Latin name: Vitex agnus-castus
Pharmacopoeial name: Agni Casti fructus
Other names: Chaste berry, Chaste Tree, Monks pepper
About Agnus castus
Vitex is the largest genus in the family Verbenaceae which comprises 250 species distributed all over the world (1). The Vitex species are deciduous shrubs. V. agnus-castus (chaste tree) is widespread on riverbanks and on shores in the Mediterranean region, Southern Europe and in Central Asia (2).
V. agnus-castus, commonly known as chaste tree or sage tree, is large shrub with a showy summertime flower display that grows 3-6 m and about as wide. The leaves are 7.6-10 cm in diameter with 5-7 fingerlike leaflets. The foliage is aromatic and is typically grey-green to dark green above and lighter on the undersides. Branched flower clusters are produced on new wood in late spring and early summer and bloom sporadically until early autumn. Flowers are followed by a fleshy fruit that contains four seeds that are sometimes used as seasoning, similar to black pepper (monk’s pepper is another of these species common names). Flower colour ranges from violet to blue to deep purple (3).
Contents includes, alkaloids-viticin; flavonoids-kaemperferol, quercetagetin derivatives; iridoids aucubin, agnuside;volatile oils-cineol, pinine, castine. The available literature reveals that among 36 species of Vitex, only 16 species have been evaluated for their pharmacological activities. Flavonoids and diterpenoids, isolated from ethyl acetate extract of V. agnus-castus fruits, have been reported to exhibit antioxidant activity (4). Essential oils, isolated from V. agnus-castus, showed a significant antibacterial activity (5). Caffeic and chlorogenic acids, extracted from leaves and fruits of V. agnus-castus, exhibited potent antioxidant activity (6). Cell culture experiments showed that flavonoid apigenin, isolated from V. agnus-castus exhibited estrogenic activity (7).
V. agnus-castus is prepared either as a fluid extracts or a dried extract in tablet or capsule form. Clinical trials have used a variety of doses (8-11). Fluid extract: 1-2.5 ml of extract daily. Dried fruit: 1.5-3 mg daily as decoction. Dried extracts in tablet or capsule form: 2-500 mg twice daily (12).
Agnus castus does not contain any oestrogenic constituents, but has been reported to diminish release of follicle stimulating hormone from the anterior pituitary and affect the release of luteinising hormone and prolactin (13,14). The precise mode of action of Agnus castus and the active constituents have not been established. However, it is thought to act on the pituitary-hypothalamic axis rather than directly on the ovaries.
Agnus castus has been found to restore progesterone concentrations, prolong the hyperthermic phase in the basal temperature curve and restore the LH-RH test to normal when given for at least three months daily. It is being recommended that Agnus castus therapy should be tried before commencing alternative treatments such as oestrogen or anti-oestrogen preparations (15).
Agnus castus also affects beneficially “luteal phase defect”, a condition marked by short menstrual cycles, thought to be caused by insufficient progesterone secretion consequent to deficits in the corpus luteum (16). Drugs that lower prolactin secretion have been shown to prolong the luteal phase of the menstrual cycle, as Agnus castus has also been shown to do (17,18)
Premenstrual Syndrome, Premenstrual mastalgia
Both hyperprolactinaemia and luteal phase defect have been suggested as causal to premenstrual syndrome and cyclical mastalgia. In clinical trials, Agnus castus was shown to relieve both PMS, and especially breast swelling and pain. (19). Compared to vitamin B6, chaste Berry was superior in reducing mastalgia, premenstrual fluid retention, headache, and fatigue (20)
The commission E approved the use of chaste tree fruit for irregularities of the menstrual cycle premenstrual complaints and mastodynia. Hence the fruits of V. agnus-castus have been used in the treatment of many female conditions, including menstrual disorders (amenorrhoea, dysmenorrhoea), premenstrual dysphoric disorder (PMDD), corpus luteum insufficiency, hyperprolactinaemia, infertility, acne, menopause, disrupted lactation, cyclic breast pain, cyclical mastalgia and inflammatory conditions, diarrhea and flatulence (2, 8-11). Also, in Iranian traditional medicine its leaves and fruits are used for increasing milk (21).
The German Commission E monograph recommends a daily intake 30-40 mg of the dried herb in capsules or in liquid preparations. V. agnus-castus is typically taken once in the morning with liquid for several months consecutively. For premenstrual syndrome, frequent or heavy periods, the plant can be used continuously for 4-6 months. Infertile women with amenorrhea can remain on V. agnus-castus for 12-18 months unless pregnancy occurs during treatment (22)
Over 30 clinical studies have been conducted on one proprietary chaste berry product. Seven studies evaluated its effectiveness in treating PMS, 4 on mastitis and fibrocystic disease, 3 on menopausal symptoms, 3 on increasing lactation, four on hyperprolactinaemia, 7 on uterine bleeding disorders, 3 acne, and 4 on miscellaneous menstrual irregularities (23) . Commercial chaste berry is administered in capsules and extract forms standardised to the iridoid constituent content, agnuside.
It is thought the dopaminergic compounds present in extract of V. agnus castus fruits are the effective components in the treatment of premenstrual mastodynia (mastalgia) as indicated by double-blind placebo-controlled studies (24).
Premenstrual Dysphoric Disorder
In one clinical trial, the serotonin reuptake inhibitor fluoxetine and the extract of V. agnus-castus were studied for the treatment of PMDD. This study showed that fluoxetine was more effective for psychological symptoms while the extract diminishes the physical symptoms of premenstrual disorders (25).
Another study suggests that at low doses V. agnus-castus increases milk production in lactating women and may also modify libido (26).
Adverse effects of V. agnus-castus are reported to be mild and reversible (27) Most frequent are:-Nausea, mild gastrointestinal complaints, fatigue, menstrual disorders, dry mouth, acne, pruritus, and erythematous rash. In the case of lactation, opinion is conflicting as to whether chaste tree increases or decreases lactation.
Use during pregnancy and lactation-not recommended unless under medical supervision.
Keywords:-Agnus castus; premenstrual syndrome; premenstrual mastalgia; menstrual disorders; Premenstrual Dysphoric disorder; Lactation
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