German Chamomile

Metadata

• Common Names: German Chamomile (English), Echte Kamille (German)
• Botanical Name: Matricaria chamomilla L. (syn. Matricaria recutita L.)
• Plant Family: Asteraceae (Compositae)
• Part Used: Flower heads (Matricariae flos)
• Evidence Quality Rating: Moderate

Approved Indications

Commission E

• Gastrointestinal spasms
• Inflammatory diseases of the gastrointestinal tract
• Skin and mucous membrane inflammations (external)
• Bacterial skin diseases including oral cavity and gums (external)
• Inflammatory diseases and irritations of the respiratory tract (inhalation)

ESCOP

• Symptomatic treatment of minor gastrointestinal complaints (dyspeptic disorders, epigastric distension, flatulence, belching)
• Minor spasms of the GI tract
• Minor inflammations and irritations of the skin and mucous membranes
• Minor inflammations of the mouth and throat

EMA/HMPC

• Traditional use: Minor gastrointestinal complaints such as bloating and minor spasms
• Traditional use: Minor inflammations of the skin and mucous membranes
• Traditional use: Relief of symptoms of common cold
• The HMPC classified chamomile as a traditional herbal medicinal product for these indications, noting that while clinical trial data is limited, effectiveness is plausible based on long-standing use (at least 30 years)

Agreement/Disagreement Between Bodies

• All three bodies agree on GI antispasmodic and anti-inflammatory indications
• Commission E provides the broadest list of approved indications, including bacterial skin conditions
• ESCOP and EMA/HMPC are closely aligned on GI and topical anti-inflammatory uses
• The EMA/HMPC is more conservative, classifying most uses as “traditional use” rather than “well-established use”

Conditions Treated

• Dyspepsia / Indigestion
• Flatulence / Bloating
• Gastrointestinal spasms
• Gastritis / Gastric mucosal inflammation
• Oral mucositis
• Skin inflammation (topical)
• Mild anxiety and insomnia (traditional use, not primary GI indication)

Mechanism of Action

• Apigenin: Binds to GABA-A benzodiazepine receptors (anxiolytic/sedative effect); also has anti-inflammatory activity via inhibition of COX-2 and NF-kB pathways
• alpha-Bisabolol: Antispasmodic on smooth muscle (inhibits pepsin activity, protects gastric mucosa); antimicrobial; anti-inflammatory by inhibiting 5-lipoxygenase
• Chamazulene (formed from matricin during steam distillation): Anti-inflammatory, anti-allergic; inhibits leukotriene B4 synthesis and blocks chemical peroxidation
• Flavonoids (apigenin, luteolin): Inhibit smooth muscle spasms in the small intestine by modulating peristaltic contractions
• Essential oil components: Carminative effect through relaxation of GI smooth muscle; promotes bile flow

Clinical Evidence Summary

• Clinical trial evidence for chamomile’s GI indications is limited and mostly of older vintage
• A 2008 monograph in Alternative Medicine Review summarized that chamomile has demonstrated anti-inflammatory, antispasmodic, and carminative activity in preclinical models, with limited but supportive human studies [Source: Altmed Rev 2008;13(1):58-68]
• A 2010 RCT (n=57) of chamomile extract (220mg/day, standardized to 1.2% apigenin) demonstrated significant reduction in generalized anxiety disorder symptoms vs placebo; GI benefits were secondary observations
• Most GI-specific human data comes from traditional use documentation and pharmacological studies rather than large RCTs
• The EMA assessment noted that while clinical trial evidence is insufficient on its own, the effectiveness is plausible given pharmacological data and 30+ years of documented safe use
• Chamomile is more extensively studied for topical anti-inflammatory and anxiolytic applications than for GI indications specifically

European vs US/Anglophone Consensus

• In Germany and continental Europe, chamomile is a mainstream pharmacy product prescribed by physicians for GI complaints, particularly as tea or standardized extracts
• In the US/UK, chamomile is primarily viewed as a calming/sleep tea; its GI applications are less emphasized
• Commission E approval gives chamomile strong standing in German integrative medicine that has no equivalent in US regulatory frameworks
• The FDA classifies chamomile as GRAS (Generally Recognized As Safe) for food use but has not evaluated it for specific GI therapeutic claims
• European physicians frequently combine chamomile with other carminatives (e.g., in STW 5/Iberogast), while US practitioners rarely use it in formal combination therapies

Safety Profile

Contraindications

• Known allergy to Asteraceae/Compositae family (ragweed, chrysanthemums, marigolds, daisies) — cross-reactivity possible
• No absolute contraindications for oral use in non-allergic individuals

Drug Interactions

• May inhibit CYP1A2, CYP1A1, and CYP3A4 (apigenin, luteolin, quercetin, caffeic acid are implicated); theoretical interactions with drugs metabolized by these enzymes
• Potential additive effects with anticoagulants (contains coumarin compounds, though clinically significant interaction is rare)
• Potential additive sedation with CNS depressants (benzodiazepines, barbiturates)

Side Effects

• Generally very well tolerated
• Rare allergic reactions (contact dermatitis, anaphylaxis in highly sensitized individuals)
• Very rare case reports of cross-reactivity in patients allergic to other Compositae plants

Pregnancy/Lactation

• Animal studies of alpha-bisabolol showed no toxicity or harm during pregnancy
• Theoretical concern about uterine stimulation at very high doses (emmenagogue properties traditionally attributed)
• Generally regarded as safe in moderate amounts (e.g., 1-2 cups of tea daily) during pregnancy in European practice
• EMA advises caution; insufficient data for formal safety declaration in pregnancy
• Compatible with breastfeeding per LactMed (NIH database); no adverse effects reported in nursing infants

Clinical Dosage

Forms and Ranges

• Tea/Infusion: 3 g of dried flower heads in 150 mL hot water, steeped 5-10 minutes, taken 3-4 times daily between meals
• Liquid extract (1:1 in 45% ethanol): 1-4 mL three times daily
• Tincture (1:5): 3-10 mL three times daily
• Standardized extract: 220-1100 mg/day standardized to 1.2% apigenin (used in anxiety studies)
• Essential oil: 4-12 drops daily for internal use (European tradition; less common in US practice)

Key Standardized Products

• Kamillosan (standardized chamomile extract, widely used in Germany)
• Matricariae flos preparations compliant with European Pharmacopoeia (PhEur) standards
• STW 5 (Iberogast) contains chamomile as one of nine herbal components

Sources

• EMA/HMPC Herbal Monograph on Matricaria recutita L., flos (European Medicines Agency)
• Commission E Monograph: Matricariae flos (Bundesinstitut fur Arzneimittel und Medizinprodukte)
• ESCOP Monograph: Matricariae flos, 2nd edition
• Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Report. 2010;3(6):895-901
• Alternative Medicine Review Monograph. Matricaria chamomilla. Altern Med Rev. 2008;13(1):58-68
• McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of chamomile tea. Phytother Res. 2006;20(7):519-530
• LactMed (NIH) - Chamomile entry
• WHO Monographs on Selected Medicinal Plants, Vol. 1: Flos Chamomillae

Connections

• Related to Fennel and Caraway as fellow carminatives
• Component of STW 5/Iberogast multi-herb combination
• German phytotherapy tradition often combines chamomile with peppermint and caraway for dyspepsia