Herbal Monograph
German chamomile
Matricaria chamomilla L.
Asteraceae (Compositae)
Gentle, versatile herb for digestive comfort, nervous tension, and skin healing
Overview
Plant Description
German chamomile is an annual herbaceous plant growing 15-60 cm (6-24 inches) tall with erect, branching stems. Leaves are bipinnate to tripinnate, finely divided into linear segments, giving a feathery appearance. Flower heads (capitula) are 10-25 mm in diameter, composed of white ligulate ray florets surrounding a conical, hollow receptacle bearing yellow tubular disc florets. The hollow receptacle is a key distinguishing feature from Roman chamomile (Chamaemelum nobile), which has a solid, convex receptacle. The entire plant is glabrous and strongly aromatic with a characteristic apple-like fragrance. The Latin name 'Matricaria' derives from 'matrix' (womb), reflecting its traditional use for female reproductive complaints.
Habitat
Native to southern and eastern Europe and western Asia. Thrives in well-drained, sandy or loamy soils in full sun. Commonly found in disturbed areas, roadsides, field margins, and waste ground. Tolerates poor soil but prefers slightly acidic to neutral pH (5.5-7.5). Adaptable to various climatic conditions from temperate to semi-arid regions.
Distribution
Widely distributed across Europe, northern and western Asia, and naturalized in North America, Australia, and many temperate regions worldwide. Major commercial cultivation in Egypt, Argentina, Germany, Hungary, Czech Republic, Slovakia, and India. Egypt is currently the world's largest producer and exporter of chamomile. Hungary and Germany are historically important production regions with registered pharmaceutical-grade cultivars.
Parts Used
Flower heads (Matricariae flos, capitula)
Preferred: Dried flower heads for infusion; hydroethanolic tincture or liquid extract; standardized dry extract; essential oil (by steam distillation)
The dried flower heads are the official drug in all major pharmacopeias (Ph. Eur., DAB, BP). Both the ligulate ray florets and the tubular disc florets are used. The essential oil content is concentrated in oil glands (schizogenous ducts) primarily in the tubular florets. Minimum essential oil content per European Pharmacopoeia: not less than 4 mL/kg (0.4% v/w) of blue essential oil. Commission E, WHO, ESCOP, and EMA monographs all specify flower heads.
Key Constituents
Essential oil (terpenoids)
The essential oil (0.4-1.5% in dried flower heads) is the primary source of anti-inflammatory, antispasmodic, and antimicrobial activity. At least four chemotypes are recognized based on dominant sesquiterpene: (A) bisabolol oxide A type, (B) alpha-bisabolol type, (C) bisabolol oxide B type, (D) bisabolone oxide A type. The alpha-bisabolol chemotype is preferred for pharmaceutical preparations. European Pharmacopoeia requires minimum 4 mL/kg essential oil. Commercial grades are often standardized to alpha-bisabolol and chamazulene content.
Flavonoids
Flavonoids are responsible for anxiolytic, mild sedative, and significant anti-inflammatory activity. Apigenin is the most pharmacologically significant flavonoid -- its binding to GABA-A benzodiazepine receptors is the primary mechanism for chamomile's anxiolytic and sleep-promoting effects (Amsterdam et al. 2009, Srivastava et al. 2010). Total flavonoid content in dried flower heads is approximately 6-8%, making chamomile one of the richest dietary sources of apigenin. Flavonoids are well-extracted in aqueous infusions.
Coumarins
Coumarins contribute to antispasmodic activity. Despite theoretical concerns about coumarin-class compounds and anticoagulant effects, the coumarins present in chamomile are simple hydroxycoumarins with no demonstrated anticoagulant activity. They are structurally distinct from dicoumarol and warfarin-type anticoagulants.
Mucilage (polysaccharides)
Mucilage components contribute to the soothing, demulcent effects on inflamed mucosal membranes, particularly in the GI tract. They provide a protective coating over irritated tissues and support the vulnerary (wound-healing) action of chamomile when applied topically.
Phenolic acids
Phenolic acids contribute to the overall antioxidant capacity of chamomile infusions. Chlorogenic acid and caffeic acid are common plant phenolics with well-documented antioxidant properties.
Herbal Actions
Reduces inflammation
Multiple mechanisms: alpha-bisabolol inhibits 5-lipoxygenase and COX-2; chamazulene scavenges reactive oxygen species and inhibits leukotriene B4 formation; apigenin and luteolin suppress NF-kB activation and pro-inflammatory cytokine production (TNF-alpha, IL-6, IL-1beta). Commission E approved for inflammatory diseases of the GI tract and skin. Srivastava et al. (2009) demonstrated chamomile extract inhibited COX-2 and suppressed LPS-induced PGE2 release in macrophages.
[1, 2, 16, 17]Relieves smooth muscle spasm
cis-Spiroether is approximately equipotent to papaverine as a smooth muscle relaxant. Alpha-bisabolol also contributes to spasmolytic activity. Clinical antispasmodic activity demonstrated in GI smooth muscle, particularly against acetylcholine- and histamine-induced contractions. Commission E approved for GI spasms and cramping. Mechanism involves both direct smooth muscle relaxation and modulation of calcium signaling.
[1, 2, 18]Relieves intestinal gas and bloating
Relieves intestinal gas and bloating through combined antispasmodic and prokinetic effects. The volatile oil components relax the lower esophageal sphincter tone while promoting coordinated peristalsis. One of the most widely used carminatives in European phytotherapy. Traditionally used in combination with other carminatives (fennel, peppermint) in 'gripe water' formulations for infant colic.
[1, 2, 4]Reduces anxiety
Apigenin binds to the benzodiazepine site on GABA-A receptors, producing anxiolytic effects without significant sedation at moderate doses. Amsterdam et al. (2009) RCT demonstrated significant reduction in Hamilton Anxiety Rating scale scores with chamomile extract (220 mg standardized to 1.2% apigenin) vs placebo in patients with mild-to-moderate generalized anxiety disorder (GAD). A follow-up long-term trial (Amsterdam et al. 2012; Mao et al. 2016) confirmed sustained anxiolytic benefit.
[6, 7, 16]Promotes wound healing
Alpha-bisabolol and apigenin promote wound healing by stimulating fibroblast proliferation and collagen synthesis, and by reducing inflammation at the wound site. Commission E approved for bacterial skin diseases and skin and mucous membrane inflammation (topical). Clinical studies of topical chamomile extracts have shown accelerated wound healing in post-surgical and dermatological contexts.
[1, 2, 16]Supports and calms the nervous system
Gentle nervine tonic and relaxant. Calms nervous irritability and restlessness. Traditionally indicated for nervous stomach, tension headaches, and irritability associated with stress. The nervine action is mediated primarily through apigenin's GABA-A receptor binding and anxiolytic effect, but is milder than dedicated sedative herbs (valerian, passionflower).
[4, 5]Promotes sleep and deep relaxation
Mild sedative action at higher doses or in combination preparations. Apigenin produces sedation at high doses in animal models but the effect in humans at typical chamomile tea doses is subtle. A 2017 clinical trial (Chang & Chen) found chamomile extract improved subjective sleep quality in elderly subjects. Often combined with valerian, passionflower, or lemon balm for enhanced sleep support.
[8, 16]Stimulates digestive secretions via bitter taste receptors
Mildly bitter taste stimulates digestive secretions including gastric acid, bile, and pancreatic enzymes. The bitter quality is contributed by sesquiterpene lactones (including matricin) and is part of the traditional digestive indication. Less intensely bitter than classic bitter herbs (gentian, wormwood).
[5]Soothes and protects irritated mucous membranes
Mucilage content provides soothing, coating action on inflamed mucosal surfaces. Relevant to the GI anti-inflammatory indication, particularly in gastritis and esophageal irritation. The demulcent action complements the anti-inflammatory and antispasmodic effects in the GI tract.
[4, 5]Kills or inhibits the growth of microorganisms
Alpha-bisabolol and the essential oil demonstrate in vitro activity against Staphylococcus aureus, Streptococcus mutans, Bacillus subtilis, and Candida albicans. Commission E approved for bacterial skin diseases (topical use). The antimicrobial potency is moderate and primarily relevant for topical applications.
[1, 18]Stimulates or increases menstrual flow
Traditional use as a mild emmenagogue to promote menstrual flow and ease menstrual cramping. The antispasmodic action on smooth muscle may contribute to relief of dysmenorrhea. The Latin name 'Matricaria' (from 'matrix,' meaning womb) reflects this longstanding gynecological association. No strong clinical evidence for emmenagogue action.
[5, 14]Therapeutic Indications
Digestive System
Gastrointestinal spasms and cramping
Commission E approved indication. WHO-listed indication. EMA well-established use. Antispasmodic activity of cis-spiroether and alpha-bisabolol demonstrated in vitro and supported by clinical use. First-line herbal treatment for functional GI cramping in European phytotherapy.
[1, 2, 3]Inflammatory conditions of the gastrointestinal tract (gastritis, minor GI inflammation)
Commission E approved indication. Alpha-bisabolol demonstrates gastroprotective activity in animal models, reducing indomethacin- and stress-induced gastric lesions. Anti-inflammatory flavonoids (apigenin, luteolin) suppress mucosal inflammatory mediators. Long history of clinical use in Europe for mild gastritis and functional dyspepsia.
[1, 2, 17]Functional dyspepsia and flatulence
Carminative, antispasmodic, and bitter actions combine to relieve dyspeptic symptoms including bloating, flatulence, and epigastric discomfort. Often used in combination formulas with peppermint and caraway (e.g., Iberogast). ESCOP and BHP recognized indication.
[4, 18]Infant colic
A clinical trial by Savino et al. (2005) found that a standardized chamomile/fennel/lemon balm extract (ColiMil) significantly reduced crying time in breastfed infants with colic. Weizman et al. (1993) demonstrated that a chamomile/fennel/vervain/licorice/balm-mint tea reduced colic symptoms in 57% of infants vs 26% with placebo (P < 0.01). Traditional use of dilute chamomile tea for infant GI distress is well documented across European cultures.
[10, 11, 18]Nervous System
Generalized anxiety disorder (mild to moderate)
Amsterdam et al. (2009) RCT: Chamomile extract (220 mg, standardized to 1.2% apigenin) significantly reduced HAM-A scores compared to placebo in 57 patients with mild-to-moderate GAD over 8 weeks (P = 0.047). Mao et al. (2016) long-term follow-up RCT (n=179): chamomile 1500 mg/day for 12 weeks significantly reduced GAD symptoms vs placebo, with lower relapse rates during follow-up. Mechanism: apigenin binding to GABA-A benzodiazepine receptors.
[6, 7]Restlessness and nervous tension
Commission E and EMA approved for restlessness and nervous tension. Long-standing traditional use across European herbal medicine. Gentle anxiolytic suitable for children and adults. Often combined with lemon balm (Melissa officinalis) and/or passionflower (Passiflora incarnata) for enhanced effect.
[1, 3, 5]Insomnia (mild, especially associated with anxiety)
Chang & Chen (2016) RCT: chamomile extract improved sleep quality in elderly subjects as measured by the Pittsburgh Sleep Quality Index. Apigenin produces sedation at higher doses in animal models. Chamomile tea is one of the most widely consumed 'bedtime' beverages worldwide. The sedative effect is considered mild and is most pronounced when insomnia is secondary to anxiety or nervous tension.
[8, 16]Skin / Integumentary
Skin and mucous membrane inflammation (topical)
Commission E approved indication for topical use. EMA well-established use. Alpha-bisabolol, chamazulene, and apigenin all demonstrate significant anti-inflammatory activity relevant to dermatological conditions. Used as compresses, washes, or in cream/ointment formulations.
[1, 3]Bacterial skin diseases (topical)
Commission E approved indication for topical use. Antimicrobial activity of alpha-bisabolol against skin pathogens (S. aureus, Streptococcus spp.) combined with anti-inflammatory effects provides dual benefit for infected skin conditions.
[1]Minor wound healing (topical)
Alpha-bisabolol stimulates granulation tissue formation and accelerates epithelialization. Apigenin promotes fibroblast migration and collagen synthesis. Kato et al. (2015) demonstrated enhanced wound healing with topical bisabolol application in animal models. Traditionally used as a wound wash or in poultice form.
[2, 16]Eczema and mild dermatitis (topical)
A comparative study by Aertgeerts et al. (1985) found chamomile cream (Kamillosan) comparable to 0.25% hydrocortisone and superior to placebo for medium-degree eczema. Patzelt-Wenczler & Ponce-Poschl (2000) RCT found chamomile cream mildly superior to 0.5% hydrocortisone for mild-moderate eczema over 3-4 weeks.
[9, 16]Reproductive System
Dysmenorrhea (menstrual cramps)
Jenabi & Ebrahimzadeh (2010) RCT found chamomile tea significantly reduced dysmenorrhea pain scores and associated anxiety compared to placebo in a crossover trial of 80 female students. The antispasmodic activity on smooth muscle is the proposed mechanism. Traditional use for menstrual discomfort is well documented.
[5, 12]Respiratory System
Upper respiratory catarrh and irritation (inhalation)
Commission E approved indication: inhalation for respiratory tract inflammation and irritation. Steam inhalation with chamomile infusion is a traditional European treatment for nasal congestion, sinusitis symptoms, and pharyngeal irritation. Anti-inflammatory volatile oil components act directly on respiratory mucosa.
[1, 4]Cardiovascular System
Cardiovascular risk factor modification (preliminary)
Rafraf et al. (2015) found chamomile tea consumption significantly improved glycemic and lipid profiles in type 2 diabetic patients. Zemestani et al. (2016) reported improved total cholesterol, triglycerides, and LDL-C with chamomile tea in diabetics. These are preliminary findings requiring larger confirmatory studies.
[13, 16]Energetics
Temperature
cool
Moisture
slightly dry
Taste
Tissue States
hot/excitation, wind/tension, damp/stagnation
German chamomile is classified as cool and slightly drying in Western herbal energetics. Its cooling nature makes it specific for conditions with signs of heat and inflammation (redness, burning, irritation). The aromatic and bitter qualities indicate its affinity for the digestive system, particularly when digestive disturbance is accompanied by nervous tension. The sweet undertone reflects its gentle, nourishing quality suitable for children and sensitive constitutions. The combination of bitter and aromatic is considered ideal for 'wind/tension' tissue states in the GI tract (cramping, bloating, nervous stomach). In traditional Unani medicine, chamomile is classified as warm in the first degree and dry in the first degree (indicating a near-neutral herb with gentle action). CAVEAT: Herbal energetics are interpretive frameworks within Western herbalism, not standardized across all practitioners.
Traditional Uses
Ancient Egyptian medicine
- Dedicated to the sun god Ra for its healing properties
- Used as a febrifuge (fever reducer)
- Cosmetic and embalming applications
- Treatment of ague (malarial fevers)
"The ancient Egyptians revered chamomile as a sacred herb dedicated to their gods. Hieroglyphic records indicate its use for fever and as an offering. Egyptian nobles used chamomile-infused oils for skin care."
[15]
Ancient Greek and Roman medicine
- Dioscorides prescribed chamomile for intestinal, nervous, and liver disorders
- Pliny the Elder documented its use for headaches and kidney, liver, and bladder disorders
- Used as an antispasmodic for colic and digestive cramping
- Chamomile baths for fever and inflammation
"The Greek name 'chamaimelon' (ground apple) refers to the apple-like scent of the fresh plant. Dioscorides (De Materia Medica, 1st century CE) recommended it for fevers, female complaints, and diseases of the kidneys and liver. Pliny (Natural History) noted chamomile for headaches."
European folk medicine (medieval to modern)
- Digestive upset, flatulence, and colic in adults and infants
- Nervous tension, restlessness, and insomnia (chamomile tea)
- Menstrual cramps and female reproductive complaints
- Teething pain in infants (rubbed on gums)
- Eye inflammation (compresses)
- Skin wounds, rashes, and burns (washes and poultices)
- Steam inhalation for colds and sinusitis
- Hair rinse for lightening blonde hair
"Chamomile is one of the most ancient and widely used medicinal plants in European folk medicine, sometimes called the 'mother of the gut' (Mutter des Darmes) in German folk tradition. The Anglo-Saxons counted it among the nine sacred herbs (Lacnunga, ca. 10th century). Culpeper (1653) wrote that chamomile is 'nourishing to everything it touches.'"
German and Central European phytotherapy
- GI spasms and inflammatory GI conditions (infusion, standardized extracts)
- Skin inflammation and bacterial skin diseases (topical preparations)
- Mucous membrane inflammation of the mouth and throat (rinse/gargle)
- Respiratory tract inflammation (steam inhalation)
- Restlessness and mild anxiety
- Pediatric colic and teething (dilute infusion)
"Chamomile is arguably the most important medicinal plant in German-speaking countries. The Commission E positive monograph (1984) formalized four centuries of documented therapeutic use. German pediatricians routinely recommend chamomile tea for infant digestive complaints. Annual consumption in Germany exceeds 4,000 tonnes of dried flower heads."
Traditional Mexican and Central American medicine
- Manzanilla tea for stomach ache, colic, and digestive upset
- Nervousness and insomnia
- Infant colic and irritability
- Menstrual cramps
- Eye washes for conjunctivitis
"Known as 'manzanilla' in Spanish-speaking countries, chamomile tea is one of the most widely consumed herbal remedies in Latin America. Its use for digestive and calming purposes is deeply embedded in folk medical tradition throughout Mexico, Central America, and South America."
[16]
Modern Research
Chamomile extract for generalized anxiety disorder (GAD)
Randomized, double-blind, placebo-controlled trial of oral Matricaria recutita extract (220 mg capsules standardized to 1.2% apigenin) in 57 outpatients with mild-to-moderate GAD over 8 weeks.
Findings: Chamomile produced a clinically meaningful and statistically significant greater reduction in mean total Hamilton Anxiety Rating (HAM-A) scores compared with placebo (P = 0.047). Adverse events were comparable between groups. This was the first controlled clinical trial to demonstrate anxiolytic activity of chamomile in humans.
Limitations: Small sample size (n=57). Single-center. Mild-to-moderate GAD only; results may not generalize to severe anxiety. Short treatment duration (8 weeks). Industry-provided study product.
[6]
Long-term chamomile for GAD prevention of relapse
Phase 2 randomized, double-blind, placebo-controlled trial in 179 adults with moderate-to-severe GAD. Open-label chamomile (1500 mg/day) for 8 weeks, then responders (n=93) randomized to chamomile or placebo for 26 weeks.
Findings: During the open-label phase, 58% of subjects responded. During the randomized phase, chamomile-treated patients maintained significantly lower GAD symptoms and reduced relapse rates compared to placebo. Mean HAM-A scores remained significantly lower in the chamomile group (P = 0.0032). Chamomile also significantly reduced body weight and mean arterial blood pressure.
Limitations: Enrichment design (only responders entered randomized phase). Moderate sample after randomization (n=93). Higher dose (1500 mg/day) than previous trial. Single center.
[7]
Anti-inflammatory activity of chamomile: COX-2 and PGE2 inhibition
In vitro study examining the anti-inflammatory properties of chamomile extract (aqueous-methanol) on LPS-stimulated RAW 264.7 macrophages, measuring COX-2 expression, PGE2 release, and nitric oxide (NO) production.
Findings: Chamomile extract significantly inhibited LPS-induced COX-2 mRNA and protein expression in a dose-dependent manner. PGE2 release was suppressed by 63% at 200 microg/mL. NO production was also significantly reduced. The extract did not affect COX-1 expression, suggesting selective COX-2 inhibition similar to pharmacological NSAIDs.
Limitations: In vitro study; results may not directly translate to in vivo or clinical settings. Macrophage cell line model. Specific concentration of active compounds not standardized.
[17]
Comprehensive review of chamomile bioactivity and health benefits
Narrative review of the pharmacological properties, constituent chemistry, and potential health applications of chamomile (Matricaria chamomilla), synthesizing evidence from in vitro, in vivo, and clinical studies.
Findings: Identified anti-inflammatory, antioxidant, antispasmodic, anxiolytic, mild sedative, anticancer (preliminary), antimicrobial, and antidiabetic (preliminary) properties supported by varying levels of evidence. Highlighted apigenin as a key bioactive compound for anxiolytic effects via GABA-A receptor modulation. Noted that chamomile is one of the most comprehensively studied medicinal plants with a strong safety profile.
Limitations: Narrative review without systematic methodology. Some cited studies were small or preliminary. Heterogeneity of chamomile preparations across studies.
[16]
Review of chamomile tea bioactivity and health benefits
Critical review of the bioactivity of chamomile constituents (flavonoids, terpenoids, coumarins) and the potential health benefits of chamomile tea consumption, drawing from pharmacological and clinical data.
Findings: Documented that chamomile tea constituents demonstrate anti-inflammatory, antispasmodic, antioxidant, and mild antimicrobial properties in preclinical models. Identified apigenin-7-O-glucoside as the predominant flavonoid in chamomile infusions. Noted that despite widespread traditional and current use, there was a relative paucity of controlled clinical trials at the time of publication.
Limitations: Review predates the Amsterdam et al. (2009) and Mao et al. (2016) clinical trials. Limited clinical evidence available at time of writing.
[18]
Chamomile extract for sleep quality in elderly
Randomized controlled trial examining the effect of chamomile extract on sleep quality in elderly subjects using the Pittsburgh Sleep Quality Index (PSQI).
Findings: Chamomile extract significantly improved overall sleep quality scores compared to controls. Improvements were noted in subjective sleep quality, sleep latency, and daytime dysfunction components of the PSQI.
Limitations: Modest sample size. Elderly population specifically; results may not generalize to younger adults. Short study duration. Subjective sleep measures only (no polysomnography).
[8]
Topical chamomile cream vs hydrocortisone for eczema
Randomized comparative trial evaluating chamomile cream (Kamillosan) against 0.5% hydrocortisone cream and placebo for mild-to-moderate eczema over 3-4 weeks.
Findings: Chamomile cream showed mild superiority over 0.5% hydrocortisone and was significantly superior to placebo in reduction of eczema symptoms (erythema, scaling, pruritus). Tolerability was excellent with no adverse effects reported.
Limitations: Low-potency corticosteroid comparator (0.5% hydrocortisone). Relatively short treatment period. Single commercial product tested (Kamillosan). Small sample size.
[9]
Chamomile/fennel/lemon balm extract for infant colic
Randomized, double-blind, placebo-controlled trial of a standardized extract of Matricaria recutita, Foeniculum vulgare, and Melissa officinalis (ColiMil) in 93 breastfed infants with colic, administered twice daily for 7 days.
Findings: Crying time was reduced in 85.4% of the chamomile group vs 48.9% of the placebo group (P < 0.005). Mean daily crying time decreased from 201 to 77 minutes/day with ColiMil vs 199 to 169 minutes/day with placebo. No side effects were reported.
Limitations: Combination product (not chamomile alone). Short treatment duration (7 days). Crying time measured by parental diary (subjective). Cannot attribute effects to chamomile specifically vs fennel or lemon balm.
[10]
Chamomile tea for dysmenorrhea
Randomized crossover trial assessing the effect of chamomile tea on primary dysmenorrhea in 80 female university students over two menstrual cycles.
Findings: Chamomile tea significantly reduced pain severity scores and associated distress compared to placebo. Pain reduction was also accompanied by reduced anxiety levels during menstruation.
Limitations: Self-reported pain scores. Crossover design may have carryover effects. University student population. Blinding challenges with herbal tea vs placebo tea.
[12]
Preparations & Dosage
Infusion (Tea)
Strength: 3 g dried flower heads per 150 mL water (approximately 2% infusion)
Pour 150 mL (approximately 5 oz) of freshly boiled water over 1 heaping tablespoon (approximately 3 g) of dried flower heads. Cover and steep for 5-10 minutes. Strain before drinking. Covering the cup during steeping is important to prevent loss of volatile oil components.
1 cup (150-250 mL) 3-4 times daily between meals
3-4 times daily for therapeutic effect; may be taken as needed for acute symptoms
May be used long-term as a daily tea. For specific therapeutic purposes, reassess after 2-4 weeks. No established maximum duration.
Infants (> 6 months): 50-100 mL of dilute infusion (half-strength) 1-3 times daily. Children 2-6 years: 50-100 mL standard infusion 1-3 times daily. Children 6-12 years: 100-150 mL standard infusion 2-3 times daily. Always consult pediatrician for infants under 6 months.
The most traditional and widely used preparation. The infusion extracts flavonoids (apigenin glycosides), mucilage, and water-soluble terpenoids. Some volatile oil is lost during steeping even with a lid. For GI indications, drink between meals. For sleep/anxiety, drink 30-60 minutes before bedtime. Commission E, WHO, ESCOP, and EMA all describe this as the primary preparation.
Tincture
Strength: 1:5, 45% ethanol (dried flower heads)
Hydroethanolic extraction of dried flower heads. Standard ratio 1:5 in 45% ethanol. Macerate for 2-4 weeks with regular agitation, then press and filter.
1-4 mL (20-80 drops) three times daily
Three times daily, or as needed for acute symptoms
May be used for extended periods. Reassess therapeutic need periodically.
Children 4-12 years: 0.5-1 mL diluted in water, 2-3 times daily (consult practitioner)
Tincture provides good extraction of both lipophilic (essential oil components, apigenin aglycone) and hydrophilic (flavonoid glycosides, phenolic acids) constituents. Higher alcohol content than some tinctures due to the importance of extracting lipophilic terpenoids. For those avoiding alcohol, the tincture dose can be added to hot water to evaporate some ethanol.
Glycerite
Strength: 1:5, 60% glycerin / 40% water
Extraction of dried flower heads in vegetable glycerin and water (typically 60:40 glycerin to water ratio). Macerate for 4-6 weeks with daily agitation.
2-5 mL three times daily
Three times daily
May be used for extended periods
Children 1-4 years: 0.5-1 mL, 2-3 times daily. Children 4-12 years: 1-2.5 mL, 2-3 times daily.
Alcohol-free preparation preferred for children, those avoiding alcohol, and patients with GI irritation. Glycerites extract flavonoids and some terpenoid compounds but may be less efficient for lipophilic essential oil components than ethanolic tinctures. Pleasant sweet taste makes it particularly suitable for pediatric use.
[5]
Standardized Extract
Strength: Varies. Clinical trial product: standardized to 1.2% apigenin (Amsterdam 2009). DER approximately 4-6:1.
Capsules or tablets containing dried chamomile extract standardized to apigenin content. The Amsterdam et al. (2009) GAD trial used 220 mg capsules standardized to contain 1.2% apigenin. The Mao et al. (2016) trial used 500 mg capsules (1500 mg/day).
220-1500 mg daily in divided doses, depending on product and indication. For anxiety: 220-1500 mg daily (based on clinical trial doses). Standardization to apigenin content (1.2% or higher) is recommended.
1-3 times daily per product label
Clinical trials used 8-38 weeks of continuous treatment safely.
Not well-established for standardized extracts in children
Standardized extracts are the form used in the pivotal anxiety clinical trials and provide consistent, quantified doses of active constituents. This preparation type is best supported by evidence for the anxiolytic indication specifically.
Essential Oil
Strength: 100% essential oil (Matricariae aetheroleum). Minimum quality: alpha-bisabolol > 10%, chamazulene > 1%.
Steam distillation of fresh or dried flower heads. Genuine chamomile essential oil is deep blue due to chamazulene content. For topical use: dilute to 1-5% in a carrier oil (e.g., jojoba, sweet almond). For inhalation: add 3-5 drops to a bowl of steaming water or diffuser. NOT for internal use undiluted.
Topical: 1-5% dilution in carrier oil, applied to affected area 2-3 times daily. Inhalation: 3-5 drops in steam inhalation, 2-3 times daily for respiratory symptoms. Internal use (encapsulated): 4-12 mg daily only under professional guidance.
2-3 times daily (topical or inhalation)
Short-term topical application. Reassess if condition does not improve within 1-2 weeks.
Topical only for children: 0.5-1% dilution. Not for internal use in children. Avoid use in infants under 6 months.
The blue color of genuine chamomile essential oil is due to chamazulene. Colorless or yellow 'chamomile' oil may indicate Roman chamomile, adulteration, or poor quality. Alpha-bisabolol content varies greatly by chemotype -- high-bisabolol cultivar oils are preferred for therapeutic use. CAUTION: Essential oils are highly concentrated. Always dilute before topical application. Patch test recommended. Commission E approved chamomile inhalation for respiratory tract inflammation.
salve-ointment
Strength: Commercial: typically 2-5% chamomile extract. Kamillosan contains standardized extract of Matricaria chamomilla.
Topical cream or ointment containing chamomile extract or essential oil. Commercial products include Kamillosan cream (standardized chamomile extract). For DIY: infuse dried flower heads in oil (olive or sunflower) for 2-4 weeks, strain, then combine with beeswax (approximately 1:4 beeswax to oil ratio).
Apply thin layer to affected skin area 3-4 times daily
3-4 times daily or as needed
Continue until skin condition resolves. Consult healthcare provider if no improvement after 2 weeks.
Suitable for children. Apply thin layer 2-3 times daily. Safe for diaper rash area.
Topical chamomile preparations are Commission E approved for skin and mucous membrane inflammation and bacterial skin diseases. The Patzelt-Wenczler & Ponce-Poschl (2000) trial found chamomile cream mildly superior to 0.5% hydrocortisone for eczema. Well-tolerated; rarely causes contact dermatitis (more common with Roman chamomile than German chamomile).
capsule-powder
Strength: Crude dried flower head powder, typically 400-500 mg per capsule
Dried chamomile flower heads, finely powdered and encapsulated. Less commonly used than infusion or standardized extract but available as a supplement form.
400-1600 mg dried flower powder daily in divided doses (2-4 capsules of 400 mg)
2-3 times daily with water
May be used long-term
Not recommended for children in capsule form; use infusion or glycerite instead
Dried powder retains all constituents but bioavailability of some compounds may be lower than in extracted forms. Standardized extracts are generally preferred when specific therapeutic outcomes are desired (e.g., anxiety reduction).
[4]
Safety & Interactions
Class 1
Can be safely consumed when used appropriately (AHPA Botanical Safety Handbook)
Contraindications
Allergic reactions including contact dermatitis, urticaria, and rare anaphylaxis have been reported. Patients with established allergies to ragweed, chrysanthemums, marigolds, or other Asteraceae plants are at elevated risk. Cross-reactivity with mugwort pollen (Artemisia vulgaris) has been documented. However, the actual incidence of chamomile allergy is very low relative to its widespread use. Allergic contact dermatitis is more commonly associated with Roman chamomile (Chamaemelum nobile) than with German chamomile (Matricaria chamomilla).
Drug Interactions
| Drug / Class | Severity | Mechanism |
|---|---|---|
| Warfarin and other coumarin anticoagulants (Anticoagulants) | theoretical | One case report described elevated INR in a patient consuming chamomile tea while on warfarin. Proposed mechanisms include coumarin content (though chamomile's hydroxycoumarins lack anticoagulant activity) and possible CYP enzyme interactions. Chamomile extracts have shown in vitro inhibition of CYP3A4 and CYP1A2, which are involved in warfarin metabolism. |
| Cyclosporine and other CYP3A4 substrates (CYP3A4 substrates) | theoretical | In vitro studies suggest chamomile constituents (particularly apigenin) may inhibit CYP3A4. One case report noted possible interaction between chamomile and cyclosporine. However, in vivo clinical significance has not been demonstrated at typical chamomile tea consumption levels. |
| Benzodiazepines and other CNS depressants (CNS depressants) | minor | Apigenin binds to the benzodiazepine site on GABA-A receptors. Additive sedation is theoretically possible when combined with pharmaceutical benzodiazepines, barbiturates, or other CNS depressants. |
| Antidiabetic medications (insulin, metformin, sulfonylureas) (Hypoglycemic agents) | theoretical | Preliminary human studies suggest chamomile tea may have modest hypoglycemic effects. Rafraf et al. (2015) observed significant reductions in HbA1c and postprandial glucose with chamomile tea in type 2 diabetics. Additive blood glucose lowering is theoretically possible. |
Pregnancy & Lactation
Pregnancy
likely safe
Lactation
likely safe
German chamomile tea has been consumed by pregnant and breastfeeding women for centuries without documented teratogenic or adverse fetal effects. The EMA classifies chamomile under 'traditional use' without specific pregnancy contraindication, noting only that the use in pregnancy and lactation has not been established due to lack of specific safety studies (precautionary language). Commission E does not list pregnancy as a contraindication. Chamomile is generally considered safe in food/tea amounts during pregnancy. Concentrated essential oil and high-dose extracts should be avoided during pregnancy due to the traditional emmenagogue reputation and lack of specific safety data at high doses. The German rating of pregnancy safety by Schaefer et al. places chamomile in a 'compatible' category for breastfeeding. As a precaution, therapeutic doses should be discussed with a healthcare provider during pregnancy.
Adverse Effects
References
Monograph Sources
- [1] German Commission E (Bundesinstitut fur Arzneimittel und Medizinprodukte). Commission E Monograph: Matricariae flos (Chamomile Flowers) -- Positive. Bundesanzeiger (Federal Gazette) (1984)
- [2] World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 1: Flos Chamomillae. World Health Organization, Geneva (1999) : 86-94
- [3] Committee on Herbal Medicinal Products (HMPC), European Medicines Agency. European Union Herbal Monograph on Matricaria recutita L., flos. European Medicines Agency (2015)
- [4] Blumenthal M, Busse WR, Goldberg A, Gruenwald J, Hall T, Riggins CW, Rister RS (eds). The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, TX (1998) . ISBN: 978-0965555500
- [5] Hoffmann D. Medical Herbalism: The Science and Practice of Herbal Medicine. Healing Arts Press, Rochester, VT (2003) . ISBN: 978-0892817498
Clinical Studies
- [6] Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol (2009) ; 29 : 378-382 . DOI: 10.1097/JCP.0b013e3181ac935c . PMID: 19593179
- [7] Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine (2016) ; 23 : 1735-1742 . DOI: 10.1016/j.phymed.2016.10.012 . PMID: 27912875
- [8] Chang SM, Chen CH. Effects of an intervention with drinking chamomile tea on sleep quality and depression in sleep disturbed postnatal women: a randomized controlled trial. J Adv Nurs (2016) ; 72 : 306-315 . DOI: 10.1111/jan.12836 . PMID: 26483209
- [9] Patzelt-Wenczler R, Ponce-Poschl E. Proof of efficacy of Kamillosan cream in atopic eczema. Eur J Med Res (2000) ; 5 : 171-175 . PMID: 10799953
- [10] Savino F, Cresi F, Castagno E, Silvestro L, Oggero R. A randomized double-blind placebo-controlled trial of a standardized extract of Matricariae recutita, Foeniculum vulgare and Melissa officinalis (ColiMil) in the treatment of breastfed colicky infants. Phytother Res (2005) ; 19 : 335-340 . DOI: 10.1002/ptr.1668 . PMID: 16041731
- [11] Weizman Z, Alkrinawi S, Goldfarb D, Bitran C. Efficacy of herbal tea preparation in infantile colic. J Pediatr (1993) ; 122 : 650-652 . DOI: 10.1016/S0022-3476(05)83557-7 . PMID: 8463920
- [12] Jenabi E, Ebrahimzadeh S. Chamomile tea for relief of primary dysmenorrhea. Iran J Obstet Gynecol Infertil (2010) ; 13 : 39-42
- [13] Rafraf M, Zemestani M, Asghari-Jafarabadi M. Effectiveness of chamomile tea on glycemic control and serum lipid profile in patients with type 2 diabetes. J Endocrinol Invest (2015) ; 38 : 163-170 . DOI: 10.1007/s40618-014-0170-x . PMID: 25194428
Traditional Texts
- [14] Grieve M. A Modern Herbal: The Medicinal, Culinary, Cosmetic and Economic Properties, Cultivation and Folk-Lore of Herbs, Grasses, Fungi, Shrubs & Trees with Their Modern Scientific Uses. Jonathan Cape, London (1931)
- [15] Singh O, Khanam Z, Misra N, Srivastava MK. Chamomile (Matricaria chamomilla L.): An overview. Pharmacogn Rev (2011) ; 5 : 82-95 . DOI: 10.4103/0973-7847.79103 . PMID: 22096322
Pharmacopeias & Reviews
- [16] Srivastava JK, Shankar E, Gupta S. Chamomile: A herbal medicine of the past with bright future. Mol Med Report (2010) ; 3 : 895-901 . DOI: 10.3892/mmr.2010.377 . PMID: 21132119
- [17] Srivastava JK, Pandey M, Gupta S. Chamomile, a novel and selective COX-2 inhibitor with anti-inflammatory activity. Life Sci (2009) ; 85 : 663-669 . DOI: 10.1016/j.lfs.2009.09.007 . PMID: 19788894
- [18] McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of chamomile tea (Matricaria recutita). Phytother Res (2006) ; 20 : 519-530 . DOI: 10.1002/ptr.1900 . PMID: 16628544
Last updated: 2026-02-26 | Status: review