Lúpulo y valeriana en el manejo del insomnio. Opinión de expertos; recomendaciones para su uso en el primer nivel de atención médica

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Introduction. Insomnia is a complaint of dissatisfaction with the quantity and/or quality of sleep. It may consist of difficulty initiating and/or maintaining sleep and waking up early in the morning, which leads to a significant deterioration in daily functioning. The breaking point between acute and chronic insomnia is three months duration. Occasionally there is an identifiable trigger. Insomnia is a frequent and commonly overlooked disorder in the primary care setting. It produces frequent complications such as anxiety, depression, decreased quality of life, diminished cognitive abilities and memory, accidents, lower productivity at work, increased risk of alcoholism, as well as cardiovascular disease, hypertension, dyslipidemia and type II diabetes mellitus. Valeriana officinalis (valerian extract) has been used as a treatment for anxiety and insomnia since the Middle Ages. It is currently approved by the FDA (Food and Drug Administration) and the EMA (European Medicines Agency) as a treatment for mild anxiety and insomnia. Likewise, Humulus lupulus (hops extract) has been traditionally used since ancient times for treating insomnia as part of the European herbal pharmacopoeia. Material and Methods. An interdisciplinary group of experts held several meetings to generate search terms, develop a literature search protocol to examine and weigh the evidence and create consensus recommendations for the use of a fixed and standardized dose of 250 mg of valerian extract and 60 mg of hops extract in the management of insomnia in primary care. Results. The evidence supports the effectiveness and safety of a fixed and standardized dose of 250 mg of valerian extract and 60 mg of hops extract in the management of mild to moderate insomnia. In order to support the diagnosis and treatment of insomnia, recommendations were generated for using these phytopharmaceuticals in the first level of medical care. Conclusions. The fixed combination of valerian and hops extracts helps manage insomnia in the practice of family and general medicine, as well as in obstetrics and gynecology at the recommended doses and duration. It is crucial to make a timely and correct diagnosis and refer patients with severe insomnia or associated pathology to a specialist.