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How to use Water Lemon

Scientific Name: Passion Flower

Other Names: Apricot Vine, Corona de Cristo, Granadilla, Maypop, Passiflora incarnata, Passion Vine, Water Lemon

Who is this for?

Oral passion flower products are most frequently used for their effects on the central nervous system. While not all of these effects are understood, it is known that certain chemicals in passion flower may act like a prescription drug class known as benzodiazepines. Drugs like benzodiazepines and herbals such as passion flower increase levels of a neurotransmitter known as gamma-aminobutyric acid (GABA). Neurotransmitters are chemicals that carry messages from nerve cells to other cells. In general, GABA decreases the activity of nerve cells in the brain, causing relaxation. This effect may make passion flower helpful in treating anxiety. Passion flower also may be used to treat insomnia. In addition, it contains chemicals known as harmala alkaloids, which are thought to block an enzyme involved in depression. This enzyme, monoamine oxidase, breaks down other neurotransmitters — especially dopamine, norepinephrine, and serotonin — which are involved in mood stability. Blocking monoamine oxidase may increase the amounts of these additional neurotransmitters and may improve mood. No large human studies have been performed to prove the effectiveness of passion flower for these uses, however.

Although applying passion flower to the skin is not as common as taking it by mouth, topical forms may help to relieve minor skin conditions such as burns, cold sores, insect bites, razor burn, scrapes, and sunburn. Passion flower has also been used to alleviate the itching and burning pain of hemorrhoids. Laboratory studies have shown that it possesses some possible mild anti-infective activity, so it may also help to prevent skin surface infections. Again, however, these uses have yet to be proven in human studies.

When should I be careful taking it?

Chemicals in passion flower may cause muscles in the uterus to tighten, which may cause a pregnant woman to miscarry. Therefore, pregnant women should avoid taking passion flower by mouth.

Precautions

Because very little is known about the possible effects of passion flower in young children, its use is not recommended for infants or for breast-feeding women.

What side effects should I watch for?

Some species of passion flower may contain varying amounts of cyanide-like chemicals. Although the amounts are very small and the species that contain them are not ordinarily used in food or medicine, the slight possibility of cyanide poisoning exists. In addition, the liver or pancreas may be damaged from cyanide exposure. Only commercially-available passion flower products from reliable sources should be taken by mouth. If you have any doubts about the source of the product you plan to take, do not use it. Talk to your doctor or pharmacist if you are concerned with the reliability of a particular source of passion flower.

One case of dangerously rapid heart beat has been reported following the oral use of passion flower.

In addition, a commercial product made from passion fruit has been associated with temporary changes in mental awareness. Formerly sold in Europe but not in the United States, the preparation may also have caused isolated cases of inflammation in blood vessels. Inflamed blood vessels may become weakened, may stretch and increase in size, or may become narrow. Any of these effects may contribute to heart conditions. The preparation thought to have caused these problems is no longer available, but whether other passion flower products may cause similar results is not known.

Less Severe Side Effects

Taking passion flower by mouth may result in:

  • Confusion
  • Dizziness
  • Drowsiness
  • Nausea

What interactions should I watch for?

Prescription Drugs

Passion flower contains chemicals that may interfere with the ability of blood platelets to stick together, thereby potentially increasing the time blood needs to clot. When it is taken with antiplatelet or anticoagulant drugs, the effect of the drug may be increased, resulting in uncontrolled bleeding.

  • Antiplatelets include Plavix and Ticlid
  • Anticoagulants include heparin and warfarin

When passion flower is used with prescription drugs that promote sleepiness, the effects of the drug may be exaggerated, resulting in sedation or mental impairment. Prescription drugs that can cause sleepiness include:

  • Anticonvulsants such as carbamazepine, phenytoin and valproic acid
  • Barbiturates such as phenobarbital
  • Benzodiazepines such as alprazolam and diazepam
  • Drugs for insomnia such as zaleplon and zolpidem
  • Tricyclic antidepressants such as amitriptyline, amoxapine, doxepin and nortriptyline

Because it may block the effects of the enzyme monoamine oxidase, passion flower may possibly increase the effects and the risk of side effects from prescription drugs that also interfere with monoamine oxidase. These drugs, known as monoamine oxidase inhibitors (MAOIs), include:

  • isocarboxazid (Marplan)
  • phenelzine (Nardil)
  • selegiline (Eldepryl)
  • tranylcypromine (Parnate)

Non-prescription Drugs

The anti-platelet effect of passion flower may decrease the ability of blood to clot after an injury. Aspirin can also delay clotting, so passion flower should not be taken orally at the same time as aspirin.

The sleep-producing effects of over-the-counter products containing diphenhydramine may be enhanced by taking passion flower at the same time. Diphenhydramine is contained in many non-prescription sleeping pills as well as in some cough and cold products, therefore caution should be used when taking these medications with passion flower because excessive drowsiness may result.

Herbal Products

Theoretically, if passion flower is used with other herbs that affect blood clotting, bleeding may occur. Some of the most common herbal products that might inhibit blood clotting are:

  • Danshen
  • Devil's Claw
  • Eleuthero
  • Garlic
  • Ginger (in high amounts)
  • Ginkgo
  • Horse Chestnut
  • Panax Ginseng
  • Papain
  • Red Clover
  • Saw Palmetto

Although it is commonly sold as combination preparations with one or more other sleep-producing herbals, passion flower may cause excessive sedation if it is taken with other potentially sedating herbs such as:

  • Catnip
  • Hops
  • Kava
  • St. John's Wort
  • Valerian

Foods

No interactions between passion flower and foods have been reported, but drinking alcohol at the same time as using passion flower by mouth may result in increased drowsiness.

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals.

Should I take it?

Over 500 different species of passion flower are known in the world. All of them grow as perennial vines that thrive in tropical climates. Some species may survive in cooler areas such as southern California; and some are grown as decorative houseplants. The wood-like stems of passion flower are supported by tendrils similar to those found on grape vines. Like grape vines, passion flower vines may be planted along vineyard-like fences or netting for commercial production in some African and South American countries. The vines bear distinctive flowers with 5 white petals and 5 magenta, purple, or blue petal-like sepals all surrounding a feathery circle of filaments. The Spaniards exploring South America in the 1500s saw these flowers as representing Christ's Crown of Thorns; hence the Spanish name "Corona de Cristo". Flowers are followed by fruits that range according to species from pea-sized to the general size and shape of eggs. When ripe, the fruits may be yellow, orange, or dark purple, again depending on the species. Not all passion fruits are suitable for humans to eat, but some species of the heavily-seeded fruits are used for juice, often in combination with other tropical fruit juices, and these edible passion fruits may be eaten raw or cooked into jam. Passion fruits may also be used as medicine in some parts of the world.

For most medical use, the leaves and flowers of the passion vines are collected and dried. Passion flower is approved as a treatment for nervousness and restlessness by Commission E of the German Federal Institute for Drugs and Medical Devices, the German governmental agency that evaluates the safety and effectiveness of herbal products. The United States does not have a comparable agency to evaluate herbal products. However, about 25 years ago the U.S. Food and Drug Administration (FDA), required manufacturers to remove passion flower from non-prescription insomnia treatments that are sold in this country. The FDA felt that not enough evidence proving the safety or effectiveness of passion flower was available.

Dosage and Administration

Passion flower supplement are available in several different oral dosage forms, including liquid extracts and powders that may be added to foods and beverages. Directions for use vary by product and condition. If you decide to use a commercial preparation of passion flower, follow the recommendations on the package you buy.

Passion flower tea may be made by adding about a teaspoonful of dried passion flowers and leaves to 5 or 6 ounces of boiling water and letting it soak for 10 minutes. The solid particles should be strained out before drinking the tea. To relieve insomnia, one cup of passion flower tea may be consumed about one hour before bedtime. For anxiety, 3 or 4 cups may be ingested per day. This tea may also be allowed to cool and then applied topically to minor skin irritations such as mild rashes or sunburn.

Summary

Taken orally, passion flower may be effective for reducing anxiety and promoting sleep. It may also lessen depression. When applied to the skin, it may help to relieve minor conditions such as scrapes and sunburn.

Risks

Due to the risk of miscarriage, pregnant women should not take passion flower. It should also be avoided by small children and women who are breast-feeding.

Side Effects

In the past, rare instances of cyanide poisoning, blood vessel inflammation, and rapid heartbeat have been attributed to the use of passion flower products. The particular passion flower species that were involved may no longer be used as medicine or the products may have been contaminated with other plant material, however. More common side effects associated with the use of passion flower include confusion, dizziness, and nausea.

Interactions

Passion flower may increase the effects of drugs and herbals that promote sleepiness. It may also enhance the blood-thinning effects of anticoagulant and antiplatelet agents.

References

Akhondzadeh S, Kashani L, Mobaseri M, Hosseini SH, Nikzad S, Khani M. Passionflower in the treatment of opiates withdrawl [sic]: a double-blind randomized controlled trial. Journal of Clinical Pharmacy and Therapeutics. 2001;25(5):369-373.

Akhondzadeh S, Naghavi HR, Shayeganpour A, Rashidi A, Khani M. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. Journal of Clinical Pharmacy and Therapeutics. 2001;26(5):363-367.

Anon: Passion flower. In: DerMarderosian A, Beutler JA, eds. Facts and Comparisons: The Review of Natural Products. St. Louis, MO, Facts and Comparisons. March 1999.

Birner J, Nicolls JM. Passicol, an antibacterial and antifungal agent produced by Passiflora plant species: preparation and physicochemical characteristics. Antimicrobial Agents in Chemotherapy. 1973;3(1):105-109.

Bourin M, Bougerol T, Guitton B, Broutin E. A combination of plant extracts in the treatment of outpatients with adjustment disorder with anxious mood: controlled study vs placebo. Fundamental Clinical Pharmacology. 1997;11(2):127-132.

California Rare Fruit Growers. Passion Flower. 1996. Available at: http://www.crfg.org/pubs/ff/passionfruit.html Accessed October 15, 2003.

Della Loggia R, Tubaro A, Redaelli C. Evaluation of the activity on the mouse CNS of several plant extracts and a combination of them. [Article in Italian] Riv Neurol. 1981;51(5):297-310.

Dhawan K, Dhawan S, Chhabra S. Attenuation of benzodiazepine dependence in mice by a tri-substituted benzoflavone moiety of Passiflora incarnata Linneaus: a non-habit forming anxiolytic. Journal of Pharmacy and Pharmaceutical Science. 2003;6(2):215-222.

Dhawan K, Kumar S, Sharma A. Anti-anxiety studies on extracts of Passiflora incarnata Linneaus. Journal of Ethnopharmacology. 2001;78:165-170.

Dhawan K, Kumar S, Sharma A. Anxiolytic activity of aerial and underground parts of Passiflora incarnata. Fitoterapia. 2001;72(8):922-926.

Fisher AA, Purcell P, Le Couteur DG. Toxicity of Passiflora incarnata L. Journal of Toxicology and Clinical Toxicology. 2000;38(1):63-66.

Hoffmann DL. Passion flower. Herbal Materia Medica. No date given. Available at: http://www.healthy.net/asp/templates/article.asp?PageType=article&ID=1438. Accessed October15, 2003.

Jellin JM, Gregory P, Batz F, Hitchens K, et al, eds. Pharmacist's Letter/Prescriber's Letter. Natural Medicines Comprehensive Database, 3rd Edition. Stockton CA: Therapeutic Research Facility, 2000.

Krenn L. Passion Flower (Passiflora incarnata L.)—a reliable herbal sedative. [Article in German] Wiener Medizinische Wochenschrift. 2002;152(15-16):404-406.

Morton J. Passionfruit. In: Morton J. Fruits of Warm Climates. Miami, Florida. J Morton Press; 1987:320-328.

Nicolls JM, Birner J, Forsell P Passicol, an antibacterial and antifungal agent produced by Passiflora plant species: qualitative and quantitative range of activity. Antimicrobial Agents in Chemotherapy. 1973;3(1):110-117.

Peirce A. The American Pharmaceutical Association Practical Guide to Natural Medicines. New York: Stonesong Press; 1999.

Salgueiro JB, Ardenghi P, Dias M, Ferreira MB, Izquierdo I, Medina JH. Anxiolytic natural and synthetic flavonoid ligands of the central benzodiazepine receptor have no effect on memory tasks in rats. Pharmacology, Biochemistry, and Behavior.1997;58(4):887-891.

Spencer KC, Seigler DS. Cyanogenesis of Passiflora edulis. Agricultural and Food Chemistry. 1983;31(4):794-796.

Speroni E, Minghetti A. Neuropharmacological activity of extracts from Passiflora incarnata. Planta Medica. 1988;54(6):488-491.

Wolfman C, Viola H, Paladini A, Dajas F, Medina JH. Possible anxiolytic effects of chrysin, a central benzodiazepine receptor ligand isolated from Passiflora coerulea. Pharmacology, Biochemistry, and Behavior. 1994;47(1):1-4.


(Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.)

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