Lorazepam/passiflora/valerian root interaction
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First report of interactions between passiflora and lorazepam, and valerian root and lorazepam, leading to movement disorders and drowsiness: case report A 40-year-old man developed movement disorders and drowsiness following self-medication with valerian root and passiflora [dosages not clearly stated], and while receiving lorazepam. His symptoms were attributed to an interaction between the herbal medicines and lorazepam. The man had a history of generalised anxiety disorder and dream disorders, and had been receiving lorazepam 2mg/24h for 2 months. He ingested an infusion of valerian root about 2 hours before bedtime for 2 consecutive days, and also took a mixture of the same infusion with an unlimited quantity of dry passiflora herbs before going to bed. He experienced no side effects, and the infusion dosage was estimated at 300mg. Before going to sleep on the third day, he took three valerian root/passiflora tablets in 1-hour intervals instead of the infusion; according to the product label, each tablet contained dried valerian root 300mg and dried passiflora 380mg. Soon after going to bed, his ’nerves and light-and-rhythmical shaking’ resolved, and he became drowsy. He repeated tablet ingestion on day 4, and developed strong hand tremor, dizziness and palpitations followed by drowsiness before going to sleep. He presented with a history of episodic tremor of his hands, dizziness, throbbing [sic] and muscular fatigue. Examination revealed nervousness while speaking and anxiety gestures, but no shaking. His HR was regular at 60bpm and his BP was 128/74mm Hg. He was advised that the intermittent movement disorder was possibly associated with an interaction between the herbal medicines and lorazepam. The man discontinued the use of valerian root and passiflora, and his symptoms resolved. Author comment: "It can be suspected that the symptoms of the case were caused by an interaction between the herbal remedies and lorazepam. The symptoms disappeared when the patient stopped the herbal treatment. An additive or synergistic effect on the central nervous system (CNS) is suspected to have produced these symptoms." Carrasco MC, et al. Interactions of Valeriana officinalis L. and Passiflora incarnata L. in a patient treated with lorazepam. Phytotherapy Research 23: 1795-6, No. 12, 803007120 Dec 2009 - Spain
» Editorial comment: A search of AdisBase, Medline and Embase did not reveal any previous case reports of associated with an interaction between lorazepam and either passiflora or valerian root. The WHO ADR database contained 27 reports associated with the concomitant use of Valeriana officinalis and lorazepam (including two reports of fatigue, and one of somnolence), and five reports associated with the concomitant use of Passiflora incarnata and lorazepam (including one report of somnolence).
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Reactions 6 Mar 2010 No. 1291
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