Herbfacts

Passionflower herb

Latin name: Passiflora incarnate

Pharmacopoeial name; Passiflorae herba

Other names: Maypop passionflower, passion vine

About Passionflower herb

Passiflora incarnata is an evergreen climber, rapidly growing up to 6 m. This plant is in leaf from December to January, in flower from June to July, and its seeds ripen from September to November. The flower is typically 6–7 cm in diameter with 5 petals, which are purplish to whitish. The word Passiflora comes from the Latin word “Passio” because in 1529, Spanish “conquistadores” described its flowers as symbols of the “passion of Christ” (1,2). Passiflora incarnata L., which originated in North America, is the most common variety used in contemporary Western phytotherapy.

Spanish conquerors first learned of passionflower from pre- Colombian people who traditionally used it as a sedative to treat insomnia and nervousness. Passiflora incarnata or ‘Passionflower’ (Flos passionis) acquired its name from the descriptions of the parts of its flower by Spanish missionaries in South America. It was known by the Spanish as ‘La Flor de las Cinco Llagas’ or the ‘The Flower With The Five Wounds.’‘Passionis’ refers to Christ’s passion, representing various elements of the Crucifixion (3)

Passionflower was brought to Europe, where it became widely cultivated and was introduced to European folk medicine, becoming a popular traditional phyotherapeutic remedy as well as a homoeopathic remedy for the relief of mild symptoms of mental stress, anxiety and mild sleep disorder (4-6).

Uses of Passionflower herb

Anxiety

Some clinical trials have been performed to assess the putative anxiolytic effect of Passiflora incarnata already reported in folk medicine. One of these trials was designed to evaluate Passiflora incarnata treatment of Generalised Anxiety Disorder (GAD), and another two clinical trials were performed to assess its effectiveness in treating pre-surgery anxiety. (7,8) compared the supposed antianxiety effect of an extract of Passiflora incarnata with the benzodiazepinic drug oxazepam in a double-blind randomised clinical trial carried out by recruiting patients suffering from GAD. Patients were enrolled if they matched the following inclusion criteria: previous diagnosis of GAD according to DSM IV criteria (duration of illness at least 6 months) and a score of 14 or more measured by the Hamilton Anxiety Rating Scale. In a 4-week trial, a group of volunteers was treated with a passionflower extract at a dose of 45 drops/day plus placebo tablet, and other volunteers received 30mg oxazepam per day plus placebo drops. The decrease in the HAM-A score from baseline was used as the main response measure. The results demonstrated that both herbal extract and oxazepam exerted positive effects, producing similar reductions in HAM-A scores with respect to baseline. In particular, oxazepam reduction was evident starting from day 4, leading to a more rapid onset of action. The results indicated that Passiflora incarnata is as effective as oxazepam for the treatment of GAD.

The anxiolytic activity of passionflower has been tested in two clinical studies conducted on patients undergoing surgery. One study was designed with the aim of comparing the effect of oral administration of a Passiflora incarnata extract with placebo as a premedication before anaesthesia. The study enrolled 60 patients undergoing inguinal herniorrhaphy. The subjects were randomly allocated in two groups of 30, one receiving Passiflora incarnata 90 min before the surgical operation. The other group of 30 patients received a placebo. Anxiolytic and sedative effects were assessed, in addition to psychomotor performance and discharge time. Anxiety scores were significantly lower in the passionflower group compared with the control group. No significant differences were observed in psychological variables in the post anaesthesia care unit, and the recovery of psychomotor function was comparable in both groups (9).

Aslanargun et al. conducted a prospective, randomised, double-blind placebo-controlled study on patients who underwent regional anaesthesia with the aim of evaluating whether treatment with Passiflora extract before spinal anaesthesia could reduce anxiety (10). The participants, allocated in 2 groups using a random procedure, received the medication under investigation (700 mg/5 ml of an aqueous extract of passionflower) or a corresponding identical placebo, 30 min before the spinal anaesthesia baseline. A statistically significant difference was observed between the two groups in the increase in the State Anxiety Inventory (STAI-S) score obtained just before spinal anaesthesia when compared to the baseline. No statistically significant difference from baseline was observed in psychomotor function for either group. Furthermore, no statistically significant difference was observed between groups in terms of the characteristics of the sensory and motor blocks, the time to first analgesic requirement, the time to discharge, and side effects. The results suggested that passionflower treatment reduces clinical symptoms anxiety before spinal anaesthesia without affecting psychomotor function, sedation level, or haemodynamic parameters.

Treatment of opiate withdrawal

To verify the possible adjuvant activity of an extract of Passiflora incarnata on the treatment of opiate withdrawal based on clonidine, a clinical double-blind randomised trial vs. placebo has been performed. A total of 65 participants with opiate addictions were randomly assigned to treatment with Passiflora incarnata extract plus clonidine tablet or clonidine tablet plus placebo. The results showed that the group of patients treated with clonidine plus Passiflora incarnata extract exhibited earlier symptom reductions than patients treated with placebo and clonidine. Statistical analysis of data regarding mental and physical symptoms showed that treatment consisting of Passiflora incarnata plus clonidine reduced mental symptoms (e.g., insomnia/sleeping problems, dysphoria, anxiety, agitation, irritability and craving for sub- stances) to a greater extent than physical symptoms of opiate withdrawal (7).

Treatment of menopausal symptoms

A clinical study compared the effects of two extracts derived from the medicinal herbs Hypericum perforatum L. and Passiflora incarnata on menopausal symptoms. The study recruited menopausal women and randomly divided them into two groups, with patients undergoing Hypericum perforatum treatment and patients treated with Passiflora incarnata. The authors concluded that Hypericum perforatum and Passiflora incarnata can exert beneficial effects on precocious menopause symptoms (vasomotor signs, insomnia, depression, anger, headaches, etc.) and that health professionals can use them as an alternative to hormone therapy (11).

Treatment of insomnia/sleep disorders

Several studies have examined the possible sedative effects of Passiflora incarnata on human sleep. As anxiety has been shown to be positively correlated with sleep disturbance (12,13), Schulz et al. investigated the potential effects of passion- flower in improving sleep quality in humans as a secondary consequence of its anxiolytic effects (14). A randomised double-blind vs. placebo clinical trial of twelve healthy females was conducted to study the effects of different medicinal herbs (including Passiflora incarnata) on sleep quality. Diazepam, placebo and passionflower extract all exerted effects, producing a similar decrease in mental alertness. EEG did not show any effect of passion flower extract in comparison with placebo.

Another randomised double-blind placebo control clinical study tested the potential efficacy of passionflower on 41 volunteers suffering from primary insomnia. The results revealed that in subjects receiving passionflower, only subjective sleep quality was significantly improved compared with the placebo group (15).

Treatment of ADHD

As Passiflora incarnata is a folk remedy for anxiety and ADHD, its potential beneficial activity against ADHD has been evaluated in a double- blind, randomised clinical trial on a sample of children with ADHD. Although the number of dropouts in the methylphenidate group was higher than that in the Passiflora incarnata group, no statistically significant differences have been reported between the two branches of the study. In addition, decreased appetite and anxiety/ nervousness occurred more often in the methylphenidate group. These results suggest that the main advantage of the Passiflora incarnata treatment is a more tolerable side-effect profile (16).

Safety

No reported side effects, excessive use may cause sedation and potentiate MAOI therapy. Not recommended in pregnancy

Keywords: anxiety; menopause; insomnia; ADHD

Monograph

http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_Community_herbal_monograph/2014/06/WC500168966.pdf

Assessment report

http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_HMPC_assessment_report/2014/06/WC500168964.pdf

References

http://www.ema.europa.eu/docs/en_GB/document_library/Herbal_-_List_of_references_supporting_the_assessment_report/2014/06/WC500168965.pdf

References

1. Kinghorn, G.,2001.Passion,stigma,andSTI.SexuallyTransmittedInfections77, 370–375.
2. Dhawan,K.,Dhawan,S.,Sharma,A.,2004.Passiflora: areviewupdate.J.Ethno- pharmacol. 94,1
3. Ratsch, C., 1998. The Encyclopedia of Psychoactive Plants: Ethnopharmacology and its Applications. Park Street Press, Rochester, U.S.A.
4. Beverley, L., 1947. The history and the present state of Virginia. University of North Carolina press, Chapel Hill
5. Bradley, P.R. (Ed.), 1992. British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, UK.
6. EMA 2008.Committee on Herbal Medicinal Products(HMPC) PASSIFLORAINCAR- NATA L., Herba Passion Flower EMA/HMPC/218548/2008 Assessment Report.
7. Akhondzadeh, S.,Kashani,L.,Mobaseri,M.,Hosseini,S.,Nikzad,S.,Khani,M.,2001a. J.Clin.Pharm.Ther.26,369–373.
8. Akhondzadeh, S.,Naghavi,H.,Vazirian,M.,Shayeganpour,A.,Rashidi,H.,Khani,M., 2001b.J.Clin.Pharm.Ther.26, 363–367.
9. Movafegh,A.,Alizadeh,R.,Hajimohamadi,F.,Esfehani,F.,Nejatfar,M.,2008. Anesth.Analg.106, 1728–1732.
10. Aslanargun,P.,Cuvas,O.,Dikmen,B.,Aslan,E.,Yuksel,M.U.,2012. J.Anesth.26,39–44.
11. Fahami,F.,Asali,Z.,Aslani,A.,Fathizadeh,N.,2010. Iran.J.Nurs. Midwifery Res.15,202.
12. Spira, A.P.,Friedman,L.,Aulakh,J.S.,Lee,T.,Sheikh,J.I.,Yesavage,J.A.,2008. J.Geriatr.PsychiatryNeurol.21,149–153.
13. Spoormaker, V.I,vandenBout,J.,2005. Euro.Psychiatry20,243–245.
14. Schulz, H.,Jobert,M.,Hübner,W.,1998.Phytomedicine5,449–458.
15. Ngan, A,Conduit,R.,2011. Phytother.Res.25,1153–1159.
16. Akhondzadeh, S.,Mohammadi,M.,Momeni,F.,2005. Therapy2,609–614.