Vitex agnus-castus L.

Last updated: 8 Sep 2016

Scientific Name

Vitex agnus-castus L.   

Synonyms

Agnus-castus robusta (Lebas) Carrière, Agnus-castus vulgaris Carrière, Vitex agnus Stokes, Vitex hybrida Moldenke, Vitex integra Medik., Vitex latifolia Mill., Vitex lupinifolia Salisb., Vitex pseudonegundo (Hausskn.) Hand.-Mazz., Vitex robusta Lebas, Vitex verticillata Lam. [1]

Vernacular Name

English Chaste tree, hemp tree, Indian spice, lilac haste tree, monk’s pepper tree, sage tree, wild pepper [2]
India Athlac, panjangust, ranukabija, shambhaluka-bija, tukhm sambhalu [2]
Philippines Agno-casto, dangla, lagundi [2]
Pakistan Gwanik [2]
Arabic Ghar, kherwa’ [2].

Geographical Distributions

Vitex agnus-castus is distributed in Mediterranean, India, and Pakistan. [2]

Botanical Description

V. agnus-castus is amember of the Lamiaceae family [1]. It is a branched shrub, aromatic, wooly tomentose, with blue corolla and small globose drupe [2].

Cultivation

No documentation.

Chemical Constituent

No documentation.

Plant Part Used

No documentation.

Traditional Use

No documentation.

Preclinical Data

Hormon stimulating activity

V. agnus-castus may also possess estrogenic activity as evidenced by in vitro up-regulation of the estrogen-inducible gene, pS2 (presenelin-2) in S30 breast cancer cells. [3]

The actual activity of the constituents of V. agnus-castus is not fully established. Studies have reported V. agnus-castus to have a significant effect on the pituitary [4][5]. Studies point to a progesterone-like component and effect as well [6]

Dopaminergic activity

The pharmacological effects of an ethanolic extract of V. agnus castus fruits was studied regarding its effects on dopamine-D2 and opioid (mu and kappa subtype) receptors. A relative potent binding inhibition was observed for dopamine-D2 and the opioid receptors. Binding to the histamine-H1, benzodiazepine, OFQ receptor, and the binding-site of the serotonin (5-HT) transporter, was significantly inhibited. The lipophilic fractions of the V. agnus castus extract contained the diterpenes which exhibited inhibitory actions on dopamine-D2 receptor binding. While binding inhibition to mu and kappa opioid receptors was most pronounced in lipophilic fractions, binding to delta opioid receptors was inhibited mainly by an aqueous fraction. The authors concluded that the data indicates a dopaminergic effect of V. agnus castus extracts and suggests additional pharmacological actions via opioid receptors. Due to this dopaminergic activity, it has been postulated that V. agnus castus may be used in the management of Parkinson’s disease, although no clinical research has been performed to support that theory. [7]

Antitumour activity

Laboratory studies have reported to constituents in V. agnus-castus may have antitumor activity through apoptosis induction and cytotoxic activity. [8]

Clinical Data

Clinical findings

V. agnus-castus is used orally for menstrual irregularities including dysmenorrhea, secondary amenorrhea, metrorrhagia, oligomenorrhea, and polymenorrhea. It is also used for symptoms of menopause, for symptoms of premenstrual syndrome (PMS) including cyclical mastalgia, luteal-phase dysfunction (corpus luteum insufficiency), and other symptoms [9]. It is also used orally for treating female infertility, preventing miscarriage in patients with progesterone insufficiency, controlling postpartum bleeding, aiding in expulsion of the placenta, increasing lactation, and treating fibrocystic breasts [10]

Studies report that V. agnus-castus stimulates the treatment of luteal phase defects due to latent hyperprolactinaemia [11]. Because of this activity, V. agnus-castus has been recommended for a variety of female complaints, such as PMS, amenorrhea, menopausal symptoms, endometriosis and hyperprolactinemia [12][13][14]. Studies have reported beneficial effects of V. agnus-castus on female-related disorders [15][16] with several clinical studies reporting beneficial results when using V. agnus-castus in treating women with infertility associated with corpus luteum deficiency [17]. It may also be of benefit in acne, as human data reports increasing healing while using a V. agnus-castus preparation [18].

A multicentric noninterventional trial (open study without control) was conducted to study the efficacy and tolerance of V. agnus-castus extract in 1,634 patients suffering PMS. Four major symptoms of PMS were monitored including depression, anxiety, craving, and hyperhydration. After a treatment period of three menstrual cycles, 93% of patients reported a decrease in the number of symptoms or even cessation of PMS complaints. Mastodynia was still present after 3 months of therapy but was generally less severe than before treatment [18]. However, a recent double-blind, placebo controlled study in two parallel groups (each 50 patients) reported that use of V. agnus castus was useful in the treatment of cyclical breast pain in women [20].

In a prospective, multi-center trial, the efficacy of a V. agnus castus extract was studied in 50 patients with PMS. At the conclusion of the study, PMS-related symptoms were reduced by treatment. Although the symptoms gradually returned after treatment cessation, a 20% difference from baseline remained up to 3 cycles thereafter. At baseline, the VAS score (visual analogue scale; self evaluated) was elevated in the late luteal phase and low at the follicular phase, as expected by the authors. During treatment, the VAS score decreased in the late luteal phase (47.2%) and remained 21.7% below baseline after 3 cycles post-cessation of treatment, with the low VAS score within the follicular phase remaining unchanged over the whole observation period. In the patient's assessment, 38 judged the global efficacy moderate to excellent with 5 patients indicating no global efficacy. The number of day’s patient’s sustained PMS symptoms was reduced slightly from 7.5 to 6, with the resting levels of blood prolactin remaining within the physiological range throughout the study. No differences were seen between patients on or off oral contraceptives. 20 patients reported 37 transient adverse events with no serious adverse reactions reported. One patient withdrew after four days of treatment due to fatigue and headache. The authors concluded that patients with PMS can be treated successfully with V. agnus castus preparations as indicated by a clear improvement in the main effect parameter during treatment and the gradual return after cessation of treatment. The main response to treatment seems related to symptomatic relief rather than to the duration of the syndrome. [21]

A randomized, double blind, placebo controlled, parallel group comparison study of 178 women taking a standardized V. agnus castus product (1 tablet daily) reported improvement in PMS symptoms (over three menstrual cycles) when compared to placebo. Improved symptoms included mood alteration, anger, headache, breast fullness and bloating, where improvement rates were 52% and 24% for V. agnus castus and placebo, respectively. [22]

A combination of V. agnus castus and St. John’s wort (Hypericum perforatum) was found in a double-blind, randomized, placebo-controlled parallel trial to be superior to placebo for total PMS-like scores including anxiety. [23]

Precautions

No documentation.

Side effects            

May cause minor side effects such as stomach upset or rash in rare instances. [24]

Pregnancy/Breast Feeding

Based on pharmacology, do not use in women of child-bearing age, women trying to conceive or in pregnant women [18]. Iridoid glycosides are found in V. agnus-castus. Structural modifications to them have demonstrated in vitro implantation preventing activity in animal cell lines [25]. In vitro studies have reported phytoestrogenic, emmenagogue and uterine stimulant activity [26].

Age limitation

No documentation.

Adverse reaction

No documentation.

Interaction & Depletion

No documentation.

Interaction with drug

Hormone replacement therapy (HRT)

Chasteberry has hormonal activity, which may alter the effects of these medications and possibly the dose needed for treatment. [4][11]

These drugs include conjugated estrogens, estradiol, estrone, esterified estrogens, estropipate, ethinyl estradiol, progesterone, medroxyprogesterone, hydroxyprogesterone, norethindrone

Oral contraceptives

Chasteberry has hormonal activity, which may alter the effects of these medications and possibly the dose needed for treatment. [5][11]

These drugs include norethindrone, ethynodiol diacetate, norgestrel, norgestimate, ethinyl estradiol, drospirenone, desogestrel, levonorgestrel

Dopamine agonists

An study reported that chasteberry may act in the body like some of these medications, which may alter the effects of these medications and possibly the dose needed for treatment. Use with caution. [14]

These drugs include selegeline, amantadine, carbidopa, levadopa, pramipexole, ropinirole, bromocriptine, pergolide

Interaction with other Herbs

No documentation.

Contraindications

No documentation.

Dosage

No documentation.

Poisonous Management

No documentation.

Line drawing

No documentation.

References

  1. The Plant List. Ver1.1. Vitex agnus-castus L. [homepage on the Internet]. c2013 [updated 2012 Mar 23; cited 2016 Aug 10]. Available from: http://www.theplantlist.org/tpl1.1/record/kew-213297
  2. Quattrocchi U. CRC world dictionary of medicinal and poisonous plants: Common names, scientific names, eponyms, synonyms, and etymology. Volume V R-Z. Boca Raton, Florida: CRC Press, 2012; p. 756.
  3. Liu J, Burdette JE, Xu H, et al. Evaluation of estrogenic activity of plant extracts for the potential treatment of menopausal symptoms. J Agric Food Chem. 2001;49(5):2472-2479.
  4. Amann W. [Amenorrhea. Favorable effect of Agnus castus (agnolyt) on amenorrhea]. ZFA. (Stuttgart). 1982;58(4):228-231. German.
  5. Sliutz G, Speiser P, Schultz AM, Spona J, Zeillinger R. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res. 1993;25(5):253-255.
  6. Amann W. [Elimination of obstipation with agnolyt]. Ther Gegenew. 1965;104(9):1263-1265. German.
  7. Meier B, Berger D, Hoberg E, Sticher O, Schaffner W. Pharmacological activities of Vitex agnus-castus extracts in vitro. Phytomedicine. 2000;7(5):373-381.
  8. Zhou Y, Liu YE, Cao J, et al. Vitexins, nature-derived lignan compounds, induce apoptosis and suppress tumor growth. Clin Cancer Res. 2009;15(16):5161-5169.
  9. He Z, Chen R, Zhou Y, et al. Treatment for premenstrual syndrome with Vitex agnus castus: A prospective, randomized, multi-center placebo controlled study in China. Maturitas. 2009;63(1):99-103.
  10. Döll M. [The premenstrual syndrome: Effectiveness of Vitex agnus castus] Med Monatsschr Pharm. 2009;32(5):186-191. German.
  11. Milewicz A, Gejdel E, Sworen H, et al. Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study. Arzneim Forsch/Drug Res. 1993;43(7):752-756.
  12. Hillebrand H. [The treatment of premenstrual aphthous ulcerative stomatitis with agnolyt]. Landarzt. 1964;40(36):1577. German.
  13. McGibbon D. Premenstrual syndrome. CMAJ. 1989;141(11):1124-1125.
  14. Jarry H, Leonhardt S, Gorkow C, Wuttke W. In vitro prolactin but not LH and FSH release is inhibited by compounds in extracts of Agnus castus: Direct evidence for a dopaminergic principle by the dopamine receptor assay. Exp Clin Endocrinol. 1994;102(6):448-454.
  15. Amann W. [Premenstrual water retention. Favorable effect of Agnus castus (Agnolyt) on premenstrual water retention]. ZFA. (Stuttgart). 1979;55(1):48-51. German.
  16. Snow JM. Vitex agnus-castus L. (Verbenaceae). Prot J Bot Med. 1996;1(4):20-23.
  17. Propping D, Katzorke T, Balkien L. [Diagnosis and therapy of corpus luteum deficiency in general practice]. Therapiewoche. 1988;38:2992-3001.
  18. Newall CA, Anderson LA, Philipson D. Herbal medicines: A guide for health care professionals. London: The Pharmaceutical Press, 1996; p. 19-20.
  19. Loch EG, Selle H, Boblitz N. Treatment of premenstrual syndrome with a phytopharmaceutical formulation containing Vitex agnus-castus. J Women's Health Gend Based Med. 2000;9(3):315-320.
  20. Halaska M, Raus K, Beles P, Martan A, Paithner KG. [Treatment of cyclical mastodynia using an extract of Vitex agnus castus: results of a double-blind comparison with a placebo]. Ceska Gynekol. 1998;63(5):388-92.
  21. Berger D, Schaffner W, Schrader E, Meier B, Brattstrom A. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with pre-menstrual syndrome (PMS). Arch Gynecol Obstet. 2000;264(3):150-153.
  22. Schellenberg R. Treatment for the premenstrual syndrome with Agnus castus fruit extract: Prospective, randomised, placebo controlled study. BMJ. 2001;322 (7279):134-137.
  23. Van Die MD, Bone KM, Burger HG, Reece JE, Teede HJ. Effects of a combination of Hypericum perforatum and Vitex agnus-castuson PMS-like symptoms in late-perimenopausal women: Findings from a subpopulation analysis. J Altern Complement Med. 2009;15(9):1045-1048.
  24. PDR for herbal medicines. 2nd ed. Montvale, New Jersey: Medical Economics Company, 2000; p. 176.
  25. Misra AP, Mathad VT, Raj K, et al. Modified iridoid glycosides as anti-implantation agents. Inhibition of cell adhesion as an approach for developing pregnancy interceptive agents. Bioorg Med Chem. 2001;9(11):2763-2772.
  26. Dugoua JJ, Seely D, Perri D, Koren G, Mills E. Safety and efficacy of chastetree (Vitex agnus-castus) during pregnancy and lactation. Can J Clin Pharmacol. 2008 Winter;15(1):e74-79.