Valerian (Valerian officinalis)
Valerian is used as a sedative, particularly in the treatment
of insomnia. Virtually all commercial herbal sleep
aids contain valerian.[113]
Valerian contains many
compounds acting synergistically, but sesquiterpenes are the primary source of the
pharmacologic effects.
Valerian produces dose-dependent sedation and hypnosis.[114]
These effects appear to be mediated through modulation of GABA neurotransmission
and receptor function.[115]
Valerian increased
barbiturate sleep time in experimental animals.[116]
Valerian also mediated benzodiazepine withdrawal in rats.[117]
In one patient, valerian withdrawal appeared to mimic an acute benzodiazepine withdrawal
syndrome characterized by delirium and cardiac complications after surgery with symptoms
attenuated by benzodiazepine administration.[118]
Based on these findings, valerian should be expected to potentiate the sedative
effects of anesthetics that act at the GABA receptor.
The pharmacokinetics of valerian's constituents have not been
studied, although their effects are thought to be short lived. Abrupt discontinuation
in patients who may be physically dependent on valerian risks benzodiazepine-like
withdrawal. In these individuals, it may be prudent to taper this herbal medication
with close medical supervision over the course of several weeks before surgery.
If this is not feasible, physicians can advise patients to continue taking valerian
up until the day of surgery. Benzodiazepines should be used to treat withdrawal
symptoms if they develop in the postoperative period.
