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Chamomile

Scientific Name(s): Chameamelum nobile (L.) All., Matricaria recutita L.
Common Name(s): Common chamomile, English chamomile, Garden chamomile, Genuine chamomile, German chamomile, Hungarian chamomile, Lawn chamomile, Roman chamomile, Scotch chamomile, Sweet chamomile, True chamomile, Wild chamomile

Medically reviewed by Drugs.com. Last updated on Apr 4, 2024.

Clinical Overview

Use

Chamomile is used topically in skin and mucous membrane inflammations and skin diseases. It can be inhaled for respiratory tract inflammations or irritations; used in baths as irrigation for anogenital inflammation; and used internally for GI spasms and inflammatory diseases, and applied topically as an analgesic and spasmolytic. Preliminary data also indicate potential benefit for maintaining remission of ulcerative colitis, improving glycemic and lipid parameters in type 2 diabetes, and improving adaptive and social functioning in children with autism. However, clinical trials supporting any use of chamomile are limited.

Dosing

Chamomile has been used as a tea for various conditions and as a topical cream, gel, or oil. Typical oral doses are 1.1 to 15 g/day. Gargles made from 8 g chamomile flowers in 1,000 mL of water have been used in clinical trials.

Contraindications

The use of chamomile-containing preparations is contraindicated in persons with hypersensitivity to ragweed pollens.

Pregnancy/Lactation

Unreferenced adverse reactions have been cited. Avoid use during pregnancy. No clinical data are available on use during lactation.

Interactions

See Drug Interactions section.

Adverse Reactions

Use of the tea and essential oil has resulted in anaphylaxis, contact dermatitis, and other severe hypersensitivity reactions. Cross-reactivity to asters, chrysanthemums, ragweed, and other members of the Asteraceae family exists.

Toxicology

Animal studies report low toxicity with oral ingestion of chamomile.

Scientific Family

Botany

M. recutita (German chamomile) grows as an erect annual, and Chamaemelum nobilis (Roman chamomile) is a slow-growing perennial. The fragrant flowering heads of both plants are collected and dried for use as teas and extracts.1, 2 Synonyms for M. recutita are Chamomilla chamomilla (L.) Rydb., Chamomilla recutita, Matricaria chamomilla, and Matricaria suavoelens, whereas synonyms for Chamaemelum nobile (L.) All, a synonym is Anthemis nobilis L. Chamomile is a member of the daisy (Asteraceae) family that includes aster, chrysanthemum, feverfew, ragweed, sunflower, tansy, and yarrow.

History

Known since Roman times for their medicinal properties, both plants have been used as antispasmodics and sedatives in the treatment of digestive and rheumatic disorders. Teas have been used to treat parasitic worm infections, and as hair tints and conditioners. The volatile oil has been used to flavor cigarette tobacco.

Chamomile has been used as a skin wash to cleanse wounds and ulcers, and to increase the sloughing of necrotic tissue and promote granulation and epithelialization. Chamomile is also reported to have antibacterial, anti-inflammatory, astringent, and deodorant properties. Various formulations of chamomile have been used to treat colic, cystitis, fever, flatulence, and vomiting.3, 4

Chemistry

Both plants contain similar chemical compounds. Chamomile tea contains 10% to 15% of the plant's essential oil. The blue-colored volatile oil is a complex mixture of sesquiterpenes (alpha-bisabolol, bisbolol-oxides A and B, and farnesene), sesquiterpenelactones (including the blue compound chamazulene), and acetylene derivatives.2

Phenolic compounds found in the flowers include hydroxycinnamic acid derivatives, caffeic acid, and flavonoids (apigenin, luteolin, and chamaemeloside).4, 5 A nonpeptide, tachykinin NK1 receptor antagonist has been identified in Matricaria flowers.6 Coumarin has also been identified in chamomile.7, 8

Uses and Pharmacology

German chamomile flower is approved by the German Commission E for use as an inhalant in skin and mucous membrane inflammations, bacterial skin diseases, including those of the oral cavity and gums, and respiratory tract inflammations and irritations. The flower has been approved for use in baths, as irrigation for anogenital inflammation, and for use internally to treat GI spasms and inflammatory diseases.(9)

Analgesic

As a follow up to significant beneficial results observed with topical application of chamomile oil in patients with severe carpal tunnel syndrome, investigators conducted a double-blind, randomized, placebo-controlled trial (n=86) in patients with mild and moderate carpal tunnel syndrome to determine the effects of chamomile oil on symptoms and functional status. After 4 weeks topical application of 1% chamomile oil (standardized to 0.227 mg/g apigenin) to the palmar area of the wrist, significant improvements were observed in symptom severity (P=0.017), functionality (P=0.0001), dynamometry (P=0.04), and compound latency (P=0.035) with chamomile compared to placebo.(58)

Anti-inflammatory

Chamomile has purported anti-inflammatory effects, but there are no published clinical trials supporting the findings of animal experiments. Chemical constituents of chamomile, such as bisabolol, chamazulene, and the flavonoids apigenin and luteolin, possess anti-inflammatory properties.(10, 11, 12, 13)

Antimicrobial

Because of the association of Helicobacter pylori with gastritis, peptic ulcer, and gastric cancer, in vitro experimentation was conducted in H. pylori-infected gastric epithelial cells with 24 medicinal plants indigenous to Pakistan to evaluate their effect on secretion of interleukin (IL)-8 and generation of reactive oxygen species (ROS) in order to assess anti-inflammatory and cytoprotective effects. Although no significant direct cytotoxic effects on the gastric cells or bactericidal effects on H. pylori were found, chamomile flower extract was observed to have mild inhibitory activity on IL-8 at 50 and 100 mcg/mL and significant suppression on ROS generation in H. pylori-infected gastric cells.(55)

Antispasmodic

Chamomile infusions have been used traditionally as GI antispasmodics despite the lack of rigorous trials to support this use. A small trial of a tea containing chamomile and other herbs was effective in treating infantile colic, but the volume of tea required for effect limited its usefulness.(14) Chemical components in chamomile (bisabolol and flavonoids) have demonstrated antispasmodic effects in animal experiments.(15, 16) The use of a chamomile preparation in children with acute, noncomplicated diarrhea reduced the duration of the diarrheal episode compared with placebo(17) and reduced stool frequency.(18)

Chamomile has also been used in traditional Persian medicine as a treatment for enuresis; spasmolytic activity on the detrusor muscle may attenuate overactivity. To evaluate use of chamomile for enuresis, children with daytime or nocturnal enuresis were enrolled in a double-blind, placebo-controlled randomized trial in Iran (n=80). According to traditional use, chamomile oil was applied topically to the perineal and suprapubic area nightly for a total of 6 weeks. Compared to baseline and placebo, topical chamomile application significantly improved mean frequency of enuresis at 2 and 6 weeks (P<0.001 each). No significant correlation was found between gender and outcome, and no adverse effects were observed.(59)

Autism

Data from a small, prospective, open-label trial (n = 40; 87.5% boys) in children with autism spectrum disorder showed significant improvement in adaptive functioning and overall behavior after 26-week administration of a supplement containing luteolin from chamomile (100 mg), quercetin (70 mg) and the quercetin glycoside rutin (30 mg); 1 capsule per 10 kg of weight was given daily with food. Changes in raw and age-equivalent scores were significant for all domains except communication raw scores and were greater than those expected by maturation per se. No major adverse effects were documented; however, 6 children from the original 50 enrolled withdrew due to increased irritability caused by the formulation.(48)

CNS/sensory effects

Animal data

Apigenin extracted from chamomile demonstrated inhibition of benzodiazepine binding in rat brain membranes, it did not display anxiolytic effects in whole rat models, indicating that CNS activity of chamomile is not mediated through this mechanism.(27)

Clinical data

In a small, blind, crossover, placebo-controlled study, aromatized chamomile oil demonstrated a sedative effect as well as a positive effect on mood.(13) Changes in alpha wave activity during chamomile oil inhalation were demonstrated using electroencephalogram mapping.(28) Diminished withdrawal symptoms were achieved when chamomile was coadministered with morphine.(29)

In a study investigating the efficacy of essential oils in reducing maternal anxiety during labor, the use of chamomile aromatherapy resulted in a reduction in opioid use, with less than 1% reporting minimal adverse reactions.(30) An 8-week, double-blind, randomized clinical trial observed statistically and clinically significant anxiolytic effects in adults (n = 49) with mild to moderate generalized anxiety disorder (GAD) who took chamomile versus placebo (P = 0.047). Pharmaceutical grade chamomile, standardized to 1.2% apigenin, was initiated at 220 mg once daily and increased weekly in nonresponders (up to 50% reduction in anxiety score) to a maximum of 1,100 mg. Timing of drug administration was not standardized. Over time, a significant improvement in mean total Hamilton Anxiety Rating (HAM-A) score was seen with chamomile. Although the study was powered to detect only large differences in secondary outcomes, clinically beneficial trends in additional anxiety and well-being scores were noted for chamomile. No significant differences in adverse events were observed between groups. Despite study limitations, these data identify chamomile as a safe and effective potential alternative therapy in patients with mild GAD.(49) Long-term use of chamomile was shown to be safe over a 38-week period in adults with GAD. Responders to chamomile supplementation during a 12-week open-label lead-in were randomized to either chamomile (1,500 mg/day; corresponding to 18 mg/day of total apigenin-7-glycosides) or placebo for a 26-week double-blind continuation period. Although no significant difference was observed in relapse rate or time to relapse during the follow-up period, significant improvements were seen in symptom occurrence (P=0.0032) and overall well-being (P=0.013), specifically in anxiety scores on well-being (P=0.0094), for those patients who continued on chamomile for the entire 38-week study period. Adverse events potentially related to treatment were mild with an incidence that did not differ between groups.(57)

Diabetes

Effectiveness of chamomile tea on glycemic and lipid parameters in patients with type 2 diabetes was evaluated in a single-blind, randomized, placebo-controlled trial (n = 64) conducted in Iran. Chamomile tea 3 g per 150 mL prepared as a 10-minute infusion without sugar or milk was given 3 times daily immediately after meals for 8 weeks. Statistically significant improvements were observed at 8 weeks with chamomile tea compared to controls, respectively, for the mean difference in serum insulin (−5.27 vs 0.34 microunits/dL; P < 0.001), HbA1c (−0.43 vs 0.01%; P = 0.03), insulin resistance measurements (−2.81 vs 0.31, P < 0.001), total cholesterol (−17.25 vs 4.06 mg/dL; P = 0.001), LDL (−8.9 vs 2.9 mg/dL; P = 0.05), and triglycerides (−38.62 vs 7.12 mg/dL; P < 0.001). Compared to baseline, all of these parameters also improved significantly in the chamomile tea group in addition to the mean difference in serum glucose (−20.4 mg/dL; P = 0.004); whereas in the control group, serum insulin levels worsened significantly (0.34 microunits/dL; P < 0.001). No adverse events were reported.(54)

Estrogenic activity

Chamomile tea is reportedly among the most common herbs used for morning sickness (as a tea made from the flowers). However, there are no reports on the safety of chamomile during pregnancy.(23) Chamomile was identified as one of the 4 most common herbs used for pregnancy-related nausea/vomiting by certified or licensed midwives in state-wide surveys conducted in California, Texas, and North Carolina.(63) Chamomile also is commonly used in menopause with a perceived high efficacy rate and few perceived adverse reactions.(24)

An ethanolic extract of chamomile containing primarily apigenin demonstrated weak estrogenic and progestational activity in an in vitro tissue system.(25)

An aqueous extract of chamomile demonstrated antiestrogenic activity on breast cell tissue and demonstrated a nonproliferative effect on cervical cancer cells in a study designed to measure the stimulatory effect of chamomile on bone osteoblasts.(26)

Insomnia

In a patient-blind, randomized, placebo-controlled trial conducted in 195 elderly participants (mean age, 70 years) living in a day care nursing home in Iran, administration of chamomile extract capsules 400 mg daily for 28 days led to significant improvements in mean sleep quality scores at day 28 (P=0.007) and 2 weeks after treatment discontinuation (P=0.002). Of the 7 sleep components, 5 were significantly improved by chamomile compared to placebo over the course of the study (eg, subjective sleep quality, sleep disturbances, daytime dysfunction, habitual sleep efficiency, sleep latency). Sleep duration and the use of sleep medication remained similar between groups. No adverse events were reported.(67)

An earlier 4-week double-blind, randomized, placebo-controlled pilot study was conducted among 34 younger patients 18 to 65 years of age with at least a 6-month history of chronic primary insomnia. Although insomnia and sleep quality index scores favored chamomile, no statistically significant difference was observed in the primary (total sleep time, sleep efficiency) or other sleep diary measures (sleep latency, wake after sleep onset, number of awakenings, sleep quality) for chamomile extract (560 mg/day for 28 days) compared to placebo. Similarly, although daytime fatigue and mood (depression, anxiety indexes) subscales improved slightly with chamomile and worsened slightly with placebo, the difference was not statistically significant between groups. Adverse events were also similar between groups.(68)

The Veteran’s Administration and Department of Defense (VA/DoD) clinical practice guideline for the management of chronic insomnia disorder and obstructive sleep apnea (2019) suggest against the use of chamomile for the treatment of chronic insomnia disorder (weak).(64)

Mouth, mucositis, and gingival bleeding

Use of chamomile in radiation- and chemotherapy-induced mucositis has been studied in several trials with conflicting results. Prophylactic use of chamomile gargles or mouth rinses prevented the occurrence, delayed the onset, and reduced the intensity of mucositis in 2 trials(31, 32); in another trial, chamomile was no more effective than placebo(33) or standard treatment.(66)

A randomized, double-blind, comparator trial in adult patients with periodontal disease (gingivitis or chronic periodontitis) found a chamomile 5% mouth rinse to significantly reduce the bleeding index (P < 0.001) and to be as effective as chlorhexidine 0.12%.(51)

A double-blind, randomized placebo-controlled trial investigated the efficacy of topical chamomile in patients with oral lichen planus (n=60). Most patients presented with buccal mucosa lesions (98%) with the remainder fairly evenly distributed between tongue or gum lesions. After 4 weeks of applying 0.5 mL of the 2% Chamaemelum nobile gel preparation to the symptomatic area 3 times daily, patient scores for pain, burning, and itching were all significantly improved from baseline (P<0.001 each) but not with placebo. Additionally, quality of life clinical characteristics as measured by Thongprasom and the Oral Health Impact Profile-14 were significantly improved with administration of chamomile (P<0.001 each), which was in contrast to placebo. Overall, more patients in the chamomile group vs placebo showed some response (92% vs 17%) with complete resolution experienced by 19.2% vs 0%, respectively. No adverse events were observed in either group.(56) In contrast, application of 2% C. nobile gel twice daily for 1 month to the oral cavity of patients with burning mouth syndrome did not provide any significant benefit in pain, severity of dry mouth, or oral health compared to placebo in a double-blind, randomized, crossover trial (n=57).(60)

Of 31 complementary and alternative medicine (CAM) remedies, chamomile as well as arnica were the most often recommended remedies for dental issues (64%) made by German dentists and maxillofacial surgeons according to a prospective, cross-sectional survey (N=250). Perceived effectiveness was rated higher among CAM proponents than opponents.(65)

Osteoarthritis

Safety and efficacy of topical chamomile oil was evaluated in a randomized, blind, placebo-controlled trial (n = 99) in Iran that enrolled adults with knee osteoarthritis. Compared to diclofenac 1% topical gel and placebo, 1.5 mL of chamomile oil applied topically 3 times daily for 3 weeks significantly reduced the number of acetaminophen tablets used for analgesia (P = 0.001). However, no significant differences were observed between groups in the questionnaire domains of pain, physical function, and stiffness.(53)

Premenstrual syndrome

In a comparator randomized, double-blind trial conducted in 90 female Iranian students with premenstrual syndrome diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed), chamomile 100 mg 3 times daily x 2 menstrual cycles was found to reduce anger and irritability significantly more than mefanamic acid (P < 0.05). Additionally, mean reduction in overall symptom intensity and reduction in psychological symptoms were significantly better with chamomile than mefanamic acid (P < 0.05, P < 0.001, respectively).(50) Pain scores for cyclical mastalgia in premenopausal women was also found to be significantly reduced with administration of chamomile for 2 months compared to placebo (P=0.004) in a double-blind, randomized, placebo-controlled trial (n=55).(61)

Skin

Eczema

Commercial preparations of chamomile-containing creams are widely available despite the lack of trials to support their use.

In a study designed to evaluate the effect of massage with chamomile essential oil versus massage only, no difference was found for the 2 study arms. Additionally, further use of the essential oil after the study period showed a decline in eczema severity, suggesting possible sensitization to the oils over time.(19)

In another trial, chamomile cream was as effective as hydrocortisone 0.25% cream in the treatment of atopic eczema.(9) A more recent trial using a nonallergenic chamomile extract showed that chamomile extract was slightly superior to hydrocortisone 0.5%, but only marginally better than placebo.(20)

Radiation dermatitis

In a study designed to investigate the efficacy of chamomile cream in acute radiation dermatitis, no difference was found between chamomile and almond creams.(21) Furthermore, review of the data did not reveal any additional trials; therefore, the use of chamomile cream for this condition is discouraged.(22)

Ulcerative colitis

A 12-month randomized, double-blind, active-controlled trial (n = 96) found no significant difference in relapse-free time, endoscopy, or fecal biomarkers in ulcerative colitis (UC) patients in remission treated with the gold standard, mesalazine, or a combination of dry extract of chamomile flowers (70 mg), myrrh (100 mg), and coffee charcoal (50 mg). Overall relapse rates were 53% and 45% in the herbal group versus the mesalazine group, respectively, and no significant differences were found between the 2 groups in Colitis Activity Index scores. This study describes first evidence of a potential non-inferior treatment to the gold standard treatment for UC.(47)

Dosing

Chamomile has been used as a tea for various conditions and as a topical cream or oil. Typical oral doses are 1,1 to 15 g/day. Gargles made from 8 g chamomile flowers in 1,000 mL water have been used in trials.31

Pregnancy / Lactation

Use during pregnancy should be avoided. Poorly documented adverse reactions have been reported (eg, abortifacient effects, menstrual cycle irregularities, uterine stimulation with excessive use).(23, 34) Extracts of chamomile have demonstrated weak estrogenic activity(25, 26) during pregnancy.

Chamomile was identified as one of the 4 most common herbs used for pregnancy-related nausea/vomiting by certified or licensed midwives in state-wide surveys conducted in California, Texas, and North Carolina.(63)

No clinical data are available on the use of chamomile during lactation.

Interactions

Warfarin: Chamomile may enhance the anticoagulant effect of warfarin. Monitor therapy.(7)

Chamomile drug interactions (more detail)

Adverse Reactions

Allergic reactions to chamomile are commonly reported. Hypersensitivity reactions include anaphylaxis, dermatitis, GI upset, lacrimation, and sneezing.38, 39, 40, 52, 62 In large amounts, the dried flowering heads are reported to be emetogenic.41 Anaphylaxis resulting from chamomile-containing enemas42 and chamomile tea have been documented62 as well as allergic conjunctivitis caused by chamomile-containing eye drops.43

Manifestations of allergy are suggested to be dependent on the route of ingestion. Asthma, bowel cramps, diarrhea, and vomiting related to oral intake via tea have been reported; inhalation of the essential oil predominantly manifests as asthma.44

Cross-reactivity is reported among people allergic to ragweed, asters, chrysanthemums, and other members of the Asteraceae family.45

Toxicology

The toxicity of bisabolol was low following oral administration in animals, with oral median lethal dose (LD50) approximately 15 mL/kg in rats and mice. In a 4-week subacute toxicity study, the administration of bisabolol (1 to 2 mL/kg body weight) to rats did not cause toxicity. No teratogenic or developmental abnormalities were noted in rats and rabbits after long-term administration of bisabolol 1 mL/kg.46

Index Terms

References

Disclaimer

This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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