Agnus-castus robusta (Lebas) Carrière; A. vulgaris Carrière; V. agnus Stokes; and others Lamiaceae (Labiatae) Agnus castus; chaste tree; monk’s pepper Agni casti fructus Whole dried ripe fruit (berry) Essential oil (up to 2%), with bornyl acetate, 1,8-cineol, limonene, α- and β-pinene as major constituents; diterpenes including viteagnusin, vitexilactone, rotundifuran, vitexilactam A, viteagnusides A-C, vitetrifolin D and others; flavonoids including casticin, chrysoplenetin, chrysosplenol D, cynaroside, 6-hydroxykaempferol, apigenin, isorhamnetin, luteolin and their derivatives; iridoids including agnuside and p-hydroxybenzoic acid derivatives have been identified. V. agnus-castus is often standardised to the content of the flavonoid casticin and sometimes also to the iridoid glycoside agnuside (Chen et al. 2011; Ono et al. 2011; WHO 2009; Williamson et al. 2013). A systematic review assessed 12 randomised controlled trials of V. agnus-castus, six of which involved over 100 participants (range 110 to 217), in alleviating symptoms of premenstrual syndrome (PMS). It was found superior to placebo (five out of six studies), pyridoxine (vitamin B6, 200 mg/day; 1 study) and magnesium oxide (1 study). The one exception found that soya-based ‘placebo’ (1800 mg/day) significantly outperformed chasteberry. Two studies investigated the use of V. agnus-castus in premenstrual dysphoric disorder: one reported that it was equivalent to fluoxetine, while the other found that fluoxetine outperformed chasteberry. In a double-blind, placebo-controlled parallel-group study involving 162 women aged 18–45 years with PMS, the proprietary extract ‘Ze 440’ (standardised to casticin) was administered over three menstrual cycles. A daily dose of 20 mg of Ze 440 was effective in relieving symptoms of PMS (Schellenberg et al. 2012). A recent open-label clinical observational study reported that chasteberry was able to reduce the frequency of migraine attacks in women with premenstrual syndrome (Ambrosini et al. 2013). One trial reported V. agnus-castus extract to be superior to placebo in reducing prolactin secretion, normalising a shortened luteal phase and increasing mid-luteal progesterone and 17β-oestradial levels in latent hyperprolactinaemia. Another found it comparable to bromocriptine for reducing serum prolactin levels and ameliorating cyclic mastalgia (van Die et al. 2013). A questionnaire survey of German gynaecologists on complementary and alternative medicine (CAM) in the treatment of climacteric symptoms found that chasteberry was assessed as ‘effective’ by 17.4% (n = 421) of respondents, 59.9% (n
Chasteberry
Vitex agnus-castus L.
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Premenstrual syndrome:
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