-IBIS-1.7.0-
rx
herb
Vitex agnus-castus (Chaste Tree)
Botanicals
definition
botanical name(s): Vitex agnus-castus.
synonyms: chaste berry, chaste tree, monk's pepper.
part(s) used: berries, fruit. Sometimes used with leafy tops.
qualities: bitter, warming, drying.
affinities: hypothalamic-pituitary-gonadal axis.
actions: reproductive tract tonic and hormonal normalizer, increases LH and inhbits FSH, increases luteal phase progesterone, decreases prolactin levels , galactagogue, antibacterial (leaf).
dosage:
» tincture: (1:5) 1 - 5 ml. per day
» infusion: 1-2 teaspoons crushed seeds per cup, steeped 15mins, one cup T.I.D
» Standardised extract: (Agnolyt) 40drops per day (Manufacturers preparations may vary).
» For full benefit, Vitex is usually prescribed from three to nine months. Results may be evident within one cycle, three to six cycles may be required for stabilisation. The herb is usually administered as a single dose in the morning.
» Dosage levels are considered critical by clinical herbalists. Too high or too low a dose may worsen some conditions, and experience of the condition, associated symptoms, the individual age and constitution are all important in establishing appropriate therapeutic dose (Trickey, 1998). See also contraindications.
therapy:
menstrual irregularities, dysmenorrhea, premenstrual syndrome: especially acne, mastodynia, hyperprolactinemia, menopausal symptoms, corpus luteum insufficiency and associated symptoms (including amenorrhea, anovulation, menorrhagia, infertility) ,oral and genital herpes outbreaks, insufficient lactation, metrorrhagia.
specific indications: corpus luteum insufficiency.
constituents
(fruit only)
Flavonoids: (including quercitin and kaempferol derivatives).
Essential Oil (Monoterpenes including pinenes, cineole limonene: sesquiterpenes including farnesene).
(leaf and flower)
Iridoids (including aucubin)
Steroids (delta 3 keto steroids including trace amounts of testosterone, hydroxyprogesterone, androstenedione) (Saden Krehula, 1991, Duke, 1998)
pharmacology:
» Vitex extracts inhibit prolactin secretion in vivo and in vitro by directly binding to dopamine (D2) receptors in rat pituitary cells.
» Human studies show serum progesterone levels restored in corpus luteum insufficiency, and prolactin levels lowered in women with hyperprolactinemia. (Reviewed, Snow 1996).
clinical trials
» PMS: Several studies have shown the ability of Vitex extracts to reduce PMS symptoms, including water retention and breast tenderness, with high success ratings by both patients and physicians.
» Corpus luteum insufficiency: relative deficiency of progesterone to estrogen can cause a range of menstrual irregularities. Numerous clinical studies have demonstrated the effectiveness of Vitex for problems such as menorrhagia, amenorrhea, metrorrhagia, polymenorrhea, oligomenorrhea, and infertility. Few of the sudies have been controlled or double blinded, but the general results show Vitex normalises cycle rhythm, extends shortened cycles, shortens bleeding period where menses is excessive, increases rate of pregnancy, elevates serum progesterone. Study intervals ranged from 7 days to 16 years. (Reviewed, Snow 1996).
» Hyperprolactinemia: Vitex reduces prolactin levelsi n women with hyperprolactinemia. (Milewicz, 1993.
» Hypogalactia: Early studies of Vitex focussed on its galactagogue action. Milk secretion was enhanced and milk composition unchanged compared to controls ( Mohr, 1954).
AHPA Botanical Safety Rating: 2d
toxicity: 1
Vitex has minimal toxicity. Several large scale (n = 6000+) monitoring studies in Germany indicate a reported side effcet rate of around 2% in medium term Vitex usage, the main reported symptoms being minor headaches, nausea, and dyspepsia (Reviewed, Snow 1996.)
contraindications:
» contraindicated in early pregnancy (speculative) due to its ability to induce menses. (Brinker, 1995, Farnsworth, 1975).
» Not recommended for women younger than 20 years of age (whose cycle may not be fully stabilised). (Trickey, 1998).
» may lessen sexual drive (Bergner, 1990) but has been reported to both increase and decrease libido in women, while larger doses are anaphrodisiac in men (McQuade Crawford, 1996).
» Self prescription contrainidcated. A report in a British Journal associates (unstated doses) of self prescribed Vitex with multiple follicular development (Cahill et al, 1994). This report is not detailed but corroborates that Vitex is unsuitable for self prescription and should be administered by a qualified herbalist.
drug interactions:
» Should not be prescribed when hormonal preparations are being used, including Birth Control Pills, ERT, HRT, or progestogen drugs such as Provera (Trickey, 1998, McGuffin, 1997).
Notes:
Since Vitex inhibits prolactin secretion but also has galactogogic actions, it is likely that the dose response dynamics are biphasic. This also would explain the sensitive nature ofdose levels (Trickey, 1998). Historically Vitex has been seen by herbalists as an "amphoteric" or normalizing remedy, restoring balance according to the requirements of the individual situation whatever the dysequilibrium. This is compatible with a biphasic pharmacodynamics, and supports herbalists' tendency to use Vitex as the remedy of first choice in menstrual irregularities.
footnotes
General Reference, see Snow 1996.
Bergner, P. 1990. Chaste Tree. Med.Herb. (2) 5: 1, 6.
Brinker F. 1995. Botanical Medicine Research Summaries (from Eclectic Dispensatory of Botanical Therapeutics, vol.11), Sandy, Oregon: Eclectic Medical Publications.
Cahill D.J., et al. 1994. Multiple follicular development associated with herbal medicine [see comments] Hum Reprod Aug;9(8):1469-70.
ABSTRACT: After three endocrinologically normal cycles while undergoing unstimulated in-vitro fertilization treatment, a woman took a herbal medicine (Vitex agnus castus) at the beginning of a fourth unstimulated IVF treatment cycle. In this fourth cycle, her serum gonadotrophin and ovarian hormone measurements were disordered. One embryo resulted from the three eggs collected but a pregnancy did not ensue. She had symptoms suggestive of mild ovarian hyperstimulation syndrome in the luteal phase. Two subsequent cycles were endocrinologically normal. We do not advocate the use of this herbal medicine to promote normal ovarian function.
Duke, J., 1998. Dr. Duke's Phytochemical and Ethnobotanical Databases http://www.ars-grin.gov/duke/ (accessed Nov 11th, 1998).
Farnsworth NR, Bingel AS, Cordell GA, Crane FA, Fong HHS. 1975. Potential Value of Plants as Sources of New Antifertility Agents I. J. Pharm. Sci., 64:535-98.
McGuffin M., ed. 1997. American Herbal Products Associations Botanical Safety Handbook. Boca Raton, FL: The CRC Press.
McQuade Crawford, A., 1996. The Herbal Menopause Book. p139. The Crossing Press, Freedom CA.
Milewicz A; et al. 1993. [Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo- controlled double-blind study] Arzneimittelforschung Jul;43(7):752-6
ABSTRACT: The efficacy of a Vitex agnus castus preparation (Strotan capsules) was investigated in a randomized double blind study vs. placebo. This clinical study involved 52 women with luteal phase defects due to latent hyperprolactinaemia. The daily dose was one capsule (20 mg) Vitex agnus castus preparation and placebo, respectively. Aim of the study was to prove whether the elevated pituitary prolactin reserve can be reduced and deficits in luteal phase length and luteal phase progesterone synthesis be normalized. Blood for hormonal analysis was taken at days 5-8 and day 20 of the menstrual cycle before and after three month of therapy. Latent hyperprolactinaemia was analysed by monitoring the prolactin release 15 and 30 min after i.v. injection of 200 micrograms TRH. 37 complete case reports (placebo: n = 20, verum: n = 17) after 3 month of therapy were statistically evaluated. The prolactin release was reduced after 3 months, shortened luteal phases were normalised and deficits in the luteal progesterone synthesis were eliminated. These changes were significant and occurred only in the verum group. All other hormonal parameters did not change with the exception of 17 beta-estradiol which rouse up in the luteal phase in patients receiving verum. Side effects were not seen, two women treated with the Vitex agnus castus preparation got pregnant. The tested preparation is thought to be an efficient medication in the treatment of luteal phase defects due to latent hyperprolactinaemia.
Mohr, H., 1954. Clinical Investigation of Means to Increase Lactation. Dtsch. Med. Wschr. 79: 1513-1516.
Saden Krehula, M., et al. 1991. D-4 3-keto steroids in flowers and leaves of Vitex agnus-castus. Acta. Pharm. Jugosl. 41: 237-241.
Snow, J., 1996. Vitex agnus-castus Monograph. The Protocol Journal of Botanical Medicine.1(4):20-23.
Trickey, R., 1998. Women Hormones and the Menstrual Cycle - Herbal and Medical Solutions from Adolescence to MenopauseAllen & Unwin, NSW, Australia. 345-348.