What is the dermatologic preoperative evaluation and management of valerian?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Valerian is an herb used as a sedative, particularly in the treatment of insomnia. Virtually all herbal sleep aids contain valerian. Valerian contains many compounds that act synergistically. Sesquiterpenes are the primary source of the pharmacologic effects of valerian.

Valerian produces dose-dependent sedation and hypnosis. These effects appear to be mediated through the modulation of GABA neurotransmission and receptor function. Based on these findings, valerian should be expected to potentiate the sedative effects of anesthetics and adjuvants (eg, midazolam) that act at the GABA receptor. The pharmacokinetics of the constituents of valerian have not been studied, although their effects are thought to be short-lived. Valerian has also been used to reduce headaches, chest tightness, mydriasis, abdominal pain, and tremor of the hands and feet.

Caution should be taken with abrupt discontinuation of use in patients who may be physically dependent on valerian because of the risk of benzodiazepinelike withdrawal. In these individuals, with close medical supervision, the dose of valerian should be tapered during the several weeks before surgery. If tapering is not feasible, physicians can advise patients to continue taking valerian up until the day of surgery. Based on the mechanism of action and a reported case of effectiveness, benzodiazepines can be used to treat withdrawal symptoms if they develop during the postoperative period.

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