Vitex is benign, but can cause an acneiform rash or urticaria in some users. Evidence supports its use for premenstrual syndrome.
[LFODPKM ] Letter Key
Latin Name
Vitex agnus-castus L.
Family
Verbenaceae
Other Common Names
Chaste-tree berry, Monk’s pepper
Description
- Vitex is a deciduous shrub, up to 6 m (18 ft) high, with twigs covered in gray down; spikes of violet flowers; and reddish black, aromatic fruit. Indigenous to the Mediterranean region and central Asia, vitex is cultivated as an ornamental in temperate climates.
Part Used
Dried ripe fruit
Known Active Constituents
- It is unclear what constituents of vitex are most active. It contains iridoids (aucubin and agnuside); flavonoids, primarily casticin (0.01% to 0.25%); monoterpenes; diterpenoids; and sesquiterpenoids. Diterpenoids include vitexilactone, rotundifuran, and 6
,7-diacetoxy-13-hydroxylabda-8,14-diene. The volatile oil contains primarily bornyl acetate and 1,8-cineole. The fruits contain fatty acids [5.5%, mainly 
-linolenic acid (75%)] (1).
Mechanism/Pharmacokinetics
- Vitex may inhibit prolactin activity and appears to have dopaminergic effects. No data are available on pharmacokinetics in humans. The bioavailability of aucubin (100 mg/kg) in rats is 83.5% after hepatoportal administration, 76.8% after intraperitoneal administration, and 19.3% after oral administration (low oral bioavailability is thought to be due to metabolism by gut flora) (1).
[Outline]
[CAO ] Letter Key
Clinical Trials
- Premenstrual syndrome (PMS)
- A randomized, double-blind, placebo-controlled trial of vitex (ZE 440, one tablet daily) in 170 women with PMS (23 on oral contraceptives) for three cycles assessed irritability, mood changes, anger, headache, breast fullness, and other symptoms, including bloating, by visual analog scale (2). Compared with the placebo group, improvements in symptom score were significantly higher in the vitex-treated group. Assessed individually, all symptoms except "other symptoms and bloating" improved more in the treated group than in the placebo group. Four women in the treated group experienced mild adverse effects including acne, urticaria, intermenstrual bleeding, and "multiple abscesses."
- A randomized controlled trial compared vitex (one capsule daily of Agnolyt, a commercial dried extract) to pyridoxine (100 mg b.i.d.) in 175 women with PMS on days 16 to 35 of the menstrual cycle for three cycles (3). Both vitex and Vitamin B6 reduced Premenstrual Tension Syndrome Scale (PTMS) scores significantly (from 15.2 to 5.1 in the vitex group and from 11.4 to 5.1 in the B6 group). Vitex was superior in relieving breast tenderness, edema, headache, constipation, and depression. More than a third (36.1%) of those in the vitex group became asymptomatic, compared with 21.3% in the pyridoxine group. Although not an endpoint of the trial, it is notable that five patients in the vitex group became pregnant, whereas none in the B6 group did. There were more adverse events in the vitex group, including gastroenteritis, nausea, and rashes.
- In 217 women given soy placebo or vitex powder (1,800 mg/day in divided doses) for 3 months, a modified Moos Menstrual Distress Questionnaire (MMDQ) showed no difference in symptoms (4). Soy may not have been an inactive placebo in this trial.
- Mastalgia
- A randomized double-blind placebo-controlled trial tested Mastodynon liquid (30 drops b.i.d.) or tablets (one tablet b.i.d.) (Mastodynon contains chaste-tree berry extract and homeopathic dilutions of several other herbs) in 104 women with mastalgia for three cycles. Both active preparations decreased breast pain by visual analog scale (5).
- Another randomized double-blind placebo-controlled trial tested Mastodynon liquid (30 drops b.i.d.) for three cycles in 97 women (86 completed); the treatment group had lower pain intensity scores than the placebo group at 1 and 2 months, but not at 3 months (6).
- A third randomized controlled trial compared Mastodynon liquid (30 drops b.i.d.) with placebo or the progestin gestagen in 160 women; both treatments were significantly more effective than placebo, with no difference between treatments (7).
- Fertility disorders
- A double-blind, placebo-controlled trial in 96 women with fertility disorders (31 luteal insufficiency, 38 secondary amenorrhea, and 27 idiopathic) tested Mastodynon (8). Only 66 were evaluated. Outcomes varied by group: pregnancy or menstrual bleeding in amenorrhea; pregnancy or improved luteal hormone levels in the two other groups. These outcomes were achieved by 54.5% of those treated with Mastodynon and 36.4% in the placebo group (p = 0.05).
- A double-blind placebo-controlled trial was done of vitex (Strotan, containing 20 mg drug, q.d. for 3 months) in 52 women with luteal phase defect and high prolactin levels [120 ng/mL at 30 minutes and 70 ng/mL at 15 minutes after thyrotropin-releasing hormone (TRH) challenge] (9). Thirty-seven case reports were complete enough for analysis. Vitex reduced prolactin levels, lengthened luteal phases significantly (by an average of 5 days), and increased midluteal phase progesterone levels to normal levels at 3 months. 17-estradiol levels were also higher in the treatment group during the luteal phase. Two women, both in the vitex group, became pregnant. No side effects were noted.
- Prolactin levels
- A randomized double-blind placebo-controlled trial tested Mastodynon liquid (30 drops b.i.d.) or tablets (one tablet b.i.d.) in 104 women with mastalgia for three cycles. Basal prolactin levels, but not metoclopramide-stimulated prolactin levels, were significantly reduced by the active treatments (10).
- A placebo-controlled crossover study tested three doses of the vitex extract BNO 1095 in 20 healthy males for 14 days; 120 mg and 480 mg, but not 240 mg, significantly increased the area under the curve for TRH-stimulated prolactin levels (11).
- Other hormone levels
- Vitex does not appear to affect luteinizing hormone (LH) or follicle-stimulating hormone (FSH) levels. Effects on progesterone and estradiol levels are not consistent (12).
Animal/In Vitro
- Extracts of vitex inhibit prolactin secretion of rat pituitary cells in vitro. In cultured anterior pituitary cells from male rats, an aqueous extract of vitex reduced both basal prolactin release by 80% and TRH-induced prolactin release by 65% (13). A later experiment in cultured anterior pituitary cells from female rats found that vitex extract inhibited both basal and TRH-induced prolactin release in a dose-dependent manner (maximum inhibition was achieved at 460 µg/mL). This effect could be blocked by haloperidol, a dopamine receptor blocker (14). In vitro, vitex affects prolactin release but not LH or FSH. Vitex extract binds to D2 receptors in the corpus striatum membrane dopamine receptor binding assay (15). In animals, high doses are necessary to inhibit prolactin; one experiment found that 60 mg intravenously was necessary to achieve significant results (16).
Other Claimed Benefits/Actions
- Menopausal symptoms
- Irregular cycles
- Menometrorrhagia
- Acne
- Lactation stimulant
- Mastalgia
- Antibacterial
[Outline]
Q: Where does the name chaste-tree berry come from?
A: Vitex has been reputed to lower libido in both women and men; and both its common and species names reflect this. Common names include chaste-tree berry and monk’s pepper. Agnus-castus comes from the Latin, agnus meaning lamb (innocence), and castus, chaste. It is also possible that agnus comes from agono, the Greek word for chaste, although this would be rather repetitious.
Q: Is it safe to combine Vitex with hormonal treatment?
A: Most herbalists note that vitex should not be combined with birth control pills or hormone replacement therapy. The modes of action seem quite distinct, and combined use is probably not harmful. Still, there is a theoretical risk that the stimulating effect vitex has on the ovaries could increase the chance of breakthrough ovulation and, thus, pregnancy with low-dose oral contraceptives.