OverviewChasteberry or Vitex, is mostly used in the treatment of premenstrual syndrome, but a list of applications for which there is no clinical evidence includes: hyperprolactinemia, corpus luteum insufficiency, infertility associated with corpus luteum insufficiency, mastodynia, premenstrual tension syndrome (ULTT), symptoms of perimenopause, fibroids, endometriosis (adjuvant therapy), Parkinson's disease, stimulation of milk production, reducing the production of surplus milk in infancy, and acne (McKenna et al., 2001). The chemistry of Vitex (V. Agnuscastus) is still not understood, nor the relationship of chemical components for therapeutic use. Standardized extracts of Vitex have had extensive clinical research. Standardization is usually 0.5% of agnusides fruit extract 20:1. The fruit, leaves and seeds of the plant Vitex have documented the use of traditional medicine, but modernday extracts of focusing only on fruits. Known chemical compounds in fruits are essential oils (0,151,0%), consisting of 73 compounds identified, including 4terpineol, pinene, phellandrene, sabinene, caryophyllene, farnesene oxide of caryophylline E, alloaromadenedrene and spathulenol, and flavonoids, including orientin, isoorientin, xyloside, vitexin and isovitexin (McKenna et al., 2001). Vitex has dopaminergic activity that inhibits the activity of prolactin. It is this activity which is mainly due to therapeutic applications (McKenna et al., 2001). Some of the most remarkable preclinical summary estrogenic activity has been reported for the equivalent of one third of the dose given to humans overiectomized female rats (Eagon et al., 1997). Several parts of the plant Vitex (most of the leaves and fruits) have shown antimicrobial activity or growth inhibitors against Pseudomonas aeruginosa, Escherichia coli, Bacillus subtilis, Staphylococcus aureus, Aspergillus parasiticus, Candida krusei, C. albicans, Penicillium viridactum, Streptococcus faecalis, Trichophyton mentagrophytes, Microsporaum gypseum, M. canis, Shigella sonei, Epidermophyton floccosum and common insect pests (Snow, 1996; Pepeljnjak et al., 1996; and Kustrak et al., 1997). A dopamine agonist action is exhibited by Vitex which then produces a antiprolactin in hypothalamuspituitary axis, however, research has found Vitex not expand the size of the secretion of dopamine (McKenna et al., 2001; Wuttke et al. 1995). Concentrationdependent reduced prolactin secretion in isolated rat pituitary cells in vitro was found using Agnolyt (Wuttke, 1992). CommentsVitex is only the second in popularity with black cohosh for women's health. Although Vitex is generally regarded as a key drug for premenstrual syndrome, also support clinical symptoms of menopause, including women SupportClinical Vitex complaints.Scientific research has been ongoing since the 1930s, with the earliest work in progress on its reputation as a galactogogue by Madusa with your product, Agnolyt (McKenna et al., 2001). BalancingCorpus hormone insufficiency luteum (CLI) is a condition in which blood levels of progesterone are low 3 weeks after the onset of menstruation (less than 1012 ng / ml). The symptoms of menstruation may be long, anovulatory periods (with the resulting infertility), PMS and mastopathy. The underlying cause is believed to hyperprolactinemia (McKenna et al., 2001). Vitex clinical work carried out in various menstrual symptoms, including premenstrual syndrome (PMS), premenstrual tension syndrome (ULTT) and CLI. Because of the similarity of syndromes and symptoms, the groups involved may represent a mixture of these diagnoses.The tolerance and the effect of high doses of Vitex extract was studied in 20 healthy men, 2032. The men were selected for this study, while prolactin levels are lower because fewer women are hormonal changes. The extracts were described as nonalcoholic extracts waterand mostly prepared from nuts thick couples agnuscastus V. (BP1095E1 special extract). The analysis of the results of the lower dose to reduce serum prolactin 24 hours over 15% and 21% on average and extracts the highest dose. Both dopamine agonist and antagonist actions are suspected, the antagonistic actions that take place with the lowest dose of Vitex. The extract was judged to be well tolerated and no significant effects were observed, and only temporary or idiosyncratic adverse effects were observed (Merz et al., 1996). A study of 52 women with latent hyperprolactinemia found that Vitex therapy (20 mg / day) produced lower levels of prolactin and the normalization of the levels of other hormones associated with the menstrual cycle. Vitex has also been found to significantly reduce symptoms of premenstrual syndrome in women who had presented at baseline. No side effects were found in the study, and two of the 17 women became pregnant, Vitex group (Milewicz et al., 1993). In another study of 13 women with hyperprolactinemia and cyclic disorders, a product called Vitex Mastodynon was tested. After three months of the study, prolactin levels were measured and found to have decreased, and some within the normal range of prolactin secretion. The women's menstrual cycle on Vitex therapy was also found to be normalized (Roeder, 1994). The use of Vitex (Agnolyt, 40 drops / day for 3 months) has been tested in an uncontrolled open study of 20 infertile women with no imbalance of prolactin. Prolactin, thyroid hormones and androgens in normal women selected for this study, but all had low progesterone levels on day 20 of the menstrual cycle. At the end of the study, progesterone levels rose to normal ranges in 7 women, and in 4 cases, progesterone levels rose above normal. Furthermore, basal body temperature rose, and women had a long phase of hyperthermia on normal cycles. Two of the women became pregnant, and no side effects (shoring and Katzork, 1987). Doubleblind In one study, placebocontrolled of 52 women with abnormal menstrual cycles and CLI, Vitex extract was administered for 3 cycles (Strotan, 20 mg / day). In the treatment group, the luteal phase had changed from an average of 5.5 days to 10.5 days, and stage of follicle was reduced from 23.8 days to 18.5 days. Furthermore, prolactin levels normalized (previous high), and there were significant increases in both estrogen and progesterone levels compared with placebo. An additional benefit of the study was that the three women who were previously unable to conceive became pregnant (Bubenzer, 1983). A series of large monitoring studies reported drug use Vitex (as drops Agnolyt) (McKenna et al., 2001): Results of a questionnaire reported the use of Vitex (several formulations) of 153 members of the National Institute of Herbal Medicine in England and Ireland. The treatments were reported for premenstrual syndrome (94.1%), perimenopausal complaints (86.3%), female infertility (89.5%), acne and female (79.7%), acne and male (10 , 5%). 98.6% of respondents believe Vitex be very effective or effective for syndromes of hormonal imbalance. The average duration of treatment for PMS = 4.8 months and for menopausal complaints = 7.1 months. The most common preparation used was dye (86.4%), followed by fluid extracts (28.1%) and herbal preparations powder (9.2%). Very few physicians use standardized extracts powder (Christie and Walker, 199798). Agnolyt A multicenter study using cases recorded in 1592 for menstrual disorders and PMS (usually with corpus luteum insufficiency). The mean treatment was 43 drops for 5 months. A good or satisfactory response was reported in 90% of cases. There were 145 patients who have expressed their desire to become pregnant, and 56 of them did. 2.4% of cases of side effects (Keep et al., 1991). Two drugcontrol studies reported using drops Agnolyt. A total of 3162 women were followed, most with some type of menstrual problem. Diagnoses included PMS (1,016 women), the inadequacy of the corpus luteum (734 women), fibroids (320 women) and symptoms of menopause (167 women). The mean treatment was 153 days, using 42 drops daily Agnolyt. Treatment efficacy was observed in 90%, 1% of the side effects experienced (Loch et al., 1991). Use Agnolyt recorded in 1571 women for menstrual problems associated with corpus luteum insufficiency or ovarian dysfunction. Average treatment was 40 drops per day on an empty stomach, and lasted for 135 days. A response rate of almost 90% was recorded with adverse effects in only 1.9% of women (Feldmann et al., 1990). In a followup drug Attleman et al. (1972) on the use of Vitex (Agnolyt) in general and consulting practices of the authors in Germany. More than 2,000 cases analyzed, using Vitex for PMS, menorrhagia, hypermenorrhea (due to uterine fibroids), headaches (to control the use of birth control pills), mastopathia, amenorrhea (primary and secondary), uterine bleeding (juvenile ), bleeding menopause, and infertility. Most treatments for menopause 40 drops per day, after meals. Adverse effects were reported as rare.PMSAn Vitex extract (Ze 440; a daily 20 mg of the extract to native menstrual cycles during 8) was administered to 50 patients with premenstrual syndrome in a prospective multicenter study. Treatment results were monitored using the validated questionnaire Moos menstrual distress (MMDQ), a visual analogue scale (VAS, self) and a global impression scale. The PMS symptoms were found to be reduced by treatment for a significant reduction in MMDQ score of 42.5%. The overall efficacy results was good to excellent (in 38 patients), and the number of days of symptoms of premenstrual syndrome have decreased slightly, from 7.5 to 6 days. There were no differences between patients of oral contraceptives in comparison with others, and without significant side effects were found (Berger et al., 2000). A solid preparation of extract of Vitex was tested again for 3 menstrual cycles in women in a large multicenter study. 1634 patients were administered a questionnaire to more common PMS symptoms, and 93% reported a decrease or disappearance of symptoms of PMS. 85% of physicians reported the efficacy of the treatment, while 81% of patients rated good or very good as or even better. No serious side effects were recorded (Loch et al., 2000). A doubleblind, placebocontrolled, randomized trial of Vitex on 600 (including the placebo groups), women with premenstrual syndrome were reported. Participants were judged using the Menstrual Distress Questionnaire. A significant improvement was found in the sense of nervousness or anxiety symptoms, but otherwise, the authors concluded the effectiveness of Vitex to be better than placebo (soybean). The authors also acknowledged that the study design may have unfairly skewed the results of the differences between the treatment groups and control (Turner and Mills, 1997). In a study published by the premenstrual tension syndrome (ULTT) was conducted in a multicenter, randomized, doubleshaped center involving 105 women. Effectiveness was assessed in 77.1% of Vitex and 60.6% of pyridoxine (by the Clinical Global Impression scale). Although the results were invalid statisitically, the authors support the overall performance benefits Agnolyt (Lauritzen et al., 1997). Another study examined the effectiveness of Agnolyt capsules (of a new preparation at the time) in TTES. The study was randomized, double blind, using 175 mg daily against pyridoxine (vitamin B6, 200 mg / day) in 175 women. Treatment continued for 3 cycles, and qualified with the scale of TTES. In the treatment group, fell TTES points from 15.2 to 5.1 points after treatment, and 11.9 to 5.1 points in the pyridoxine group (reflecting a significant improvement in symptoms). Assessments of patients were 36.1% for Vitex versus 21.3% of pyridoxine, and medical evaluations Vitex 24% reported excellent compared with 12.1% of pyridoxine (Reuter et al., 1995) . In a study of 1542 women Vitex drug control is used to treat various disorders such as premenstrual syndrome, corpus luteum insufficiency, uterine fibroids, and the symptoms of menopause. 20,120 was used Agnolyt falls by an average of 42 drops per day over a period of 7 days to 16 years. Symptom improvement began after an average of approximately 25 days, and the dissatisfaction rate was only 4.5% for consultants and patients (Dittmar et al., 1992). Madusa AcneThe company is the manufacturer of Agnolyt one of the most popular Vitex preparations in Europe. In its prospectus (1994) describe several clinical studies. One use for the experiments are recorded for the treatment of acne. In one, Agnolyt was used to treat 118 patients in 1224 months. This treatment group was compared with a group of 43 patients who received conventional treatment. Vitex end of the study group that have healed faster and had fewer relapses than those of conventional treatment. Men and women are described as candidates for the treatment of acne in the brochure Vitex Madusa (McKenna et al., 2001). LactationVitex has historically been used to carry lactation in women who are having trouble producing milk. The exact mechanisms of hormones involved in lactation are complex and not fully understood, and similarly, the use of Vitex to breastfeeding has been controversial because of our lack of understanding of their actions. Breastfeeding women with high prolactin levels and suppressed ovulatory function often show symptoms associated with follicular development, corpus luteum disorganized and inadequate. More than half of all women with menstrual problems (62%) also have abnormally high levels of prolactin. The reverse is also true that women are almost always hyperprolactinemic menstrual disorders (B Hnert, 1997). PainHalaska Seno et al. (1998) Vitex extract administered to patients with a doubleblind mastodynia, placebocontrolled. Two parallel groups of 50 patients were treated for 3 menstrual cycles (60 drops of Vitex extract daily or placebo). The intensity of breast pain was found to decrease more rapidly in Vitex treatment groups versus placebo, and tolerability of treatment was found to satisfactory.In doubleblind a randomized, placebocontrolled, multicenter using Vitex (Mastodynon N ) has been tested in women with cyclical mastalgia. 120 women (ages 2340) who had presented with breast pain for 3 or more cycles (for 3 or more days of cycle) in the study. A parallel group design and technology doubledummy was used in the study, using a tablet and form of liquid extract of Vitex, and matching placebos. Prolactin levels were measured during the study, and participants were evaluated with a linear analog scale (VAS). Both the form of tablets (3.7 ng / ml, p = 0.015) and fluids (4.35 ng / ml, p = 0.039) of Vitex produced significant decreases in prolactin levels in the subjects. Vitex Liquid preparation was found to produce changes more quickly than the tablet, and none of the preparations for the changes in FSH, LH and progesterone. The symptoms of headache, abdominal pain, psychological symptoms, and a tendency to edema were reduced in the treatment groups compared with placebo, and the number of days without pain increased by 15% in treatment groups compared with 8% in the placebo group. Estradiol levels were found to increase the treatment groups (25.7 pg / mL for the tablet, and 28.5 pg / NL for liquids) compared with placebo (10.8 ng / ml). Besides this study, small studies have reported good results for the use of Vitex in mastalgia treatment (Kubista et al., 1983 and Wuttke et al., 1995). / Security DosageMost studies of black cohosh have used brand names as Agnolyt (liquid or capsules) Strotan or Mastodyne. Dosage recommendations for the various preparations are (McKenna et al., 2001): Agnolyt liquid (58% alcohol, 100 g of solution containing 9 g of dye from berries (1.5)) 40 drops a day after meals for several months. Agnolyt capsule (175 mg dried berries, alcoholic extract 1:5) once daily for several months.Standardized juice powder (175 mg 20:1 fruit extract, standardized to agnusides 0.5%) one capsule a day, which is a common preparation in the U.S. and is similar to the capsules formulation.Strotan Agnolyt capsule (20 mg of alcohol extract, 5070% v / v) daily.Mastodyne time (ethanolwater extract containing 55.4% ethanol by volume) 60 drops side effects daily.Serious have been cited for Vitex, but the rashes and itching have been reported. Although there are no contraindications are found in the monographs of the German Commission E, others have expressed concern the use of Vitex in conjunction with oral contraceptives. Due to recently discovered the dopamine agonist activity of Vitex, can be a problem with people taking Vitex which are also dopamine antagonists (McKenna et al., 2001). A review of the literature cites various opinions about the use of Vitex to pregnancy (especially in the initial phase), but in general is usually contraindicated. Reports of possible negative reactions to Vitex in women undergoing IVF have been cited. Vitex use during lactation has also been of mixed opinion (McKenna et al., 2001). References1.Attelman H, K Bends, Hellenkemper H, et al. Agnolyt in treating gynecological complaints. Zeitschrift f r Praklinishche Geriatrie. 1972, 2:239 (translation) .2. Berger D, Schaffner W, Schrader E, Meier B, Brattstrom A. Efficacy of Vitex agnus castus L. extract Ze 440 in patients with premenstrual syndrome (PMS). Arch Gynecol Obstet. 2000 Nov; 264 (3): 1503 .3. B Hnert KJ. Clinical study on Vitex for menstrual disorders. Quarterly Report of Natural Medicine (Spring) 1997; 1921.4.Christie S, Walker, AF. Agnuscastus Vitex L. (1) a review of its therapeutic use traditional and modern (2) the current use of a survey of professionals. The European Journal of 199,798 herbal medicine, 3: 29 45.5.Dittmar FW, Bohnert KJ, Peeters M. et al. The treatment of premenstrual syndrome with the PPP. Gyn Therapiewoche kologie 1992, 5:6068 (translation) .6. Eagon CL, Elm MS, Teepe AG, Eagon PK. Medical botany: estrogenicity in rat uterus and liver. Proceedings of the American Association for Cancer Research, 1997, 38: 293 (1967 summary) .7. Feldman, HU, Albrechet M, Lamertz M. et al. The treatment of corpus luteum insufficiency and premenstrual syndrome. Experience in a multicenter study on the conditions of clinical practice. Gyne 1990; 12:422425 (translation) .8. Halaska M, Raus K, Beles P, Martin A, Paithner KG. Treatment for cyclical breast pain using a Vitex agnus extract: results of a comparison with placebo doubleblind. Ceska Gynekol. 1998 Oct; 63 (5): 38,892 .9. Krustrak D Kuftinec J., Blazevic D. The composition of essential oil Vitex agnuscastus. Medica1992 Plant, 58 (Suppl 1): A681.10.Kubista E, Muller G, J. Spon conservative treatment of mastopathy. Zentralbl Gynakol. 1983, 105 (18): 115.362 .11. Lauritzen CH, Reuter HD, Repgen R. et al. Treatment of premenstrual tension syndrome with Vitex agnuscastus. Controlled, double blind versus pyridoxine. Phytomedicine 1997, 4: 183189.12.Loch EG, Bohnert KJ, Peeters M. et al. The treatment of menstrual disorders with Vitex tincture agnuscastus. Der Fraunarzt 1991, 32:867870 (translation) .13. Loch EG, Selle H, N. Boblitz treatment of premenstrual syndrome with a formulation containing Vitex agnus plant. J Women # 39; s Health Gend Based Med 2000 Apr; 9 (3): 31.520 .14. McKenna DJ, Jones K, Hughes K (eds). Botanical drugs: a desk reference for major herbal supplements. Haworth Press: New York15.Madaus Co. (1994). Agnolyt hormone imbalance naturally. Prospectus and the summary of research (translation) .16. Merz PG, Gorkow C, Schrodter A, Rietbrock S, Sieder C, Loew D, DericksTan JS, Taubert HD.The effects of a special Agnus castus extract (BP1095E1) on prolactin secretion in healthy men. Exp Clin Endocrinol Diabetes. 1996, 104 (6): 44.753 .17. Milewicz A, Gejdel E, Swor H, K Sienkiewicz, Jedrzejak J, T Teuch, Schmitz H. Vitex Agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. The results of a randomized controlled trial doubleblind. Arzneimittelforschung. 1993 Jul; 43 (7): 7526 .18. Pepeljnjak S, A. Antolic Kustrak D. antibacterial and antifungal activities of extracts of Vitex L. agnuscastus. Acta Pharmaceutica (Zagreb) 1996, 46: 201206.19.Propping, D and T. Katzorke. 1987. The treatment of corpus luteum insufficiency. Zeitschrift f r Allgemeinmedizin 63:932933 (English translation) .20. Keep D., Bohnert KJ, Peeters M. et al. Agnuscastus Vitex treatment of gynecological syndromes. Therapeutikon 1991, 5:581585 (translation) .21. Reuter HD, Bohnert KJ, Schmidt U. The treatment of premenstrual syndrome with Vitex agnus: doubleblind controlled with pyridoxine. Zeitschrift f r Phytotherapie 1995, 7 (Abstracts volume): 7 (summary translation) .22. Roeder DA. Disorders Vitex agnuscastus cyclic therapy. F; rPhytotherapie1994 Zeitschrift, 15:155159 (English abstract) .23. Snow JM. Agnuscastus Vitex L. (Verbenaceae). Protocol Journal of Botanical Medicine (Spring) 1996; 2023.24.Turner S, Mills S. Doubleblind view a herbal remedy for premenstural syndrome: a case study. Complementary therapies in Medicine1993; 1:7377.25. Wuttke, W. Untersuchungen Zellbiologische MIMT Agnolyt Praparation (NH 246, NH 247). Keit Nlich Mittleilung Pers 1992; 8.7 (cited in Madaus Co., 1994) .26. Wuttke W, Gorkow C, Jarry H. Dopaminergic compounds in Vitex agnuscastus in: Loew, D. and N. Rietbrock (eds.), one klinischer Phytopharmaka Forschung und Anwendung. , 1995; Darmstatd, Germany: Steinkopff Verlag. 8191.27.Wuttke W, Splitt G, Gorkow C. et al. Treatment of cyclical mastalgia with Agnus castus: results of a randomized, placebocontrolled, doubleblind. Geburtshilfe und Frauenheilkunde 1997; NOTE 57:569574 (translation). EDITOR: This monograph can be found in the guide for health care of dietary supplements (Lippincott Williams Wilkins) Shawn M. Talbott, PhD and Kerry Hughes, MS. br br br br
