Table of Contents > Herbs & Supplements > Sage (Salvia officinalis, Salvia lavandulaefolia, Salvia lavandulifolia) Print

Sage (Salvia officinalis, Salvia lavandulaefolia, Salvia lavandulifolia)

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Also listed as: Salvia officinalis, Salvia lavandulaefolia, Salvia lavandulifolia
Related terms
Background
Evidencetable
Tradition
Dosing
Safety
Interactions
Attribution
Bibliography

Related Terms
  • Abietane diterpenes, alpha-humulene, alpha-pinene, alpha-thujone, alpha-tocopherol, apigenin, atuntzensin A, berggarten sage, beta-carotene, beta-caryophyllene, beta-myrcene, beta-pinene, beta-sitosterol, beta-thujone, beta-trans-ocymene, beta-ursolic acid, black sage, bornyl acetate, broad-leafed sage, caffeic acid, caffeoyl-coumarin conjugates, caffeoylquinic acid, camphene, camphor, carnosic acid, carnosol, caryophyllene, cineole, cirsimaritin, clary sage, columbaridione, common sage, coumaric acid, Dalmatian sage, diterpene quinones, east Mediterranean sage, Edelsalbei (German), epirosmanol, essential oil, ethyl beta-D-glucopyranosyl tuberonate, eucalyptol, ferulic acid, feuilles de sauge (French), flavones, flavonoids, galdosol, gallic acid, gamma-terpinene, garden sage, Gartensalbei (German), genkwanin, geraniol, Greek sage, glucopyranoside, glucosylapigenin, Herba salviae, hesperetin, hispidulin, (-)-hydroxyjasmonic acid, hydroxyacetophenone, hydroxyluteolin, isocaryophyllene, isoferulic acid, isorosmanol, isothujone, Judean sage, kew gold, kitchen sage, Labiatae (former family name), Lamiaceae (family), limonene, linalool, lupeol, luteolin, manool, meadow sage, methoxyrosmanol, methoxysalvigenin, miltirone, monoterpene glycosides, monoterpene hydrocarbons, Newe Ya'ar No. 4, nutmeg sage, oleanolic acid, oleoresin sage, oxygenated monoterpenes, oxygenated sesquiterpenes, oxytriterpenic acids, pentacyclic triterpenes, phenolic diterpenes, p-hydroxybenzoic acid, physcion, polysaccharides, purpurascens, quinines, red sage, rosmadiol, rosmanol, rosmarinic acid, rouleanone, royleanone, S. hypoleuca, S. reuterana, S. verticillata, S. virgata, sagecoumarin, Salbeiblatter (German), Salvia acetabulosa, Salvia argentea, Salvia bertolonii, Salvia fruticosa, Salvia hispanorum, salvia honey, Salvia judaica, Salvia lavadulifolia, Salvia lavandulaefolia, Salvia libanotica, Salvia mellifera, Salvia miltiorrhiza, Salvia multicaulis, Salvia officinalis, Salvia pratensis, Salvia reflexa, Salvia repens, Salvia rhytidea, Salvia runcinata, Salvia sclarea, Salvia somalensis, Salvia splendens, Salvia stenophylla, Salvia triloba, salvigenin, salvin, sawge, scarlet sage, selenium, sesamol, sesquiterpene hydrocarbons, shell flower sage, silver sage, Spanish sage, stigmasterol, tannins, tanshinone IIA, terpineol, thujenone, thujone, triterpenoids, true sage, ursolic acid, vicenin-2, viridiflorol, water-soluble polysaccharide complex.

Background
  • Sage has been used in Europe for centuries as a spice and a medicine. Salvia officinalis and Salvia lavandulifolia (Salvia lavandulaefolia) are two of the most common species of sage.
  • Sage is a popular European treatment for inflammation of the mouth and throat, upset stomach (dyspepsia), and excessive sweating, in addition to other uses. It has also been used to decrease human milk production and as a mouthwash. Sage mouthwashes and gargles have been approved in Germany by the German Commission E for many years for use against sore throat.
  • Early clinical evidence exists supporting the use of sage for Alzheimer's disease, pharyngitis, herpes infections, and improvement of mood, cognition, and memory. Sage has also been studied for menopausal symptom improvement, lung cancer prevention, bacterial infections, postoperative pain, and ultraviolet light-induced swelling (erythema). Further study is necessary.
  • Despite its common historical use, sage is known to be toxic when taken in excessive doses.

Evidence Table

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. GRADE *


Based on early human study, Salvia lavandulaefolia essential oil may be useful in the treatment of Alzheimer's disease. Also, a product containing an extract of sage prevented memory worsening. Additional study is needed in this area.

C


Early study has shown that sage extracts may prevent the ability of the herpes virus to affect cells. In human study, a product containing sage leaf and other ingredients helped reduce side effects on the skin normally associated with herpes. Additional study is needed in this area.

C


Although there is a lack of human study, sage used daily as a spice in foods has been associated with a lower risk of lung cancer in the Mediterranean diet. Additional study is needed in this area.

C


Sage is traditionally used to improve memory and cognition. Early human study suggests that sage (Salvia lavandulaefolia essential oil or Salvia officinalis leaf as capsules) may aid memory, even in stressful situations. Additional study is needed in this area.

C


Sage may contain compounds that act like the hormone estrogen. In theory, these compounds may decrease symptoms of menopause. Sage has been tested against menopausal symptoms with promising results. Additional study is needed in this area.

C


Sage is traditionally used to improve mood. Preliminary human study suggests that sage (Salvia lavandulaefolia essential oil or Salvia officinalis leaf as capsules) may aid mood, even in stressful situations. Additional study is needed in this area.

C


Sage mouthwashes and gargles have been approved in Germany by the German Commission E for many years for use against sore throat. Good clinical evidence exists for the use of sage for pharyngitis.

C


Preliminary evidence in humans suggests that Salvia officinalis may be an inferior treatment for postoperative pain compared to benzydamine hydrochloride. Additional study is needed in this area.

C


Sage mouthwashes and gargles have been approved in Germany by the German Commission E for many years for use against sore throat. Also, an echinacea/sage spray for three days may result in a decrease in sore throat symptoms. Additional study is needed in this area.

C


Based on early study, a topical sage extract may prevent ultraviolet light-induced skin swelling (erythema) in healthy subjects. Additional study is needed in this area.

C


Based on early study in humans, a sage extract may reduce vaginal pH levels and improve symptoms of vaginosis. Additional study is needed in this area.

C
* Key to grades

A: Strong scientific evidence for this use
B: Good scientific evidence for this use
C: Unclear scientific evidence for this use
D: Fair scientific evidence for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)


Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.

  • Abdominal pain, acne, acute alcohol withdrawal, aging, antibacterial, anticonvulsant, antifungal, anti-inflammatory, antimicrobial, antioxidant, antiseptic, antitumor, antiviral, appetite stimulant, asthma, bad breath, baldness, bleeding gums, bloating, blood clotting disorders, bone loss, bronchitis, carbuncles, colds/flu, dental conditions, diabetes, dyspepsia, eczema, estrogenic effects, fever, food uses, gallstones, gastric disorders, gum disease, headaches, infection, hemorrhoids, high blood pressure, high cholesterol, HIV/AIDS, immune system function, insect bites, insecticide, lactation suppression, liver diseases, liver protection, lymphedema, malaria, menstrual problems, muscle relaxant, neuroprotection, pain, parasites, Parkinson's disease, respiratory disorders, sedative, sexually transmitted disease, sleep aid, sweating (excessive), ulcers, urinary tract infection, venereal disease, withdrawal from narcotics, wound healing, yeast infection.

Dosing

Adults (18 years and older)

  • There is no proven effective dose for sage in adults. Sage has been used as a spice in food for centuries.
  • For Alzheimer's disease, Salvia officinalis extract, 60 drops daily for four months, was used. As a memory aid, single doses of Salvia lavandulaefolia essential oil (25-150 microliters) and 167-1332 milligrams of a standardized extract have been used. For mood enhancement, 300 or 600 milligrams of dried sage leaf in single daily doses have been used and an essential oil of S. lavandulaefolia, 50 microliters as a single dose, has been used. For postoperative pain, Salvia officinalis following surgery has been used along with pain medications without evidence of benefit.
  • Sage has also been used topically. For pharyngitis, a 15% spray containing 140 microliters of Salvia officinalis extract per dose has been used 6-9 times daily for three days. For bacterial vaginosis, an extract of Salvia officinalis has been used once or twice daily for four weeks. For herpes, a cream including 23 milligrams per gram of dried sage extract has been used daily without evidence of benefit. For sunburn prevention, a topical 2% sage extract in an ointment, as a single application, has been used.
  • Sage essential oil has also been used in aromatherapy.

Children (younger than 18 years)

  • There is no proven safe or effective dose for sage in children. Sage has been used as a spice in food for centuries.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

  • People with a known allergy or hypersensitivity to sage and related plants should avoid sage. Anaphylaxis, a life-threatening allergic reaction, is possible. Dust from sage plants may contain microorganisms that may induce allergic reactions in agricultural workers and herb processors. Other allergic reactions include skin reactions (contact dermatitis) and airway (bronchial) reactions.

Side Effects and Warnings

  • Sage essential oil therapy may increase or decrease blood pressure. Caution is advised in patients taking drugs that affect blood pressure.
  • Sage may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or those taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.
  • Sage may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia and those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery or if taking certain sedatives or antidepressants.
  • Essential oil or tinctures of sage should be used cautiously in patients with epilepsy, due to possibility of seizure induction with these preparations.
  • Only sterile preparations of sage should be used in the eye.
  • Skin irritation may occur due to contact with sage essential oil. Other side effects include the potential for mild burning of the throat when a spray containing sage extract is used. Use by mouth (oral use) may result in local irritation, cracked lips (cheilitis), dry mouth, and stomach effects. Inhalation of sage dust may result in airway irritation.
  • Avoid in patients with a known allergy or hypersensitivity to sage and related plants.
  • Avoid medicinal use of sage during pregnancy or lactation.

Pregnancy and Breastfeeding

  • Sage is not recommended above levels normally found in the diet in pregnant or breastfeeding women, due to a lack of available safety information.

Interactions

Interactions with Drugs

  • Sage essential oil therapy may result in increased or decreased blood pressure. Caution is advised in patients taking drugs that affect blood pressure.
  • Sage may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants (blood thinners) such as warfarin (Coumadin®) or heparin, antiplatelet drugs such as clopidogrel (Plavix®), and nonsteroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
  • Sage may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking insulin or drugs for diabetes by mouth should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.
  • Sage may interfere with the way the body processes certain drugs using the liver's cytochrome P450 enzyme system. As a result, the levels of these drugs may be increased in the blood and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.
  • Because sage contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Sage may increase the amount of drowsiness caused by some drugs. Examples include benzodiazepines such as lorazepam (Ativan®) or diazepam (Valium®), barbiturates such as phenobarbital, narcotics such as codeine, some antidepressants, sedatives, and alcohol. Caution is advised while driving or operating machinery.
  • Sage may also interact with Alzheimer's agents, antianxiety drugs, antibiotics, anticholinergics, anticonvulsant agents, antifungals, anti-inflammatory agents, antiprotozoals, antivirals, cholesterol-lowering drugs, chemotherapy drugs, drugs that may lower seizure threshold, drugs used for osteoporosis, immune system altering agents, and thyroid hormones.

Interactions with Herbs and Dietary Supplements

  • Sage essential oil therapy may result in increased or decreased blood pressure. Caution is advised in patients taking herbs or supplements that affect blood pressure.
  • Sage may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
  • Sage may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.
  • Sage may interfere with the way the body processes certain herbs or supplements using the liver's cytochrome P450 enzyme system. As a result, the levels of other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.
  • Because sage contains estrogen-like chemicals, the effects of other agents believed to have estrogen-like properties may be altered.
  • Sage may increase the amount of drowsiness caused by some herbs or supplements such as some sedatives or antidepressants.
  • Sage may also interact with herbs and supplements used for Alzheimer's disease and osteoporosis, herbs and supplements that lower the seizure threshold, as well as those with antianxiety, antibacterial, anticholinergic, anticonvulsant, antifungal, anti-inflammatory, antiparasitic, antiviral, cholesterol-lowering, anti-cancer, immune system altering, and thyroid stimulating properties. Sage may increase the effectiveness of alfalfa, antioxidants, rhubarb, sumac, and herbs with protective effects for the stomach and intestines (gastroprotective effects). Sage may have similar effects to perillyl alcohol-containing herbs.

Attribution
  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. Akhondzadeh S, Noroozian M, Mohammadi M, et al. Salvia officinalis extract in the treatment of patients with mild to moderate Alzheimer's disease: a double blind, randomized and placebo-controlled trial. J.Clin.Pharm.Ther 2003;28(1):53-59.
  2. De, Leo V, Lanzetta D, Cazzavacca R, et al. [Treatment of neurovegetative menopausal symptoms with a phytotherapeutic agent]. Minerva Ginecol 1998;50(5):207-211.
  3. Dos Santos-Neto LL, Vilhena Toledo MA, Medeiros-Souza P, et al. The use of herbal medicine in Alzheimer's disease-a systematic review. Evid.Based.Complement Alternat.Med 2006;3(4):441-445.
  4. Fortes C, Forastiere F, Farchi S, et al. The protective effect of the Mediterranean diet on lung cancer. Nutr Cancer 2003;46(1):30-37.
  5. Guaschino S and Benvenuti C. SOPHY project: an observational study of vaginal pH, lifestyle and correct intimate hygiene in women of different ages and in different physiopathological conditions. Part II. Minerva Ginecol 2008;60(5):353-362.
  6. Hubbert M, Sievers H, Lehnfeld R, et al. Efficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis - a randomised, double-blind, placebo-controlled study with adaptive design and interim analysis. Eur J Med Res 1-31-2006;11(1):20-26.
  7. Kennedy DO, Pace S, Haskell C, et al. Effects of cholinesterase inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery. Neuropsychopharmacology 2006;31(4):845-852.
  8. Lalicevic S. and Djordjevic I. Comparison of benzydamine hydrochloride and Salvia officinalis as an adjuvant local treatment to systemic nonsteroidal anti-inflammatory drug in controlling pain after tonsillectomy, adenoidectomy, or both: An open-label, single-blind, randomized clinical trial. Current Therapeutic Research, Clinical and Experimental 2004;65:360-372.
  9. Perry NS, Bollen C, Perry EK, et al. Salvia for dementia therapy: review of pharmacological activity and pilot tolerability clinical trial. Pharmacol Biochem Behav 2003;75(3):651-659.
  10. Reuter J, Jocher A, Hornstein S, et al. Sage extract rich in phenolic diterpenes inhibits ultraviolet-induced erythema in vivo. Planta Med 2007;73(11):1190-1191.
  11. Saller R, Buechi S, Meyrat R, et al. Combined herbal preparation for topical treatment of Herpes labialis. Forsch.Komplementarmed.Klass.Naturheilkd 2001;8(6):373-382.
  12. Schapowal A, Berger D, Klein P, et al. Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomized double-blind trial. Eur.J Med Res 9-1-2009;14(9):406-412.
  13. Scholey AB, Tildesley NT, Ballard CG, et al. An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers. Psychopharmacology (Berl) 2008;198(1):127-139.
  14. Tildesley NT, Kennedy DO, Perry EK, et al. Salvia lavandulaefolia (Spanish sage) enhances memory in healthy young volunteers. Pharmacol Biochem Behav 2003;75(3):669-674.
  15. Tildesley NT, Kennedy DO, Perry EK, et al. Positive modulation of mood and cognitive performance following administration of acute doses of Salvia lavandulaefolia essential oil to healthy young volunteers. Physiol Behav 1-17-2005;83(5):699-709.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


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