Vitex agnus-castus

Pronunciation

Vitex agnus-castus (vy-teks ag-nus kast-us)

Summary

Vitex agnus-castus (VAC) is also commonly known as chaste tree or chasteberry. The plant’s main constituents include vitexin, casticin, agnuside, p-hydroxybenzoic acid, alkaloids, and diterpenoids. The fruit consists of flavonoids, terpenoids, neolignans, phenolic compounds, and glycerides (42). The extracts of the dried ripe fruits themselves demonstrate antioxidant activity (44) and have been used in treating symptoms of premenstrual syndrome (PMS) (53). Essential oils from the fruit contain 20.73–23.36% 1,8-cineole + 16.09–22.28% sabinene, and 6.60–19.73%f α-pinene (25). Its main flavonoids include casticin, vitexin, and orientin (13). Standardized extracts typically measure the iridoid or flavonoid content where aucubin (iridoid glycoside) (14) or agnuside is used as the reference material.

Main Medical Uses

Research supports the use of VAC in treating the symptoms of PMS (6, 17, 23, 30, 31, 32, 37, 42, 46, 47, 52, 59), premenstrual dysphoric disorder (4, 42), premenstrual migraines (3), premenstrual tension syndrome (26), postmenopausal hot flushes (1), cyclical mastalgia (11, 15, 16, 36) and hyperprolactinemia (35). Evidence also demonstrates similar effectiveness of VAC to low dose oral contraceptives (49) and metformin (50) in polycystic ovarian syndrome, and to ethinyl estradiol/drospirenone in dysmenorrhea (2). VAC can reduce intrauterine device induced bleeding (58), and may promote the healing of fractures (12).

Dosing and Administration

For an explanation of the classes of evidence, please see the Rating Scales for Evidence-Based Decision Support.

Adverse Effects

VAC extract is considered safe to use (7), with trials reporting safety without serious adverse events in daily doses of up to 40mg for three menstrual cycles (17). It has been shown that there is no difference in side effects between VAC standardized up to 3mg of aucubin and low doses of oral contraceptives (30 mcg ethyinyl estradiol/150 mcg levonorgestrel)(49). Commonly reported side effects include nausea, headache, gastrointestinal disturbances, menstrual disorders, acne, pruritus, and erythematous rash. However, these side effects are mild and reversible (7, 10). A systematic review of 33 studies suggests that VAC does not pose serious health risks. However, it is recommended that pregnant and lactating women avoid its use due to limited safety data in these states (10).

Proprietary Extracts

Associated Interactions and Depletions

Pharmacokinetics

The pharmacokinetics of VAC have been scarcely studied. In mice, the oral bioavailability of agnuside was 0.7%. Peak plasma concentrations were reached within 30-45 mins and VAC was found in highest amounts in the intestine, kidney, liver, spleen, brain, lungs and heart (43). In vitro, BNO 1095 (a VAC extract) solubility and permeability was improved once it was nano-emulsified, suggesting the possibility for improved bioavailability (41). An in vitro study also demonstrated that VAC inhibited CYP2C19 and CYP3A4, which may have implications for future studies on herb-drug interactions (18).

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