PEP Topic 
Sleep-Wake Disturbances

Guaraná (Paullinia cupana) is a plant native to the central Amazon and has been used medicinally for centuries. It has a popular reputation of being a stimulant and an aphrodisiac and exhibiting gastric-protective effects. Guaraná contains caffeine and other similar chemicals. Guaraná has been used for the treatment of diarrhea, weight loss, and fatigue. Evaluation in patients with cancer has been performed related to the symptoms of fatigue, sleep-wake disturbance, and depression.

Effectiveness Not Established

Research Evidence Summaries

de Oliveira Campos, M. P., Riechelmann, R., Martins, L. C., Hassan, B. J., Casa, F. B., & Del Giglio, A. (2011). Guarana (Paullinia cupana) improves fatigue in breast cancer patients undergoing systemic chemotherapy. Journal of Alternative and Complementary Medicine, 17, 505–512.

doi: 10.1089/acm.2010.0571

Study Purpose:

To determine whether the average decrease in fatigue from days 1 (baseline) to 21 and from days 21 to 49 was greater in patients who received guarana versus placebo, as measured by Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) scores.

Intervention Characteristics/Basic Study Process:

Patients received baseline evaluations with questionnaires, then 50 mg of guarana or placebo twice daily, study questionnaires 21 days later, and a seven-day washout of the drug. Patients were then crossed over to the opposite group for 21 days of the drug, followed by questionnaire completion and toxicity assessment.

Sample Characteristics:

  • The study included 60 women with breast cancer.
  • Mean age was 50.2 years in the placebo-guarana group and 51.76 years in the guarana-placebo group.
  • All patients had worsening fatigue on the Brief Fatigue Inventory (BFI) for eligibility and were entered prior to their second cycle of initial chemotherapy.
  • Those with severe fatigue were excluded.


The study took place in two public and academic hospitals in São Paulo, Brazil.

Phase of Care and Clinical Applications:

Patients were undergoing the active treatment phase of care.

Study Design:

This was a double-blind, placebo-controlled, randomized, crossover trial.

Measurement Instruments/Methods:

  • General demographic questionnaire    
  • FACIT-Endocrine Symptoms (FACIT-ES)
  • Hospital Anxiety and Depression Scale (HADS)
  • Pittsburgh Sleep Quality Index (PSQI)
  • Chalder Fatigue Scale


More patients showed improvement in FACIT-F in the guarana group at day 21 (p = 0.01) and day 49 (p = 0.02). Chalder Fatigue Scale scores decreased by 4.6 points on day 21 (p < 0.01), with no significance for day 49 compared to placebo. Sleep improvement was seen at day 49 (p = 0.05). Four patients discontinued guarana use because of tachycardia. Analysis was conducted between groups on specific days of the study, rather than analyzing the intervention condition and control condition as a whole between groups.


Guarana showed a superior effect to placebo in improving fatigue in patients with breast cancer undergoing treatment.


  • The study had a small sample size, with less than 100 patients.
  • Only one tumor type was used, and common comorbidities were excluded. 
  • The statistical analysis was conducted to compare results between groups at days 21 and 49, rather than at a specific time point in the study and analyzing the findings between the experimental and control condition. This is not a meaningful comparison study.

Nursing Implications:

Guarana may be an option to treat fatigue in this population, but additional research is needed to provide support for its clinical use. Patients should be cautioned on its use if they have angina, other cardiovascular disease, uncontrolled hypertension, or neurologic disorders.