FROM NATURAL STANDARD
Catherine Ulbricht, PharmD, Column Editor
Lavender (Lavandula angustifolia Miller)
Ethan Basch, MD
Ivo Foppa, MD, PhD
Richard Liebowitz, MD
Jamie Nelson, PharmD
Michael Smith, MRPharmS, ND
David Sollars, MAc, HMC
Catherine Ulbricht, PharmD
Ethan Basch is affiliated with the Natural Standard Research Collaboration. Ivo
Foppa is affiliated with Harvard University. Richard Liebowitz is affiliated with Duke
University. Jamie Nelson is affiliated with the University of Rhode Island. Michael
Smith is affiliated with the Canadian College of Naturopathic Medicine. David Sollars
is affiliated with the New England School of Acupuncture. Catherine Ulbricht is affili
ated with Massachusetts General Hospital. All are members of Natural Standard Re
search Collaboration (www.naturalstandard.com).
The information in this monograph is intended for informational purposes only, and
is meant to help users better understand health concerns. Information is based on re
view of scientific research data, historical practice patterns, and clinical experience.
This information should not be interpreted as specific medical advice. Users should
consult with a qualified healthcare provider for specific questions regarding therapies,
diagnosis and/or health conditions, prior to making therapeutic decisions.
Copyright 2003 Natural Standard Inc. Reprinted with permission.
Journal of Herbal Pharmacotherapy, Vol. 4(2) 2004
Digital Object Identifier: 10.1300/J157v04n02_07 63
ABSTRACT. An evidence-based systematic review including scien
tific evidence, expert opinion, folkloric precedent, history, pharmacol
ogy, kinetics/dynamics, interactions, adverse effects, toxicology, and
[Article copies available for a fee from The Haworth Document Deliv
ery Service: 1-800-HAWORTH. E-mail address: <docdelivery@haworthpress.
com> Website: <http://www.HaworthPress.com>]
KEYWORDS. Lavender, Lavendula angustifolia Miller, limonene, perillyl
SYNONYMS/COMMON NAMES/RELATED SUBSTANCES
Common lavender, English lavender, garden lavender, Lavandula
burnamii, Lavandula dentate, Lavandula dhofarensis, Lavandula latifolia,
Lavandula officinalis L., Lavandula stoechas, limonene, perillyl alcohol,
pink lavender, POH, true lavender, white lavender.
CLINICAL BOTTOM LINE/EFFECTIVENESS
Lavender is native to the Mediterranean, the Arabian Peninsula, Rus-
sia, and Africa. It has been used cosmetically and medicinally through-
out history. In modern times, lavender is cultivated around the world
and the fragrant oils of its flowers are used in aromatherapy, baked
goods, candles, cosmetics, detergents, jellies, massage oils, perfumes,
powders, shampoo, soaps, and tea. English lavender (L. angustifolia)is
the most common species of lavender used, although other species are in
use, including Lavandula burnamii, L. dentate, L. dhofarensis, L. latifolia,
and L. stoechas.
64 JOURNAL OF HERBAL PHARMACOTHERAPY
Many people find lavender aromatherapy to be relaxing, and it has
been reported to have anxiolytic effects in several small, methodologi
cally flawed trials. Overall, the weight of the evidence suggests a small
positive effect, although additional data from well-designed studies are
required before the evidence can be considered strong.
Lavender aromatherapy is also used as a hypnotic, although there is
insufficient evidence in support of this use.
Small phase I human trials of the lavender constituent perillyl alcohol
(POH) for cancer have suggested safety and tolerability (up to 1200 mg/
four times/day), although efficacy has not been demonstrated.
Scientific Evidence for Common/Studied Uses
Historical or Theoretical Uses that Lack Sufficient Evidence
Acne, alopecia, analgesia, angioprotectant, anticolic, anticonvulsant,
antidepressant, antiflatulant, antifungal, anti-inflammatory,
antipyretic, antiseptic, anxiety, appetite stimulant,
asthma, balenotherapy (functional circulatory disorders), cholagogue,
choleretic, chronic bronchitis, ciatrizant, cordial, diabetes,
douche, emmenagogue, exercise recovery, gas, hangovers, hyptension,
infertility, insect repellent, insomnia,
lice, migraine, non-tubercular
parasitic infection, psychosis, rheumatism,
Roehmheld’s syndrome, rubefacient, toothache, varicose veins, vomit
Expert Opinion and Historic Precedent
Lavender is rich in volatile oils and has been used for centuries both
as a fragrance and medicinal herb. Linen bags containing lavender
flowers were commonly placed under pillows for their alleged soporific
Lavender is thought by some experts to possess antibacterial proper
ties. Currently, lavender oil is often used as an aromatherapeutic anxio
Monograph from Natural Standard 65
Perineal discomfort following childbirth (bathing)
Cancer (oral perillyl alcohol [POH])
lytic and hypnotic, including in the hospital setting.
lavender flowers have been used for similar indications.
Brief Safety Summary
Likely Safe: When consumed in amounts commonly found in foods and
beverages (received Generally Recognized as Safe [GRAS] status for food
use in the United States), or when used in recommended oral/topical doses.
Possibly Unsafe: When used concomitantly with central nervous system
depressants, due to potential additive effects.
Recommended doses are based on those most commonly used in
available trials, or on historical practice. These doses have not necessarily
been shown effective. Anecdotal dosing regimens are based on traditional
health practice patterns and/or expert opinion. With natural products it is
often not clear what the optimal doses are to balance efficacy and safety.
Preparation of products may vary from manufacturer to manufacturer,
and from batch to batch within one manufacturer. Because it is often not
clear what are the active components of a product, standardization may
not be possible, and the clinical effects of different brands may not be
Lavender products are not standardized in the United States.
Each species of lavender has unique chemical constituents and ac
The flowers are the part of lavender most often used medicinally.
Adult Dosing (18 Years and Older)
Tea: One to two teaspoons of the herb taken as a tea (based on anecdote
and expert opinion). The tea can be made by steeping 2 U.S. teaspoons (10
grams) of leaves in 250 mL (1 cup) boiling water for 15 minutes.
66 JOURNAL OF HERBAL PHARMACOTHERAPY
Oral Perillyl Alcohol (POH): In preliminary (phase I) cancer trials,
doses between 800-1200 mg/m
four times/day in a 50:50 POH:soybean
oil preparation were tolerated with minimal adverse effects (efficacy has
not been demonstrated).
Aromatherapy: Two to four drops in 2-3 cups boiling water; inhale va
pors. Aromatherapy can be administered intermittently or daily as needed
(based on anecdote and expert opinion).
Bath Additive: For perianal discomfort after childbirth, 6 drops of laven
der oil has been studied as a bath additive (no specific brand).
wishing to use the whole flower may add 1/4 to 1/2 cup of dried laven-
der flowers to hot bath water (based on anecdote and expert opinion).
Massage Therapy: One to four drops per tablespoon of base oil (based
on anecdote and expert opinion).
Pediatric Dosing (Younger Than 18 Years)
Insufficient data available.
There have been rare reports of sensitization after topical use of lav-
Lavender has been reported to exert ‘narcotic-like’ effects in both an
Caution should be exercised in patients with known allergy/hyper
sensitivity to lavender. Persons with allergy to lavender may experience
mild local skin reactions after topical use of lavender oil.
General: In recommended doses, lavender is generally considered to be
well-tolerated, with minimal adverse effects.
Monograph from Natural Standard 67
Dermatologic: There have been case reports of mild dermatitis follow
ing the use of topical lavender oil.
One individual developed an itchy
dermatitis on his face after using lavender oil on his pillow.
ing subsequently confirmed a positive allergy to lavender. There have been
reports of photosensitization and changes in skin pigmentation after the use
of topical products containing lavender oil.
Neurologic/CNS: Central nervous system depression has rarely been re
ported with aromatherapy,
and additive narcotic effects have been noted
in rats when taken orally concomitantly with barbiturates or chloral hy
Hematologic: Reversible neutropenia has been noted after high oral
doses of perillyl alcohol (POH), a monoterpene constituent of lavender, in
patients with untreatable malignancies (on multiple chemotherapy regi
Gastrointestinal: Nausea, vomiting and anorexia have been reported af-
ter large oral doses of lavender (>5.0 g/day),
and after large doses of the
lavender constituent perillyl alcohol (POH).
Avoid in patients with a known allergy/hypersensitivity to lavender,
based on several case reports of dermatitis in patients with lavender al-
Use cautiously in patients who are currently taking drugs that depress
the central nervous system, because concomitant use of lavender may
Pregnancy and Lactation
Not recommended due to lack of sufficient data.
Due to its purported properties as an emmenagogue, excessive inter
nal use should be avoided during pregnancy. However, there is no de
finitive evidence in this area.
Sedating Drugs: In rats, concomitant use of lavender and pentobarbital
or chloral hydrate has significantly increased sleeping time and narcotic ef
68 JOURNAL OF HERBAL PHARMACOTHERAPY
Concurrent use with other sedative or hypnotic agents theoreti
cally may act in an additive or synergistic fashion.
Anticoagulants, NSAIDs, Anti-Platelet Agents: Lavender contains vary
ing amounts of coumarins and may therefore theoretically increase the ef
fect of anticoagulant medications.
Anti-Seizure Medications: Lavender enhances GABA effects and may
therefore intensify the sedative effects of GABA-dependent antiepileptics.
HMG-CoA Reductase Inhibitors, Niacin, Cholesterol Lowering Agents;
Theoretical Positive Interaction: Lavender may act in an additive fashion
with cholesterol-lowering agents: Cineole, a cyclic monoterpene found in
lavender, lowers cholesterol in rats via inhibition of the HMG-CoA en
zyme; the lavender constituent perillyl alcohol (POH) has been shown to
inhibit the conversion of lathesterol to cholesterol.
Sedating Agents: Lavender has been found to have sedative effects in
animal models, and acts additively with sedatives including pentobarbital
and chloral hydrate.
In theory, it may intensify the effects of other seda-
tive agents such as kava or valerian root.
Anticoagulant Herbs/Supplements: Lavender contains varying amounts
of coumarins and may therefore theoretically increase the effect of antico-
Insufficient available evidence.
Low Density Lipoprotein (LDL), Total Cholesterol, High Density Lipo-
protein (HDL): Based on animal studies, oral lavender may act similarly to
HMG-CoA reductase inhibitors and lower total cholesterol/LDL while
MECHANISM OF ACTION
Lavender is comprised of over 100 constituents, including linalool,
perillyl alcohol, linalyl acetate, camphor, limonene, tannins, triterpenes,
coumarins, cineole, and flavonoids.
Linalool has been shown to reduce motor activity in mice due to a
Monograph from Natural Standard 69
dose-related binding to glutamate, a primary excitatory neurotransmitter
of the central nervous system, and it has been suggested that hypnotic
and anticonvulsant effects of lavender may be due to the potentiation of
the neurotransmitter GABA.
The mechanism of lavender’s spasmolytic activity has not been fully
elucidated. Gamez et al. studied the antispasmodic effect of L. dentate (a
lavender species) in vitro.
An observed antagonism of acetylcholine-in
duced muscle contractions was attributed largely to cineole. Lis-Balchin et
al. observed that the linalool and linalyl acetate in L. angustifolia oil can in
duce cAMP-mediated relaxation of guinea pig ileum smooth muscle.
authors postulated a cAMP-based mechanism for lavender’s purported
physiological effects on sympathetic nervous system activity.
Components of lavender appear to have cytotoxic properties. Fulton
et al. demonstrated cell proliferating effects of perillyl alcohol (POH)
on smooth muscle cell cultures.
Both limonene and POH have been
shown to inhibit tumor growth in rats by blocking initiation and by pro-
One in vitro study evaluated the effects of POH in
lung carcinogenesis, and described an inhibitory effect on farnesylation, a
step towards activation of the oncogene K-ras.
The lipid-lowering effect of lavender has been attributed to the con-
stituent cineole, a cyclic monoterpene which lowers cholesterol in rats
via inhibition of the HMG-CoA enzyme.
The lavender constituent
perillyl alcohol (POH) has been shown to inhibit the conversion of lathesterol
Caffeic acid, a constituent of lavender, has been demonstrated to pos-
sess antioxidant effects in vitro.
Topical: Lavender oil is quickly absorbed by the skin. The constituents
linalool and linalyl acetate are detectable in the blood five minutes after
topical application, peak at 19 minutes, and largely disappear from the
blood within 90 minutes.
Oral: The constituents limonene and perillyl alcohol (POH) are metabo
lized into perillic acid (PA) and dihydroperillic acid (DHPA). In rats fed a
diet containing POH or limonene, peak levels of PA can be seen at 1-2.5
hours, peak levels of DHPA are noted at 2-3.5 hours, and half-lives for
each metabolite are 1-2 hours.
POH, PA, and DHPA are detectable in
subjects’ urine following high doses of POH ingestion. Approximately
9% of the total dose can be recovered in the first 24 hours. PA is the ma
jor metabolite found, with <1% of recovered POH.
70 JOURNAL OF HERBAL PHARMACOTHERAPY
The absorption of POH does not appear to be affected by concomi
tant ingestion of foods.
The name lavender is derived from the Latin lavare, meaning to wash.
In ancient Greece, Persia and Rome, it was used as a perfume in baths and
laundry, and as an antiseptic. Ancient Egyptians created mummification
casts by soaking linen in oil of lavender containing asphalt, then wrapping
the bodies with these and drying them in the sun until the casts were hard.
Lavender has been renowned as a ‘healing agent’ in India and Tibet. In Ti
betan Buddhist medicine, lavender is still used to treat insanity and psycho-
ses. Today, in Europe and the Americas, lavender is often used as an
anxiolytic and sleep aid.
Monograph from Natural Standard 71
Condition Study Design Author,
ARR NNT Comments
Anxiety Not randomized,
10 Yes 1 Small NA NA Poor
Yes 1 Small NA NA Initial benefit
Anxiety Not randomized,
42 Yes 0 Large NA NA Small study,
due to lack of
Anxiety Case series Itai, 2000 14 Yes NA Large NA NA No significant
Hypnotic Case series Hardy,
4 NA NA None NA NA Small series
No 3 None NA NA Subjective
(phase I clinical
18 NA 1 NA NA NA Uncontrolled
Summary: In general, the evidence supporting lavender aromatherapy as
an anxiolytic is weak. There are conflicting results from methodologically
flawed studies, with some showing lack of effect. However, overall, the
weight of the evidence suggests a small positive effect in relieving anxiety.
Further study through well-designed randomized trials would strengthen this
case. However, there are inherent difficulties involved with designing blind
ing or placebo control for study of an olfactory therapy. These difficulties
must be overcome before compelling results can be generated.
Evidence: Saeki et al. attempted to demonstrate that lavender aromatherapy
via footbath produced anxiolytic effects compared to placebo.
fore and after” study, which consisted of 10 subjects, concluded that a hot
footbath with lavender oil is associated with small but significant changes
in autonomic activity. However, the incomplete description of methodol-
ogy and analysis make results difficult to interpret.
Dunn et al. conducted a randomized, single-blind study in 122 inten-
sive care unit patients, allocated to one of three groups: body massage
with grapeseed oil, body massage with lavender oil, or undisturbed
Psychological endpoints were assessed using an arbitrary 4-point
scale, and physiological endpoints included blood pressure, heart rate,
and breaths-per-minute. Treatment ranged from one to three 30-minute
sessions, 24 hours apart. All patients received at least one session; 66
patients completed three sessions. After the first session, patients who
had received a massage with lavender oil had significantly less anxiety
than the group who rested. This difference was not maintained in the
following sessions. It is not clear to what extent the lack of dou-
ble-blinding, or the high dropout rate, affected results.
Motomura et al. conducted an experiment in which 42 students were di
vided into three groups: Group 1 experienced a “stressful condition;” group
2 experienced a “stressful condition” with the addition of lavender odor;
group 3 experienced a “non-stressful condition.” Stress was evaluated
based on a Japanese version of Cox and Mackay’s stress/arousal adjective
checklist. The experiment found that scores in the lavender group were sig
nificantly lower than the group who was stressed and did not receive laven
However, blinding and randomization were not clearly
In a case series consisting of 14 female, chronic renal failure patients
on hemodialysis, Itai et al. evaluated the effect of lavender oil on mood
72 JOURNAL OF HERBAL PHARMACOTHERAPY
using the Hamilton rating scale for depression (HAMD) and the Hamil
ton rating scale for Anxiety (HAMA).
Compared to natural smell (base
line), lavender was observed to decrease anxiety as evidenced by the
HAMA scale (P = 0.05). Lavender did not significantly alter patients’
HAMD scores from baseline. When lavender was compared to odorless
conditions, the difference in HAMA and HAMD scores was minimal.
Buckle compared therapeutic benefits of oils from two different spe
cies of lavender (L. angustifolia and L. burnatti) applied by massage to 28
A semi-structured interview to collect qualitative,
subjective data was used several days after treatment. The study reported
that L. burnatti had significantly more relaxing effects than its counterpart.
However, further details of statistical analysis or methodology were in-
complete, thus raising question about the results.
Summary: Many experts and patients believe that lavender aromatherapy
is an effective hypnotic. Although preliminary evidence suggests some
hypnotic effects of lavender, there are no randomized trials in the available
literature. Without further study, the current evidence can only be consid-
ered equivocal. However, there are inherent difficulties involved with de-
signing blinding or placebo control for study of an olfactory therapy. These
difficulties must be overcome before compelling results can be generated.
Evidence: Hardy et al. evaluated aromatherapeutic lavender as an alter-
native to conventional hypnotics in four geriatric patients.
were monitored during three two-week phases. During phase I, subjects
continued their current hypnotic (temazepam, promazine, chlormethiazole).
Phase II involved a withdrawal and washout period. During phase III, lav
ender oil was introduced into the patients’ sleeping quarters via an odor dif
fuser. The results demonstrated that hours asleep were comparable to the
number of hours asleep during phase I of the trial for all four participants.
However, without controls or blinding, results can only be considered pre
Diego et al. demonstrated the effects of three-minute aromatherapy
sessions using a 10% lavender oil concentration on participants’ brain
waves via electroencephalogram (EEG).
The EEG reading was re
corded prior, during, and after sessions. Alpha and beta activity were found
to increase after the inhalation of lavender. Notably, increased frontal alpha
and beta activity have been associated with increased drowsiness, which
provides mechanistic supportive evidence for this purported indication.
Monograph from Natural Standard 73
Perineal Discomfort Following Childbirth (Baths)
Summary: There is insufficient scientific evidence regarding the use of
lavender oil baths for the relief of postpartum perineal discomfort.
Evidence: Dale and Cornwell examined the effect of lavender oils baths
on perineal discomfort in 635 postpartum women in a randomized trial.
Subjects were divided into three groups: Group 1 added a natural lavender
oil extract to baths, group 2 added a synthetic lavender oil to baths, and the
third group used an unspecified control substance that had U.S. “Generally
Recognized As Safe” status. The control was reported to be distinguishable
from the other two oils by smell, and in efforts to compensate for this, pa
tients were informed that the trial was testing “different bath additives.” To
evaluate discomfort, women were asked to complete visual analogue
scales (VAS), a subjective questionnaire used to evaluate the degree of dis-
comfort over the 10 days of the experiment. Data were obtained from
~60% (n = 386) of participants. Although this trial found no significant dif-
ferences in perineal relief between the groups, the large dropout rate and
lack of information about the control substance (which could have been ac-
tive) raise doubts about the validity of results.
Summary: Preliminary data from animal and in vitro studies indicate a
potential spasmolytic effect of lavender oil inhalation. However, human
evidence is lacking.
Animal Data: A variety of lavender species have demonstrated an abil-
ity to inhibit stimulated muscle contractions in the ileum and conjunctiva of
Summary: Preliminary data from in vitro studies suggest that lavender
oils possess antibiotic activity. However, this has not been tested in animal
or human studies, and results cannot be considered clinically relevant.
In Vitro Data: Gabbrielli et al. demonstrated in vitro activity of lavender
oil (L. angustifolia and L. latifolia) against various strains of non-tubercular
Nelson et al. found documented activity of 2% to
0.12% (v/v) lavender oils against both methicillin-resistant Staphylo
coccus aureus (MRSA) and vancomycin-resistant enterococci (VRE).
74 JOURNAL OF HERBAL PHARMACOTHERAPY
Summary: Preliminary data from animal studies suggest an antineoplastic
effect of oral perillyl alcohol (POH) and other monoterpenes found in lav
ender. Studies have focused on cancers of the pancreas, breast, and intes
tine. Small phase I studies have been conducted in humans, suggesting
safety and tolerability of POH (up to 1200 mg/m
four times/day), but effi
cacy has not been established.
Animal Data: Elegbede et al. and Haag et al. demonstrated regression of
primary mammary tumors in rats after supplementing diets with limonene
and POH (lavender constituents).
Burke et al. documented inhibition of
pancreatic adenocarcinoma growth in hamsters using a similar diet.
Reddy et al. found a significant chemoprotective effect of oral POH on
carcinogenesis of the large and small intestines in rats.
Human Evidence: In a phase I clinical trial, Ripple et al. examined
the potential of POH to suppress tumor growth in humans.
consisted of 18 patients with advanced malignancies of various origins,
refractory to standard therapies. POH was formulated in gelatin cap-
sules containing 250 mg of POH and 250 mg of soybean oil. Prior to re-
ceiving POH, as a washout, patients did not receive hormonal or
immunological therapy for two weeks, or chemotherapy/radiation for
four weeks. Patients were divided into three groups: 800 mg/m
/dose; or 2400 mg/m
/dose, three times/day. Although no
objective tumor responses were noted, disease stabilization was noted
in several patients for up to six months. POH was generally well toler-
ated, although dose-dependent gastrointestinal side effects (nausea,
early satiety) and fatigue led to withdrawal of one patient from the
In a second case series, the same authors examined the effects of
more frequent administration at slightly lower doses.
with various malignancies, refractory to standard treatment, were treated
at the following doses: 800 mg/m
/dose; 1200 mg/m
/dose; or 1600 mg/
/dose, four times/day. The maximum tolerated dose of POH given
continuously four times/day was 1200 mg/m
/dose. Patterns of disease
progression similar to the initial trial were observed at all doses. Al
though promising, these results must be further evaluated through con
trolled studies before a recommendation can be made. Nonetheless,
these small studies suggest safety and tolerability of POH at doses up to
Monograph from Natural Standard 75
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78 JOURNAL OF HERBAL PHARMACOTHERAPY
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