German chamomile

What it is

German chamomile is the dried flower head of Matricaria chamomilla L., a daisy-family plant used since antiquity and drunk as tea or taken as a standardised extract. It is one of the most commonly used herbal products for anxiety and sleep. Because it belongs to the Asteraceae family, it cross-reacts with ragweed and mugwort in people with pollen allergy.

What the research says

The best evidence is for anxiety rather than sleep, and it is thin. A randomised placebo-controlled trial in 57 people with mild-to-moderate generalised anxiety disorder found a greater fall in Hamilton Anxiety scores with chamomile (P = 0.047). A longer trial found chamomile did not significantly reduce relapse of generalised anxiety disorder, and a randomised pilot trial in chronic primary insomnia found no significant differences in any sleep diary measure. A 2026 preprint meta-analysis of herbal sedatives reported a large but extremely heterogeneous pooled effect for chamomile on sleep. Adverse events in trials are mostly minor and self-limiting, but six of eleven published case reports involved allergic reactions, three of them anaphylactic.

Evidence grade: Limited evidence.

What goes wrong

A systematic review of adverse events found mostly minor, self-limiting effects in trials, but allergic reactions including anaphylaxis in published case reports. (Source 1)

• Systematic review, Low certainty.
• Size: seventy-two trials and eleven case reports; 2896 patients received chamomile.
• Who: participants in chamomile clinical trials plus published case reports.
• How long: varied; literature searched to February 2024.
• Result: 65 adverse events reported across 10 trials; most common were gastrointestinal complications and drowsiness; among 11 case reports, six involved allergic reactions, with anaphylactic reactions in three patients.
• Funding: not stated.

among the eleven case reports, six reported adverse events associated with allergic reactions to chamomile, ranging from anaphylactic reactions (in three patients) to short-lasting acute rhinitis

The adverse-event review also flagged incomplete safety reporting in the trial literature and a lack of data in pregnancy and lactation. (Source 1)

• Systematic review, Low certainty.
• Size: seventy-two trials; 28 trials reported no adverse event data at all.
• Who: chamomile trial participants.
• How long: literature to February 2024.
• Result: no rates could be pooled because of incomplete reporting.
• Funding: not stated.

the incomplete reporting of adverse events in these trials, along with the absence of any data on adverse events in 28 trials, limited the scope of our review

Position: NCCIH notes that chamomile side effects, though uncommon, include severe hypersensitivity reactions and anaphylaxis. (Source 2)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: general public, particularly people allergic to ragweed and related plants.
• How long: not applicable; NCCIH page carries the label Last Updated: November 2024.
• Result: no rates given.
• Funding: US government agency.

Side effects are uncommon and may include nausea, dizziness, and allergic reactions, including severe hypersensitivity reactions and anaphylaxis, in some people.

Position: NCCIH reports that interactions between chamomile and warfarin and some drugs metabolised by the liver have been reported, and that other interactions, such as with sedatives, are so far only theoretical. (Source 2)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: people taking chamomile alongside prescribed medicines.
• How long: not applicable; NCCIH page carries the label Last Updated: November 2024.
• Result: no rates or case counts given; NCCIH separates reported interactions from theoretical ones.
• Funding: US government agency.

Interactions between chamomile and some drugs metabolized by the liver and warfarin (a blood thinner) have been reported, and there are theoretical reasons to suspect that chamomile might interact with other drugs as well, such as sedatives.

What the evidence supports

A randomised, double-blind, placebo-controlled trial found chamomile extract reduced generalised anxiety symptoms more than placebo over 8 weeks. (Source 3)

• Randomized trial, Low certainty.
• Size: Sixty-one outpatients enrolled, 57 randomised (chamomile n = 28, placebo n = 29)
• Who: outpatients with mild to moderate generalized anxiety disorder.
• How long: 8 weeks.
• Result: significantly greater reduction in mean total HAM-A score during chamomile versus placebo therapy (P = 0.047); secondary outcomes moved in the same direction but were not powered.
• Funding: not stated.

We observed a significantly greater reduction in mean total HAM-A score during chamomile versus placebo therapy (P = 0.047).

A meta-analysis of herbal sedatives for insomnia pooled ten chamomile studies and reported a large improvement in sleep outcomes, but with heterogeneity so high that the studies barely agreed with each other. (Source 4)

• Meta-analysis, Low certainty.
• Size: 10 chamomile studies within a review of 32 studies; 23 RCTs in the overall meta-analysis.
• Who: adults with insomnia or poor sleep in randomised trials of herbal sedatives.
• How long: varied between trials.
• Result: chamomile subgroup SMD = -1.06, 95% CI [-1.88, -0.24]; p = 0.01, with I2 = 96%; overall pooled effect across 23 RCTs SMD -0.77, 95% CI -1.14 to -0.40, p = 0.0001, I2 = 92%.
• Funding: not stated.

Limit of this finding: This is an unrefereed preprint. Its own results give I-squared of 96% for the chamomile studies, which means the ten trials disagreed with one another almost completely, and its abstract says most of the randomised trials were at high risk of bias. A pooled number drawn from studies that conflict that much is not a reliable estimate of how well chamomile works.

For the 10 studies of chamomile, a significant improvement in sleep outcomes was found compared with the control (SMD= −1.06, 95% CI [−1.88, −0.24]; p= 0.01), even though significant heterogeneity was present (I² = 96%, χ² = 98.37, p < 0.00001).

What the evidence does not support

A randomised placebo-controlled pilot trial in chronic primary insomnia found no significant differences between chamomile and placebo on any sleep diary measure. (Source 5)

• Randomized trial, Low certainty.
• Size: 34 patients aged 18-65 years with DSM-IV primary insomnia for at least 6 months.
• Who: adults with chronic primary insomnia.
• How long: 28 days.
• Result: no significant differences in total sleep time, sleep efficiency, sleep latency, wake after sleep onset, sleep quality or number of awakenings; effect sizes generally small to moderate, with total sleep time favouring placebo.
• Funding: not stated.

There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings.

In a long-term randomised trial, continuing chamomile did not significantly reduce relapse of generalised anxiety disorder compared with switching to placebo. (Source 6)

• Randomized trial, Low certainty.
• Size: 179 participants enrolled in the open-label phase; 93 (51.9%) responders randomised.
• Who: adults with moderate-to-severe generalized anxiety disorder who had responded to open-label chamomile.
• How long: 12 weeks open-label chamomile, then 26 weeks of double-blind randomised continuation (38 weeks in total)
• Result: relapse 12/47 (25.5%) on placebo versus 7/46 (15.2%) on chamomile; mean time to relapse 11.4 +/- 8.4 weeks for chamomile and 6.3 +/- 3.9 weeks for placebo; hazard ratio 0.52, 95% CI 0.20-1.33; P = 0.16.
• Funding: not stated.

Long-term chamomile was safe and significantly reduced moderate-to-severe GAD symptoms, but did not significantly reduce rate of relapse.

Position: NCCIH states that studies of chamomile have not produced sufficient reliable evidence to rate its clinical usefulness. (Source 7)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: general public.
• How long: not applicable; NCCIH page carries the label Last Updated: November 2024.
• Result: no pooled estimate given.
• Funding: US government agency.

Studies of the effectiveness of chamomile for a variety of specific conditions have not produced sufficient reliable evidence to rate clinical usefulness.

In the same long-term trial the hazard of relapse was lower with chamomile than placebo but did not reach statistical significance. (Source 8)

• Randomized trial, Low certainty.
• Size: 93 responders randomised (chamomile n = 46, placebo n = 47)
• Who: adults with moderate-to-severe generalized anxiety disorder who had responded to open-label chamomile.
• How long: 26 weeks of double-blind randomised continuation.
• Result: relapse 12/47 (25.5%) on placebo versus 7/46 (15.2%) on chamomile; hazard ratio 0.52, 95% CI 0.20–1.33, P = 0.16.
• Funding: not stated.

Hazard of relapse was non-significantly lower for chamomile (hazard ratio, 0.52; 95% CI, 0.20–1.33; P = 0.16).

Where the research disagrees

Whether chamomile improves sleep

• Authors of a 2026 meta-analysis of herbal sedatives, meta-analysis of 23 randomised trials, chamomile subgroup of 10 studies with I-squared 96%, unrefereed preprint: For the 10 studies of chamomile, a significant improvement in sleep outcomes was found compared with the control (SMD= −1.06, 95% CI [−1.88, −0.24]; p= 0.01), even though significant heterogeneity was present (I² = 96%, χ² = 98.37, p < 0.00001). (Source 4)
• Zick and colleagues, randomised placebo-controlled pilot trial, randomised, double-blind, placebo-controlled pilot trial in 34 adults with chronic primary insomnia: There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings. (Source 5)

How much

• Reference intake: No reference intake (RDA or AI) exists for chamomile. It is a botanical used as a tea and extract, not a nutrient. (Source 9)
• Upper limit: No tolerable upper intake level or ADI was found in the sources searched. NCCIH (page labelled Last Updated: November 2024) states only that chamomile is likely safe in the amounts commonly found in teas and foods. (Source 2)
• Studied: A randomised pilot trial in chronic primary insomnia gave 270 mg of chamomile twice daily for 28 days. (Source 5)
• Studied: A trial in generalised anxiety disorder randomised 57 outpatients to chamomile extract or placebo for 8 weeks. (Source 3)
• Studied: A long-term randomised trial gave pharmaceutical grade chamomile extract 1500 mg per day (500 mg capsule 3 times daily) for 12 weeks of open-label therapy, followed by 26 weeks of randomised continuation or placebo. (Source 10)

A common belief, and what the research shows

The belief: Chamomile tea is a gentle, universally safe sleep remedy.

What the research shows: Its sleep evidence is weak and its allergy risk is real. A randomised trial in chronic insomnia reported "There were no significant differences between groups in changes in sleep diary measures, including total sleep time (TST), sleep efficiency, sleep latency, wake after sleep onset (WASO), sleep quality, and number of awakenings.", and a systematic review of adverse events found that "among the eleven case reports, six reported adverse events associated with allergic reactions to chamomile, ranging from anaphylactic reactions (in three patients) to short-lasting acute rhinitis".

Questions and answers

What is it?

German chamomile is the dried flower of Matricaria chamomilla L., a member of the daisy family. It is drunk as tea and sold as standardised extract capsules. It has a long documented history of medicinal use. (Source 1)

What does it do in the body?

Chamomile is taken for anxiety and for sleep. The clearest human signal is for anxiety: an 8-week randomised trial in mild-to-moderate generalised anxiety disorder found a greater fall in Hamilton Anxiety scores than placebo, described by the authors as modest. Sleep results are inconsistent. (Source 3)

Is it good or bad for you?

Mostly benign in ordinary amounts, with a real allergy exception. Trials report minor, self-limiting effects such as gastrointestinal upset and drowsiness, but case reports include anaphylaxis, and people allergic to ragweed or mugwort are at higher risk. The benefit side remains unproven for most uses. (Source 7)

How do you get more of it?

Chamomile is taken as an infusion of the dried flowers or as an extract. Trials have used 270 mg of chamomile twice daily for 28 days in insomnia and an 8-week course of extract in generalised anxiety disorder. These are the amounts studied, not a recommendation. (Source 5)

If it is harmful, what reduces it?

Chamomile is cleared once the tea or supplement is stopped. The situation where removal matters is an allergic reaction, which can be severe: six of the eleven published case reports in a systematic review of adverse events involved allergy, three of them anaphylaxis. NCCIH separately notes that interactions with warfarin and some liver-metabolised drugs have been reported. (Source 1)

Why might someone be low in it or missing it?

Does not apply. Chamomile is not a nutrient or a resident of the body, so there is no deficiency. People simply do or do not drink the tea or take the extract; those with Asteraceae pollen allergy may avoid it deliberately. (Source 2)

Which whole foods contain it or feed it?

Chamomile reaches people mainly as a herbal tea made from the dried flower heads, and in smaller amounts as a flavouring in foods and drinks. It is not a component of staple whole foods. (Source 2)

What happens if you do not have it?

Nothing happens from not drinking chamomile; there is no deficiency state. Trials suggest a person not taking it is not missing a proven sleep treatment, since a randomised trial in chronic insomnia found only mixed and non-significant effects. (Source 5)

How can you test for it?

No validated test for chamomile status or response exists in the literature we searched. The only testing described is allergy assessment after a reaction, and the adverse-event review notes reporting in trials was too incomplete to quantify risk. (Source 1)

We searched: Searched for chamomile biomarkers, apigenin status assays and validated tests via WebSearch, and within the 2025 systematic review of chamomile adverse events, the NCCIH page and the randomised trials; no validated status or response test was described.

References

1. Complementary Therapies in Medicine (Elsevier). Chamomile: A systematic review of adverse events. 2025. Read the source
2. National Center for Complementary and Integrative Health (NIH). Chamomile (safety section: "What Do We Know About Safety?"). 2024. Read the source
3. Journal of Clinical Psychopharmacology. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. 2009. PMID 19593179, DOI 10.1097/JCP.0b013e3181ac935c. Read the source
4. medRxiv (preprint, not peer reviewed). Effectiveness of Lesser Known Herbal Sedatives for Insomnia: A Systematic Review and Meta-Analysis (Results, chamomile subgroup). 2026. DOI 10.64898/2026.03.23.26349099. Read the source
5. BMC Complementary and Alternative Medicine (Springer). Preliminary examination of the efficacy and safety of a standardized chamomile extract for chronic primary insomnia: a randomized placebo-controlled pilot study. 2011. PMID 21939549, DOI 10.1186/1472-6882-11-78. Read the source
6. Phytomedicine (Elsevier). Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial (abstract, Conclusions section). 2016. PMID 27912875, DOI 10.1016/j.phymed.2016.10.012. Read the source
7. National Center for Complementary and Integrative Health (NIH). Chamomile (section: "How Much Do We Know?"). 2024. Read the source
8. Phytomedicine (Elsevier). Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial (abstract, Results section). 2016. PMID 27912875, DOI 10.1016/j.phymed.2016.10.012. Read the source
9. National Center for Complementary and Integrative Health (NIH). Chamomile (introductory section: what chamomile is and how it is used). 2024. Read the source
10. Phytomedicine (Elsevier). Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial (abstract, Methods section). 2016. PMID 27912875, DOI 10.1016/j.phymed.2016.10.012. Read the source