Valerian is a botanical extract derived from the roots of Valeriana officinalis, which is widely used in herbal medicine for insomnia, anxiety and digestive and urinary problems. Valerian has been linked to rare instances of clinically apparent liver injury.


Valerian (va ler' ee an) is the common name of the plant genus Valeriana, several species of which are used in herbal medicine, most typically Valeriana officinalis. Valerian has been used for centuries in Europe, usually for digestive and urinary problems. The name valerian derives from the Latin word valere, which means “to be in good health.” Valerian is claimed to have sedative, hypnotic, anxiolytic, anticonvulsant, antispasmodic and antidepressant activities. Presently, it is used most commonly as a sleeping aid and for therapy of stress. The basis for its sedative effects is believed to be valepotriates (which are terpene alcohols) and volatile oils (including monoterpenes and sesquiterpenes). Components of valerian are believed to interact with the gamma amino butyric acid (GABA) receptor in a manner similar to the benzodiazepines. The typical dosage of valerian is 300 to 600 mg at bedtime for sleep or taken 3 times daily for stress. Valerian is found in many relaxation drinks. Valerian has few side effects, which are mostly mild and transient and include sedation, dizziness and withdrawal symptoms on stopping.


Valerian has been implicated in a small number of cases of clinically apparent liver injury, but usually in combination with other botanicals such as skullcap or black cohosh. In view of its wide scale use, valerian has to be considered a very rare cause of hepatic injury. In published cases, the latency to onset ranged from 3 to 12 weeks and the pattern of enzyme elevations was usually hepatocellular or mixed hepatocellular-cholestatic. The liver injury was usually mild-to-moderate in severity with recovery within 2 to 4 months of stopping. Immunoallergic and autoimmune features were not present. Severe cases with features of hepatic failure have been described, but usually in association with other potentially hepatotoxic herbals.

Likelihood score: C (probable rare cause of clinically apparent liver injury).

Mechanism of Injury

The cause of the liver injury associated with valerian use is not known. Valerian extracts contain multiple ingredients, but none have been shown to be specifically hepatotoxic.

Outcome and Management

Hepatotoxicity from valerian is usually mild-to-moderate in severity and self-limiting. Only a small number of cases of liver injury attributed to valerian have been published, and there have been no instances of chronic hepatitis, cirrhosis or vanishing bile duct syndrome attributed to its use, and no convincing case of acute liver failure.

Other Names: All-heal, Garden heliotrope, Tagara, Valeriana officinalis, Common valerian, Garden valerian, Indian valerian

Drug Class: Herbal and Dietary Supplements


Case 1. Acute hepatitis due to valerian.(1)

A 57 year old woman developed fatigue one week after starting an herbal medication for stress (Neurelax: believed to contain valerian, hops, asafetida and gentian). Two weeks later, 3 weeks after starting the botanical, she developed jaundice. She had no history of liver disease or risk factors for viral hepatitis. She drank socially, averaging 1 to 2 alcoholic beverages daily, and took no other medications except indapamide (a nonthiazide diuretic) which she had taken for many years. Physical examination showed jaundice, but no fever, rash or signs of chronic liver disease. Laboratory tests showed marked elevations in serum bilirubin (18.4 mg/dL) and ALT levels (1165 U/L) (Table). There was no mention of results of testing for viral or autoimmune hepatitis. Ultrasonography showed no evidence of biliary obstruction. Despite stopping the herbal, she deteriorated clinically over the next few weeks, developing ascites and hepatic encephalopathy. The jaundice persisted for 4 months but eventually resolved. A liver biopsy showed evidence of chronic hepatitis and fibrosis. Ten months after initial presentation, she was well enough to return to work, but serum ALT levels were still slightly elevated.

Key Points

Laboratory Values


While this case was convincing as an example of drug induced liver injury, the herbal responsible for the injury was somewhat unclear and it is always possible that the hepatic injury was due to a contaminant of the product. The clinical pattern was of an acute viral hepatitis-like illness with acute liver failure, but eventual partial recovery.



Valerian – Generic


Herbal and Dietary Supplements


Fact Sheet at National Center for Complementary and Integrative Health, NIH

Fact Sheet at Office of Dietary Supplements, NIH



MacGregor FB, Abernethy VE, Dahabra S, Cobden I, Hayes PC. Hepatotoxicity of herbal remedies. BMJ. 1989;299:1156–7. [PMC free article: PMC1838039] [PubMed: 2513032]


References updated: 05 April 2020

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    (Four cases of hepatitis attributed to herbals, all women, ages 41 to 57, developed jaundice 2-8 weeks after starting herbals for stress [“Neurelax” and “Kalms”], believed to contain skullcap and/or valerian [bilirubin 13.5-28.3 mg/dL, ALT 293-1165 U/L, Alk P 97-730 U/L], resolving 2-19 months after stopping: Case 1).
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    (Among 521 cases of drug induced liver injury submitted to Spanish registry, 13 [2%] were due to herbals, one attributed to valerian, onset in 1 week [bilirubin 16.9 mg/dL, ALT and Alk P normal], resolving in 6 months).
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    (Review of relaxation drinks which now include more than 300 bottled beverages available in the US, some of which include valerian as an anxiolytic and sleeping aid with names such as Bula, Drank, iChill, Marley Mellow Mood, miniCHILLL, Slow Cow).
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    (In a population based study of drug induced liver injury from Iceland, 96 cases were identified over a 2 year period, including 15 attributed to herbals or dietary supplements, but none specifically to valerian).
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    (Review of HDS induced liver injury including regulatory problems, difficulties in diagnosis and causality assessment; mentions that valerian containing products have been implicated in several cases of liver injury usually with a hepatocellular pattern).
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    (Among 85 cases of HDS associated liver injury [not due to anabolic steroids] enrolled in a US prospective study between 2004 and 2013, one was attributed to valerian).
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    (Extensive review of possible beneficial as well as harmful effects of herbal products on the liver mentions that valerian has been implicated in causing drug induced liver injury resembling an acute hepatitis).
  • Kia YH, Alexander S, Dowling D, Standish R. A case of steroid-responsive valerian-associated hepatitis. Intern Med J. 2016;46:118–9. [PubMed: 26813905]
    (57 year old man developed jaundice 2 weeks after taking 3 tablets of a cold medication that included 2 grams of valerian in each [bilirubin 5.1 mg/dL, ALT 1191 U/L, Alk P 221 U/L, INR 1.3], enzymes not improving over the next 4 weeks when prednisolone was added with prompt resolution and continued normalization after it was stopped).
  • Schroeck JL, Ford J, Conway EL, Kurtzhalts KE, Gee ME, Vollmer KA, Mergenhagen KA. Review of safety and efficacy of sleep medicines in older adults. Clin Ther. 2016;38:2340–72. [PubMed: 27751669]
    (Extensive systematic review of medications for sleep mentions that valerian and melatonin are unrelated products that have a small impact on sleep latency and can produce residual sedation; no mention of adverse events except to say that side effects were no greater with valerian than with placebo in small efficacy trials).
  • García-Cortés M, Robles-Díaz M, Ortega-Alonso A, Medina-Caliz I, Andrade RJ. Hepatotoxicity by dietary supplements: A tabular listing and clinical characteristics. Int J Mol Sci. 2016;17:E537. pii. [PMC free article: PMC4848993] [PubMed: 27070596]
    (Listing of published cases of liver injury from HDS products, but does not list those attributed to valerian).
  • Brown AC. Liver toxicity related to herbs and dietary supplements: Online table of case reports. Part 2 of 5 series. Food Chem Toxicol 2017; 107 (Pt A): 472-501. [PubMed: 27402097]
    (Description of an online compendium of cases of liver toxicity attributed to HDS products, lists at least 3 reports of liver injury attributed to valerian, often in combination with other potential causes of liver injury Cohen [2008], Vassiliadis [2009], MacGregor [1989]).
  • de Boer YS, Sherker AH. Herbal and dietary supplement-induced liver injury. Clin Liver Dis. 2017;21:135–49. [PMC free article: PMC5117680] [PubMed: 27842768]
    (Review of the frequency, clinical features, patterns of injury and outcomes of HDS hepatotoxicity with specific mention of anabolic steroids, black cohosh, germander, green tea, kava, pyrrolizidine alkaloids and proprietary multiingredient dietary supplements [MIDS], but does not specifically discuss valerian).
  • Drugs for chronic insomnia. Med Lett Drugs Ther. 2018;60(1562):201–5. [PubMed: 30625122]
    (Concise review of the mechanism of action, clinical efficacy, side effects and costs of medications for chronic insomnia mentions valerian and other herbal therapies but LAO that “there is no convincing evidence that any of the “natural remedies” used for insomnia are effective or safe for this indication and the purity and optimal doses of all of these products is unknown”).