Chaste Tree (Vitex agnus-castus)

(Vitex agnus-castus)

Other common names: Vitex, agnus-castus, chasteberry,
monk’s pepper
Latin name: Vitex agnus-castus L. [Verbenaceae]
Plant part: Fruit


Chaste tree is a shrub native to the Mediterranean region. The hard,
black, round berries are used medicinally. The dried, ripe fruits are
characterized as containing approximately 0.5 percent volatile oil.
Also characteristic of the fruits are the iridoid glycosides (agnuside
and aucubin), flavonoids (aglycone, casticin), and diterpenes (Schulz,
Hänsel, and Tyler, 2001). Although chaste tree preparations are
sometimes standardized to the content of the water-soluble iridoid
glycosides, lipid-soluble constituents, in particular the bicyclic diterpenes,
have been reported in experimental studies to have dopaminergic
activity (Stansbury et al., 2001).

Mastodynon® N, manufactured by Bionorica Arzneimittel GmbH
in Germany, contains chaste tree tincture (53 percent alcohol) in combination
with five homeopathic herbal extracts: Caulophyllum thalictroides,
Cyclamen purpurascens, Strychnos ignatia, Iris versicolor,
and Lilium tigrinum. The daily dose of 2 × 30 drops (1.8 ml solution)
contains 32.4 mg chaste tree fruit tincture (2 g plant material in 10 g
tincture). Mastodynon N is also sold in tablet form. Mastodynon is
distributed in the United States by Mediceutix, Inc.
Agnolyt® capsules, produced by Madaus AG, Germany, contain
3.5 to 4.2 mg dry extract (plant/extract ratio 9.58 to 11.5:1, 60 percent
ethanol). Agnolyt is also available in liquid form. Agnolyt was previously
sold by Nature’s Way Products, Inc., as Femaprin, but the formulation
of this product has changed and an equivalent of Agnolyt
capsules is not currently available in the United States.

Clinical studies on chaste tree have explored its use for cyclical
mastalgia (breast pain), female infertility, and premenstrual syndrome
(PMS). Mild elevation of prolactin levels has been linked with
breast tenderness, menstrual irregularities, infertility, and PMS. Chaste
tree preparations are thought to reduce prolactin levels in the blood.
Prolactin is secreted by the pituitary gland, and that secretion is mediated
by dopamine through interaction with D2 receptors. Chaste tree
preparations are thought to act through stimulation of those receptors
(Gorkow, Wuttke, and März, 1999).


Clinical studies on chaste tree have explored its use for cyclical
mastalgia (breast pain), female infertility, and premenstrual syndrome
(PMS). Mild elevation of prolactin levels has been linked with
breast tenderness, menstrual irregularities, infertility, and PMS. Chaste
tree preparations are thought to reduce prolactin levels in the blood.
Prolactin is secreted by the pituitary gland, and that secretion is mediated
by dopamine through interaction with D2 receptors. Chaste tree
preparations are thought to act through stimulation of those receptors
(Gorkow, Wuttke, and März, 1999).
Mastodynon
Mastalgia (Cyclic Breast Pain)
Three trials studied the use of Mastodynon for the treatment of cyclical
mastalgia. The dose was 30 drops twice daily, or one tablet
twice daily, taken for three to four menstrual cycles. In the first of two
good-quality trials, Mastodynon solution and tablets were compared
to placebo in a double-placebo designed trial with 104 women who
had breast pain for at least three days in their most recent cycle. At the
end of three menstrual cycles, the intensity of breast pain was significantly
lower for both forms of Mastodynon compared to placebo. The
onset of pain relief was earlier with the solution than with the tablet.
The treatment had no effect on plasma levels of progesterone, folliclestimulating
hormone (FSH), or luteinizing hormone (LH). However,
estradiol levels decreased and basal prolactin levels fell in comparison
with placebo (Wuttke et al., 1997). The second study included 86
women who had breast pain for at least five days in the previous cycle.
After the first and second cycles of treatment, pain intensity decreased
significantly compared to placebo. After the third cycle, the
pain scale level was so low for the Mastodynon group that only slight
reductions were possible, and as a result, there was only a borderline
difference between the Mastodynon and the placebo group at this
time. After three and four cycles, the total number of pain-free days
was significantly greater for the Mastodynon group (Halaška et al.,
1999).
A third trial compared Mastodynon (30 drops twice daily) and
progestin (5 mg twice daily) to placebo in 121 women with severe
breast pain. Both treatments were better than placebo. After four cycles,
good relief from premenstrual symptoms was reported for 82
percent of those given progestin, 74.5 percent of those given Mastodynon,
but only 36.8 percent of those given placebo (Kubista, Muller,
and Spona, 1986). Due to several methodological inadequacies, the
efficacy of treatments used in this trial was deemed undetermined.


Female Infertility
Another placebo-controlled study with 66 women indicated a possible
role for Mastodynon in female infertility due to secondary
amenorrhea (cessation of menstruation) and luteal insufficiency. As a
result of three months of treatment with Mastodynon, pregnancy occurred
more than twice as often as in the placebo group (Gerhard
et al., 1998). The outcomewas evaluated as a trend toward efficacy. A
longer trial, especially for secondary amenorrhea, would be more
conclusive.