further research is needed before a strong recommendation can be made.
Grade: C

Eczema: The German Commission E authorizes the use of topical chamomile for diseases of the skin. However, little research has been done on topical chamomile for eczema and further research is needed.
Grade: C

Gastrointestinal conditions: Chamomile is used traditionally for numerous gastrointestinal conditions, including digestion disorders, "spasm" or colic, upset stomach, flatulence (gas), ulcers, and gastrointestinal irritation. However, currently there is a lack of reliable human research available in any of these areas. Additional study is needed.
Grade: C

Hemorrhagic cystitis (bladder irritation with bleeding): Preliminary study reports that the combination of chamomile baths plus chamomile bladder washes and antibiotics is superior to antibiotics alone for hemorrhagic cystitis. Additional research is necessary before a conclusion can be reached.
Grade: C

Hemorrhoids: Preliminary study reports that chamomile ointment may improve hemorrhoids. Better evidence is needed before a strong recommendation can be made.
Grade: C

Infantile colic: Chamomile is reputed to have anti-spasmodic activity, but there is little research to substantiate this claim. Additional research evaluating chamomile alone is needed.
Grade: C

Mucositis from cancer treatment (mouth ulcers/irritation) : Poor-quality studies have used chamomile mouthwash for the prevention or treatment of mouth mucositis caused by radiation therapy or cancer chemotherapy. Results are conflicting, and it remains unclear if chamomile is helpful in this situation.
Grade: C

Quality of life in cancer patients: A small amount of research suggests that massage using chamomile essential oil may improve anxiety and quality of life in cancer patients. However, this evidence is not high quality. Additional study is needed before a firm conclusion can be reached.
Grade: C

Skin inflammation: Topical chamomile preparations have traditionally been used to soothe skin inflammation. The existing human evidence shows that chamomile may be of little, if any, benefit while animal studies support its anti-inflammatory action. Additional human research is needed in this area.
Grade: C

Sleep aid / sedation: Traditionally, chamomile preparations, such as tea and essential oil aromatherapy, have been used for insomnia and sedation (calming effects). Better research is needed before a recommendation can be made.
Grade: C

Vaginitis (inflammation of the vagina): Vaginitis may involve itching, discharge, or pain with urination. Chamomile douche may improve symptoms of vaginitis with few side effects. Because infection (including sexually transmitted diseases), poor hygiene, or nutritional deficiencies can cause vaginitis, medical attention should be sought by people with this condition. Better research is needed before a conclusion can be drawn regarding the role of chamomile in the management of vaginitis.
Grade: C

Wound healing: There is promising preliminary evidence supporting the topical use of chamomile for wound healing. However, the available literature is not adequate to support a recommendation either for or against this use.
Grade: C

Post-operative sore throat/hoarseness due to intubation: Chamomile spray has not been found to prevent post-operative sore throat and hoarseness any more than normal saline.
Grade: D

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Abdominal bloating, abortifacient, abrasions, abscesses, acne, anorexia, antibacterial, anticoagulant, antifungal, antioxidant, antipruritic, antispasmodic, antiseptic, anxiety, aromatic, arthritis, asthma, back pain, bedsores, bladder disorders, blood purification, bruises, burns, cancer, canker sores, carpal tunnel syndrome, catarrh, chicken pox, constipation, contact dermatitis, cough, Crohn's disease, croup, delirium tremens (DTs), diaper rash, diaphoretic, diuretic (increasing urination), diverticulitis, dry skin, dysmenorrhea (painful menstruation), ear infections, eye disorders (blocked tear ducts), eye infections, fatty liver, fever, fistula healing, frostbite, gallstones, gingivitis, gout, hay fever, headaches, heartburn, hives, hypoglycemia (low blood sugar), hysteria, impetigo, inflammatory conditions, insect bites, insomnia, intestinal cramps, irregular menstrual cycles, irritable bowel syndrome, kidney disorders, leg ulcers, liver disorders, low back pain, malaria, mastitis (breast inflammation), menopause, menstrual cramps, menstrual disorders, morphine withdrawal, motion sickness, muscle strength, nasal inflammation, nausea, nervous stomach, neuralgia (nerve pain), nightmares, oral hygiene (mouthwash), osteoporosis, parasites/worms, peptic ulcers, perineal trauma, poison ivy, post-natal depression, psoriasis, rash (heat), respiratory inflammatory, restlessness, rheumatism, Roehmheld's syndrome, sciatica, seizure disorder, sinusitis, stomach cramps, sunburn, sunstroke, teething pain (mouth rinse), tension, tics, toothache, travel sickness, tuberculosis, ulcerative colitis, ulcers, uterine disorders, uterine stimulant, uterine tonic, vaginal infections, viral infection (flu-like symptoms or polio), vomiting, vomiting/nausea during pregnancy.

Dosing

Adults (18 years and older)

Capsules/tablets containing 400 to 1,600 milligrams in divided doses have been taken by mouth daily. As a liquid extract (1:1 in 45% alcohol), 1 to 4 milliliters three times daily has been taken by mouth. As a tincture (1:5 in alcohol), 15 milliliters three to four times per day has been used. As a mouth rinse, a 1% fluid extract or 5% tincture has been used.

Chamomile is frequently consumed as tea, and 1 to 4 cups of chamomile tea taken daily (from tea bags) is a common dose.

There are no standard doses for chamomile used on the skin. Some natural medicine publications have recommended paste, plaster, or ointment containing 3% to 10% chamomile flower heads. Chamomile has been also used as a bath additive and as a douche.

Children (younger that 18 years)

There is not enough reliable scientific data available to recommend the safe use of chamomile products in children.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

There are multiple reports of serious allergic reactions to chamomile taken by mouth or as an enema, including anaphylaxis, throat swelling, and shortness of breath. Skin allergic reactions have been frequently reported, including dermatitis and eczema. Chamomile eyewash can cause allergic conjunctivitis (pinkeye).

People with allergies to other plants in the Asteraceae (Compositae) family should avoid chamomile. Examples include: aster, chrysanthemum, mugwort, ragweed, and ragwort. Cross-reactions may occur with celery, chrysanthemum, feverfew, tansy, and birch pollen. Individuals with allergies to these plants should avoid chamomile. Contact skin allergy has been reported.

Side Effects

Impurities (adulterants) in chamomile products are common and may cause adverse effects. Atopic dermatitis (skin rash) has been reported.

Chamomile in various forms may cause drowsiness or sedation. Use caution when driving or operating heavy machinery. In large doses, chamomile can cause vomiting. Due to its coumarin content, chamomile may theoretically increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. Increases in blood pressure are possible.

Pregnancy and Breastfeeding

In theory, chamomile may act as a uterine stimulant or lead to abortion. It therefore should be avoided during pregnancy. There is not enough scientific data to recommend the safe use of chamomile while breastfeeding.

Interactions

Interactions with Drugs

Chamomile interactions are not well studied scientifically.

Chamomile may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, and alcohol. Caution is advised while driving or operating machinery.

In theory, chamomile may increase the risk of bleeding when used with anticoagulants or antiplatelet drugs. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Chamomile may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a healthcare professional including a pharmacist about possible interactions.

Be aware that many tinctures contain high levels of alcohol and may cause vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).

An extract containing Matricaria chamomile, Sideritis euboea, Sideritis clandestine, and Pimpinella anisum was associated with selective estrogen receptor modulator (SERM) properties against osteoporosis. Theoretically, chamomile may interact with SERM drugs like raloxifene (prescription drug used for osteoporosis) or tamoxifen (a prescription drug used for cancer).

Constituents in chamomile may alter blood sugar or blood pressure. Patients taking medications that affect blood sugar or blood pressure should be cautious.

Chamomile may have anti-inflammatory effects. Theoretically, use of chamomile with other anti-inflammatory drugs, such as NSAIDs or ibuprofen, may have additive effects.

Chamomile may interact with medications that act as cardiac depressants, central nervous system depressants, calcium channel blockers, cardiac glycosides, and respiratory depressants.

Chamomile may also interact with antibiotics, antifungals, antihistamines, diuretics, as well as drugs for high cholesterol, ulcers, diarrhea, or gastrointestinal disorders.

Interactions with Herbs and Dietary Supplements

Chamomile may increase the amount of drowsiness caused by some herbs or supplements. Caution is advised while driving or operating machinery.

In theory, chamomile may increase the risk of bleeding when taken with other products that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Chamomile may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system. Patients using any medications should check the package insert and speak with a healthcare professional including a pharmacist about possible interactions.

Chamomile may have anti-estrogenic effects and interact with herbs and supplements like red clover or soy.

Based on preliminary study, constituents in chamomile may alter blood sugar or blood pressure. Patients taking herbs or supplements that affect blood sugar or blood pressure should be cautious.

Chamomile may have anti-inflammatory effects. Theoretically, the use of chamomile with other anti-inflammatory herbs and supplements may have additive effects.

Chamomile may interact with herbs and supplements that act as cardiac depressants, cardiac glycosides, respiratory depressants, or spasmolytics.

Chamomile may also interact with antibacterial, antifungal, antihistamine, or diuretic herbs and supplements, as well as herbs and supplements used for high cholesterol, ulcers, diarrhea, or gastrointestinal disorders.

Attribution

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Winnie Abramson, ND (Natural Standard Research Collaboration); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Lisa Cheung, PharmD (University of Rhode Island); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cynthia Dacey, PharmD (Natural Standard Research Collaborative); Nicole Giese, MS (Natural Standard Research Collaboration); Sadaf Hashmi, MD, MPH (Johns Hopkins School of Hygiene and Public Health); Carol Rainville, ND (Natural Standard Research Collaboration); Anabela Santos, PharmD (Northeastern University); Erica Seamon, PharmD (Nova Southeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Aertgeerts P, Albring M, Klaschka F, et al. [Comparative testing of Kamillosan cream and steroidal (0.25% hydrocortisone, 0.75% fluocortin butyl ester) and non-steroidal (5% bufexamac) dermatologic agents in maintenance therapy of eczematous diseases]. Z Hautkr 2-1-1985;60(3):270-277.

Benetti C, Manganelli F. [Clinical experiences in the pharmacological treatment of vaginitis with a camomile-extract vaginal douche]. Minerva Ginecol 1985;37(12):799-801.

de la Torre MF, Sanchez MI, Garcia Robaina JC, et al. Clinical cross-reactivity between Artemisia vulgaris and Matricaria chamomilla (chamomile). J Investig Allergol Clin Immunol 2001;11(2):118-122.

Glowania HJ, Raulin C, Swoboda M. [Effect of chamomile on wound healing--a clinical double-blind study]. Z Hautkr 9-1-1987;62(17):1262, 1267-1271.

Hormann H, Korting H. Evidence for the efficacy and safety of topical herbal drugs in dermatology: part 1: anti-inflammatory agents. Phytomedicine 1994;1(2):161-171.

Ikram M. Medicinal plants as hypocholesterolemic agents. J Pak Med Assoc 1980;30(12):278-281.

Konig GM, Wright AD, Keller WJ, et al. Hypoglycaemic activity of an HMG-containing flavonoid glucoside, chamaemeloside, from Chamaemelum nobile. Planta Med 1998;64(7):612-614.

Kyokong O, Charuluxananan S, Muangmingsuk V, et al. Efficacy of chamomile-extract spray for prevention of post-operative sore throat. J Med Assoc Thai 2002;85 Suppl 1:S180-S185.

Maiche A, Grohn P, Maki-Hokkonen H. Effect of chamomile cream and almond ointment on acute radiation skin reaction. Acta Oncol 1991;30:395-397.

Maiche A, Maki-Kokkonen H, Grohn P. [Comparative trial of chamomile cream in radiotherapy]. Suomen Laakarilehti 1991;46(24):2206-2208.

Patzelt-Wenczler R, Ponce-Pöschl E. Proof of efficacy of Kamillosan cream in atopic eczema. Eur J Med Res 2000;5:171-175.

Rycroft RJ. Recurrent facial dermatitis from chamomile tea. Contact Dermatitis 2003;48(4):229.

Saller R, Beschomer M, Hellenbrecht D, et al. Dose dependency of symptomatic relief of complaints by chamomile steam inhalation in patients with common cold. Eur J Pharmacol 1990;183:728-729.

Weizman Z, Alkrinawi S, Goldfarb D, et al. Efficacy of herbal tea preparation in infantile colic. J Pediatr 1993;122(4):650-652.

Wilkinson S, Aldridge J, Salmon I, et al. An evaluation of aromatherapy massage in palliative care. Palliat Med 1999;13(5):409-417.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.