Sage (Salvia officinalis) Herbal Monograph

What Is Sage?

Sage is a grey-leaved, aromatic shrublet of the mint family, grown worldwide as a kitchen herb and used for centuries as a medicine for the mouth, throat and digestion. Its genus name, Salvia, comes from the Latin word “to heal” ^{37Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →}.

Salvia officinalis is native to the northern Mediterranean and has naturalised far beyond it ^{1,37Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →}. The leaves are used fresh or dried in cooking, brewed as tea and used as a gargle.

The leaf holds an essential oil led by α-thujone, 1,8-cineole and camphor, and antioxidant phenolics such as rosmarinic acid and carnosic acid ^{1,2Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}. Human trials have looked at sage for memory and attention, menopausal hot flushes, sore throat, and blood sugar and lipids, mostly with positive results in small studies ^{3,7,12,16,19Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →Reference 7Wightman et al. · 2021RCTThe acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humansView study →Reference 12Moradi et al. · 2023Meta-analysisThe effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysisView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →Reference 19Hubbert et al. · 2006RCTEfficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled studyView study →}.

Common sage is a different plant from white sage (Salvia apiana), the smudging herb, and from the psychoactive Salvia divinorum. Fresh “sage” sold in shops is often Greek sage (Salvia fruticosa), which has leaves divided into three leaflets ^{37Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →}.

How Is Sage Used?

Leaf tea — dried leaf infused in hot water, drunk for digestion or used as a gargle and mouthwash ^{1,23Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →Reference 23Walch et al. · 2011Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea)View study →}.
Throat spray and lozenges — sage extract, alone or with echinacea, for acute sore throat ^{19,20,21Reference 19Hubbert et al. · 2006RCTEfficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled studyView study →Reference 20Schapowal et al. · 2009RCTEchinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomised double-blind trialView study →Reference 21Weishaupt et al. · 2023Clinical trialReduction of viral load in patients with acute sore throats: results from an observational clinical trial with echinacea/salvia lozenges — observational, n=74View study →}.
Leaf extracts and tablets — standardised extracts for memory, and fresh-leaf tablets for hot flushes ^{3,11,16Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →Reference 11Bommer et al. · 2011Clinical trialFirst-time proof of sage’s tolerability and efficacy in menopausal women with hot flushes — clinical trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}.
Tincture and liquid extract — in Western herbal practice.
Essential oil — distilled from the leaf; used in flavouring and aromatherapy, and in some memory trials ^{4,10Reference 4Tildesley et al. · 2005Clinical trialPositive modulation of mood and cognitive performance following administration of acute doses of Salvia lavandulifolia essential oil to healthy young volunteers — clinical trialView study →Reference 10Moss et al. · 2010RCTDifferential effects of the aromas of Salvia species on memory and mood — randomised controlled trialView study →}.
Culinary herb — fresh or dried leaves in cooking.

Traditional Uses

European Herbal Medicine

In European traditional medicine, sage is used for mild indigestion such as heartburn and bloating, for excessive sweating, for age-related memory problems, and for inflammation of the throat and skin ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}. Germany’s Commission E approved it for inflammation and indigestion ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}.

Sage tea and gargles are used for inflammation in the mouth and throat, and the tea for minor skin inflammation ^{23Reference 23Walch et al. · 2011Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea)View study →}. Sage is also used to dry up breast milk at weaning.

Folk Medicine in Asia and Latin America

In folk medicine in Asia and Latin America, sage has been used for seizures, ulcers, gout, rheumatism, inflammation, dizziness, tremor, paralysis, diarrhoea and high blood sugar ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}.

Indications

Sore throat and acute pharyngitis [leaf extract spray; lozenges]
Mouth and gum inflammation [leaf infusion, as a gargle; European traditional use]
Mild indigestion and bloating [leaf; European traditional use]
Excessive sweating [leaf; European traditional use]
Menopausal hot flushes [fresh-leaf tablet; leaf extract] Caution: A meta-analysis of four trials reported fewer hot flushes, but its pooled confidence interval crossed zero and the effect on severity was not significant. The largest single study had no placebo group ^11,12.
Memory and attention [standardised leaf extract]
Mild to moderate Alzheimer’s disease [leaf extract]
High cholesterol and triglycerides [leaf extract]
High blood sugar in type 2 diabetes [leaf extract]
Blood lipids and oxidative stress in polycystic ovary syndrome [leaf extract]
Drying up breast milk at weaning [leaf; European traditional use]

Botany

Sage is a bushy, spreading perennial with stems that turn woody at the base. It grows up to about 60 cm tall and 60–90 cm wide ^{37,38Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →Reference 38Li et al. · 1994Salvia officinalis Linnaeus — species description — floraView study →}.

The young stems are square and covered in fine white hairs. The leaves grow in opposite pairs. They are oblong to ovate, 1–8 cm long, grey-green and finely wrinkled, with a soft, felted surface ^{37,38Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →Reference 38Li et al. · 1994Salvia officinalis Linnaeus — species description — floraView study →}.

The flowers grow in whorls of 2–18 along upright spikes 4–18 cm long. Each is two-lipped, purple or blue, and 1.8–1.9 cm long, and sits in a calyx often tinged purple. The fruit splits into dark brown nutlets about 2.5 mm across ^{37,38Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →Reference 38Li et al. · 1994Salvia officinalis Linnaeus — species description — floraView study →}.

Sage flowers in early summer, and the blooms attract bees and butterflies ^{37Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →}.

Salvia is the largest genus in the mint family (Lamiaceae), with nearly 900 species ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}. It includes dan shen (Salvia miltiorrhiza), whose red root is used in Chinese medicine.

Distribution

Sage grows wild in the northern Mediterranean. Its native range runs from Spain and France through Italy, Switzerland and Germany to Slovenia, the western Balkans and Greece ^{37Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →}. It grows on hillsides and mountains in shrubland and grassland ^{37Reference 37North Carolina Extension Gardener Plant Salvia officinalis — description, native range, size and plant traits — species databaseView study →}.

It has naturalised throughout the world, particularly in Europe and North America ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}. It is cultivated in China as a medicinal and aromatic herb ^{38Reference 38Li et al. · 1994Salvia officinalis Linnaeus — species description — floraView study →}.

Growing Conditions

Cultivation snapshot for Sage

Full sun and sharp, well-drained soil are essential; sage rots in wet or heavy ground far more readily than it suffers from cold.
Drought-tolerant once established and happiest on the lean, dry side — avoid rich soil and overwatering.
Hardy roughly through USDA zones 4–8, surviving cold winters if drainage is good.
Evergreen and long-lived; woody old plants can be renewed by cutting back in spring or replaced every few years as they get leggy.

Grow it yourself

Farm Wiki is our cultivation-focused sister site, also run by Justin Cooke.

How to growComing soon

Find seedsComing soon

Phytochemistry

Sage leaf contains an essential oil and a non-volatile phenolic fraction. In three sage oil samples analysed in one study, the main components were α-thujone at 17.2–27.4%, 1,8-cineole at 11.9–26.9% and camphor at 12.8–21.4% ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}. The oil also contains borneol ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}, β-thujone ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →} and bornyl acetate.

Oil composition varies widely. A cluster analysis of 185 published sage oil compositions, plus those three samples, found five chemotypes. The most common is α-thujone > camphor > 1,8-cineole; the others are rich in α-humulene, in β-thujone, in 1,8-cineole and camphor, or in sclareol and α-thujone ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}. Some commercial sage oils contain no thujone at all ^{36Reference 36Rasmussen et al. · 2020A rapid GC-FID method for determination of sabinene, β-pinene, α-thujone and β-thujone in the essential oil of kitchen sage (Salvia officinalis L.)View study →}.

The strongest antioxidants in the leaf are carnosol, rosmarinic acid and carnosic acid, followed by caffeic acid, rosmanol and cirsimaritin ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}. Carnosic acid oxidises readily to carnosol and to further abietane diterpenes, including epirosmanol, isorosmanol and galdosol.

Alcoholic and water extracts are rich in rosmarinic acid and luteolin-7-glucoside (galuteolin). In sage tea, rosmarinic acid and ellagic acid are the most abundant phenolics, followed by rutin, chlorogenic acid and quercetin ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}. Rosmarinic acid content varied up to 20-fold between commercial sage teas ^{23Reference 23Walch et al. · 2011Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea)View study →}.

The flavonoids luteolin and cirsiliol have been isolated from the leaf ^{32Reference 32Yanagimichi et al. · 2021In vitroAnalyses of putative anti-cancer potential of three STAT3 signalling inhibitory compounds derived from Salvia officinalis — in vitroView study →}. The leaf also contains ursolic acid, apigenin, hispidulin and salvianolic acid.

Research on Spanish sage (S. lavandulifolia) and on combined-species extracts should be read separately from studies of S. officinalis itself ^{4,6,7Reference 4Tildesley et al. · 2005Clinical trialPositive modulation of mood and cognitive performance following administration of acute doses of Salvia lavandulifolia essential oil to healthy young volunteers — clinical trialView study →Reference 6Kennedy et al. · 2011RCTMonoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trialView study →Reference 7Wightman et al. · 2021RCTThe acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humansView study →}.

Constituent Summary

Oil figures are from three sage oil samples; the full range across chemotypes is wider ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}.

Grouped by class · 14 compounds

Monoterpene5 compounds5 with data

Monoterpeneα-Thujone17.2–27.4% of oil ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}

Monoterpene1,8-Cineole11.9–26.9% of oil ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}

MonoterpeneCamphor12.8–21.4% of oil ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}

Monoterpeneβ-ThujoneDominant in one chemotype ^{2Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →}

MonoterpeneBorneolOil and infusion ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}

Phenolic Acid3 compounds2 with data

Phenolic AcidRosmarinic acidMain phenolic of tea; up to 20-fold variation ^{23Reference 23Walch et al. · 2011Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea)View study →}

Phenolic AcidCaffeic acidMethanolic extract ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}

Phenolic AcidSalvianolic acidNo data

Diterpene2 compounds2 with data

DiterpeneCarnosic acidMain antioxidant ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}

DiterpeneCarnosolMain antioxidant ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}

Flavonoid4 compounds3 with data

FlavonoidApigeninNo data

FlavonoidLuteolinLeaf ^{32Reference 32Yanagimichi et al. · 2021In vitroAnalyses of putative anti-cancer potential of three STAT3 signalling inhibitory compounds derived from Salvia officinalis — in vitroView study →}

FlavonoidQuercetinInfusion ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}

FlavonoidCirsiliolLeaf ^{32Reference 32Yanagimichi et al. · 2021In vitroAnalyses of putative anti-cancer potential of three STAT3 signalling inhibitory compounds derived from Salvia officinalis — in vitroView study →}

Pharmacology & Research

Sage has been tested in human trials for memory, menopause, sore throat and metabolic health. Small placebo-controlled trials and a systematic review cover memory and attention ^{3,5,6,7,8,9Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →Reference 5Kennedy et al. · 2006RCTEffects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trialView study →Reference 6Kennedy et al. · 2011RCTMonoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trialView study →Reference 7Wightman et al. · 2021RCTThe acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humansView study →Reference 8Akhondzadeh et al. · 2003RCTSalvia officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double-blind, randomised and placebo-controlled trialView study →Reference 9Miroddi et al. · 2014Systematic reviewSystematic review of clinical trials assessing pharmacological properties of Salvia species on memory, cognitive impairment and Alzheimer’s diseaseView study →}. A meta-analysis of four trials covers hot flushes ^{12Reference 12Moradi et al. · 2023Meta-analysisThe effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysisView study →}. A placebo-controlled trial supports a sage throat spray ^{19Reference 19Hubbert et al. · 2006RCTEfficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled studyView study →}, and small Iranian trials report better blood sugar and lipids ^{15,16,17,18Reference 15Kianbakht et al. · 2011RCTAntihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomised double-blind placebo-controlled clinical trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →Reference 17Kianbakht et al. · 2016RCTSalvia officinalis (sage) leaf extract as add-on to statin therapy in hypercholesterolemic type-2 diabetic patients: a randomised clinical trialView study →Reference 18Maleki-Hajiagha et al. · 2025RCTExploring the therapeutic impact of Salvia officinalis on lipid and oxidative stress markers in patients with polycystic ovary syndrome — a randomised placebo-controlled clinical trialView study →}.

The rest is preclinical: antioxidant, anti-inflammatory, antimicrobial and anticancer work in cells and animals ^{24,25,26,27,28,29,30,31,32,33Reference 24Mervić et al. · 2022In vitroComparative antioxidant, anti-acetylcholinesterase and anti-α-glucosidase activities of Mediterranean Salvia species — in vitroView study →Reference 25Kolac et al. · 2017AnimalThe anti-inflammatory and antioxidant effects of Salvia officinalis on lipopolysaccharide-induced inflammation in rats — animal modelView study →Reference 26Margetts et al. · 2022In vitroEvidence for anti-inflammatory effects and modulation of neurotransmitter metabolism by Salvia officinalis L. — in vitroView study →Reference 27Bonesi et al. · 2017ReviewAnti-inflammatory and antioxidant agents from Salvia genus (Lamiaceae): an assessment of the current state of knowledge — reviewView study →Reference 28Stojanović-Radić et al. · 2016In vitroPotential of Ocimum basilicum L. and Salvia officinalis L. essential oils against biofilms of P. aeruginosa clinical isolates — in vitroView study →Reference 29Stefanović et al. · 2012In vitroSynergistic antibacterial activity of Salvia officinalis and Cichorium intybus extracts and antibiotics — in vitroView study →Reference 30Alomar et al. · 2023In vitroAnti-Helicobacter pylori and anti-inflammatory potential of Salvia officinalis metabolites — in vitro and in silicoView study →Reference 31Jiang et al. · 2017In vitroAntiproliferative effects of extracts from Salvia officinalis L. and Salvia miltiorrhiza Bunge on hepatocellular carcinoma cells — in vitroView study →Reference 32Yanagimichi et al. · 2021In vitroAnalyses of putative anti-cancer potential of three STAT3 signalling inhibitory compounds derived from Salvia officinalis — in vitroView study →Reference 33Garcia et al. · 2016In vitroPharmacological perspectives from Brazilian Salvia officinalis (Lamiaceae): antioxidant and antitumor in mammalian cells — in vitroView study →}.

What the Evidence Supports

Best-supported: short-term memory and attention gains from standardised leaf extracts in healthy adults ^{3,5,6,7Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →Reference 5Kennedy et al. · 2006RCTEffects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trialView study →Reference 6Kennedy et al. · 2011RCTMonoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trialView study →Reference 7Wightman et al. · 2021RCTThe acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humansView study →}; fewer hot flushes in menopause ^{11,12Reference 11Bommer et al. · 2011Clinical trialFirst-time proof of sage’s tolerability and efficacy in menopausal women with hot flushes — clinical trialView study →Reference 12Moradi et al. · 2023Meta-analysisThe effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysisView study →}; relief of acute sore throat from a sage spray ^{19Reference 19Hubbert et al. · 2006RCTEfficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled studyView study →}.
Emerging, worth watching: improved glucose and lipid profiles in type 2 diabetes and high cholesterol ^{15,16Reference 15Kianbakht et al. · 2011RCTAntihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomised double-blind placebo-controlled clinical trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}, and antioxidant markers in a PCOS trial ^{18Reference 18Maleki-Hajiagha et al. · 2025RCTExploring the therapeutic impact of Salvia officinalis on lipid and oxidative stress markers in patients with polycystic ovary syndrome — a randomised placebo-controlled clinical trialView study →}.
Mechanistically thin: antimicrobial and anticancer claims rest almost entirely on in vitro work with no human dosing data ^{28,29,30,31,32,33Reference 28Stojanović-Radić et al. · 2016In vitroPotential of Ocimum basilicum L. and Salvia officinalis L. essential oils against biofilms of P. aeruginosa clinical isolates — in vitroView study →Reference 29Stefanović et al. · 2012In vitroSynergistic antibacterial activity of Salvia officinalis and Cichorium intybus extracts and antibiotics — in vitroView study →Reference 30Alomar et al. · 2023In vitroAnti-Helicobacter pylori and anti-inflammatory potential of Salvia officinalis metabolites — in vitro and in silicoView study →Reference 31Jiang et al. · 2017In vitroAntiproliferative effects of extracts from Salvia officinalis L. and Salvia miltiorrhiza Bunge on hepatocellular carcinoma cells — in vitroView study →Reference 32Yanagimichi et al. · 2021In vitroAnalyses of putative anti-cancer potential of three STAT3 signalling inhibitory compounds derived from Salvia officinalis — in vitroView study →Reference 33Garcia et al. · 2016In vitroPharmacological perspectives from Brazilian Salvia officinalis (Lamiaceae): antioxidant and antitumor in mammalian cells — in vitroView study →}.
The caveat: most human trials are small and short, and the effects belong to specific standardised extracts, not to tea or whole leaf ^{9,23Reference 9Miroddi et al. · 2014Systematic reviewSystematic review of clinical trials assessing pharmacological properties of Salvia species on memory, cognitive impairment and Alzheimer’s diseaseView study →Reference 23Walch et al. · 2011Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea)View study →}.

The trials used several different preparations, and they are not interchangeable. Standardised leaf extract, fresh-leaf tablets, essential oil, throat spray and tea each deliver a different mix of compounds, and several memory trials used Spanish sage rather than common sage ^{4,6,7,9Reference 4Tildesley et al. · 2005Clinical trialPositive modulation of mood and cognitive performance following administration of acute doses of Salvia lavandulifolia essential oil to healthy young volunteers — clinical trialView study →Reference 6Kennedy et al. · 2011RCTMonoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trialView study →Reference 7Wightman et al. · 2021RCTThe acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humansView study →Reference 9Miroddi et al. · 2014Systematic reviewSystematic review of clinical trials assessing pharmacological properties of Salvia species on memory, cognitive impairment and Alzheimer’s diseaseView study →}.

Evidence by IndicationStrength of support

Cognitive & MemoryPromising

77%

AntioxidantPromising

72%

Menopausal Hot FlushesPromising

70%

Sore Throat & Oral InflammationPromising

69%

Glycaemic & Lipid ControlPromising

66%

Anti-InflammatoryPromising

62%

AntimicrobialPromising

51%

AnticancerShaky

36%

1. Cognitive & Memory

A series of small double-blind, placebo-controlled crossover trials from one UK group tested single doses of sage. In 20 volunteers over 65, a standardised Salvia officinalis extract improved secondary memory at every test point at 333 mg, the best of four doses tested from 167 to 1,332 mg ^{3Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →}. In 30 young adults, 300 and 600 mg of dried sage leaf improved mood, and the higher dose improved performance on a demanding multitasking battery ^{5Reference 5Kennedy et al. · 2006RCTEffects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trialView study →}.

Spanish sage (S. lavandulifolia) essential oil produced similar acute gains in memory and mood ^{4,6Reference 4Tildesley et al. · 2005Clinical trialPositive modulation of mood and cognitive performance following administration of acute doses of Salvia lavandulifolia essential oil to healthy young volunteers — clinical trialView study →Reference 6Kennedy et al. · 2011RCTMonoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trialView study →}. In 135 volunteers, simply smelling S. officinalis essential oil improved memory quality compared with no aroma ^{10Reference 10Moss et al. · 2010RCTDifferential effects of the aromas of Salvia species on memory and mood — randomised controlled trialView study →}.

A 2021 trial in 94 adults aged 30–60 tested a combined S. officinalis polyphenol and S. lavandulifolia terpenoid extract at 600 mg a day. It improved working memory and accuracy both acutely and after 29 days, one of the few trials to run beyond a single dose ^{7Reference 7Wightman et al. · 2021RCTThe acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humansView study →}.

In mild to moderate Alzheimer’s disease, a 4-month Iranian trial in 42 patients aged 65–80 found better cognitive scores on sage extract than placebo ^{8Reference 8Akhondzadeh et al. · 2003RCTSalvia officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double-blind, randomised and placebo-controlled trialView study →}. A systematic review found consistent benefit in healthy and cognitively impaired people, but noted methodological problems and poorly described preparations ^{9Reference 9Miroddi et al. · 2014Systematic reviewSystematic review of clinical trials assessing pharmacological properties of Salvia species on memory, cognitive impairment and Alzheimer’s diseaseView study →}.

Sage extracts and Spanish sage oil inhibit acetylcholinesterase and butyrylcholinesterase in vitro ^{5,6Reference 5Kennedy et al. · 2006RCTEffects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trialView study →Reference 6Kennedy et al. · 2011RCTMonoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trialView study →}.

The same α-thujone found in the oil is also the herb’s principal toxin at high doses, acting on the GABA-A receptor ^{34,35Reference 34Pelkonen et al. · 2013ReviewThujone and thujone-containing herbal medicinal and botanical products: toxicological assessment — reviewView study →Reference 35Höld et al. · 2000Höld, K. M., et al. (2000). α-Thujone (the active component of absinthe): γ-aminobutyric acid type-A receptor modulation and metabolic detoxification — animal. Proc Natl Acad Sci USA, 97(8), 3826–3831. https://pubmed.ncbi.nlm.nih.gov/10725394/View study →}.

Gap: most trials are acute or short and small (20–94 people), and use different extracts or essential oils. None tested sage tea, so the effect cannot be assumed for ordinary culinary use.

2. Antioxidant

The antioxidant activity tracks the non-volatile phenolic fraction, chiefly rosmarinic acid and the diterpenes carnosic acid and carnosol ^{1,24Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →Reference 24Mervić et al. · 2022In vitroComparative antioxidant, anti-acetylcholinesterase and anti-α-glucosidase activities of Mediterranean Salvia species — in vitroView study →}.

In sage teas, antioxidant capacity depended heavily on rosmarinic acid, which varied up to 20-fold between commercial products ^{23Reference 23Walch et al. · 2011Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea)View study →}.

In a placebo-controlled trial in women with polycystic ovary syndrome, 330 mg of sage extract daily for eight weeks lowered malondialdehyde, a marker of lipid peroxidation, and improved total antioxidant capacity ^{18Reference 18Maleki-Hajiagha et al. · 2025RCTExploring the therapeutic impact of Salvia officinalis on lipid and oxidative stress markers in patients with polycystic ovary syndrome — a randomised placebo-controlled clinical trialView study →}.

In rats, sage reduced oxidative-stress markers and raised superoxide dismutase and catalase activity ^{25Reference 25Kolac et al. · 2017AnimalThe anti-inflammatory and antioxidant effects of Salvia officinalis on lipopolysaccharide-induced inflammation in rats — animal modelView study →}.

Human data are limited to biomarker changes in disease-specific trials. No study shows that dietary sage raises antioxidant status in healthy people, and tea strength is unstandardised.

3. Menopausal Hot Flushes

A 2023 systematic review and meta-analysis of four trials (310 women) reported that Salvia officinalis reduced the frequency of hot flushes compared with placebo, though the pooled confidence interval crossed zero. The effect on severity was not significant ^{12Reference 12Moradi et al. · 2023Meta-analysisThe effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysisView study →}.

The largest single study was an open multicentre trial in 69 menopausal women in Switzerland. A once-daily fresh-sage tablet cut the intensity-weighted hot-flush score by 50% within four weeks and 64% within eight ^{11Reference 11Bommer et al. · 2011Clinical trialFirst-time proof of sage’s tolerability and efficacy in menopausal women with hot flushes — clinical trialView study →}.

A pilot study in 10 men on androgen-deprivation therapy for prostate cancer found that 150 mg of sage extract three times daily roughly halved hot-flush scores, with no side effects ^{13Reference 13Vandecasteele et al. · 2012Clinical trialEvaluation of the efficacy and safety of Salvia officinalis in controlling hot flashes in prostate cancer patients treated with androgen deprivation — clinical trialView study →}.

In vitro, a sage tincture showed no oestrogenic activity, but one of its sub-extracts did. The active compounds were the flavonoids luteolin-7-O-glucuronide and luteolin-7-O-glucoside (galuteolin). The tincture had no serotonin-reuptake or acetylcholinesterase activity ^{14Reference 14Rahte et al. · 2013In vitroSalvia officinalis for hot flushes: towards determination of mechanism of activity and active principles — in vitroView study →}.

Gap: four trials, one of them uncontrolled, with different preparations. The long-term safety of medicinal-strength dosing in menopause has not been studied.

4. Sore Throat & Oral Inflammation

In a double-blind, placebo-controlled trial in 286 patients with acute pharyngitis, a 15% sage-extract throat spray relieved throat pain within two hours of first use ^{19Reference 19Hubbert et al. · 2006RCTEfficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled studyView study →}.

In a trial in 154 patients, an echinacea and sage spray matched a chlorhexidine and lidocaine spray for acute sore throat ^{20Reference 20Schapowal et al. · 2009RCTEchinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomised double-blind trialView study →}.

In an observational study of 74 patients, echinacea and sage lozenges reduced throat pain by 48% after one lozenge. In the 18 patients who tested positive for a virus, viral load fell by 96% over four days ^{21Reference 21Weishaupt et al. · 2023Clinical trialReduction of viral load in patients with acute sore throats: results from an observational clinical trial with echinacea/salvia lozenges — observational, n=74View study →}.

In human gingival fibroblasts, the anti-inflammatory action of a sage infusion came from its volatile constituents, 1,8-cineole, borneol, camphor and thujone, rather than from rosmarinic acid ^{22Reference 22Ehrnhöfer-Ressler et al. · 2013In vitroIdentification of 1,8-cineole, borneol, camphor, and thujone as anti-inflammatory compounds in a Salvia officinalis L. infusion using human gingival fibroblasts — in vitroView study →}.

Gap: the effects are local (spray, gargle, lozenge), and two of the three trials combined sage with echinacea.

5. Glycaemic & Lipid Control

Several small human trials, mostly from one Iranian group, report metabolic benefits. In 80 people with type 2 diabetes and high blood lipids, three months of sage leaf extract (500 mg three times daily) lowered fasting glucose, HbA1c, total cholesterol, triglycerides and LDL and raised HDL, with no adverse effects ^{16Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}.

An earlier trial in 67 people with high blood lipids showed the same lipid pattern after two months ^{15Reference 15Kianbakht et al. · 2011RCTAntihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomised double-blind placebo-controlled clinical trialView study →}. In 100 people with type 2 diabetes already taking atorvastatin, adding sage extract improved blood sugar and lipids further, with no adverse effects ^{17Reference 17Kianbakht et al. · 2016RCTSalvia officinalis (sage) leaf extract as add-on to statin therapy in hypercholesterolemic type-2 diabetic patients: a randomised clinical trialView study →}.

The 2025 PCOS trial also lowered triglycerides ^{18Reference 18Maleki-Hajiagha et al. · 2025RCTExploring the therapeutic impact of Salvia officinalis on lipid and oxidative stress markers in patients with polycystic ovary syndrome — a randomised placebo-controlled clinical trialView study →}.

Proposed mechanisms include PPAR-γ agonism, inhibition of pancreatic lipase and lipid absorption, and antioxidant protection ^{15Reference 15Kianbakht et al. · 2011RCTAntihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomised double-blind placebo-controlled clinical trialView study →}.

The human trials are small, short and largely from a single research group, and the effects belong to a specific leaf extract, not tea or whole herb.

6. Anti-Inflammatory

In human primary intestinal and blood-brain-barrier cells, sage extract reduced the release of most pro-inflammatory cytokines and chemokines and reduced reactive-oxygen overproduction ^{26Reference 26Margetts et al. · 2022In vitroEvidence for anti-inflammatory effects and modulation of neurotransmitter metabolism by Salvia officinalis L. — in vitroView study →}.

In rats given bacterial lipopolysaccharide, sage lowered NF-κB and TNF-α and improved antioxidant enzyme activity ^{25Reference 25Kolac et al. · 2017AnimalThe anti-inflammatory and antioxidant effects of Salvia officinalis on lipopolysaccharide-induced inflammation in rats — animal modelView study →}.

Reviews attribute the effect to phenolics and diterpenes acting on the NF-κB and arachidonic-acid pathways ^{27Reference 27Bonesi et al. · 2017ReviewAnti-inflammatory and antioxidant agents from Salvia genus (Lamiaceae): an assessment of the current state of knowledge — reviewView study →}. In a Helicobacter pylori study, the extract suppressed COX-2 expression about as well as celecoxib in vitro ^{30Reference 30Alomar et al. · 2023In vitroAnti-Helicobacter pylori and anti-inflammatory potential of Salvia officinalis metabolites — in vitro and in silicoView study →}.

The clearest human-relevant signal is local, from the throat and gum studies above ^{22Reference 22Ehrnhöfer-Ressler et al. · 2013In vitroIdentification of 1,8-cineole, borneol, camphor, and thujone as anti-inflammatory compounds in a Salvia officinalis L. infusion using human gingival fibroblasts — in vitroView study →}.

No dedicated human anti-inflammatory trial exists.

7. Antimicrobial

Sage essential oil inhibited biofilm formation by clinical Pseudomonas aeruginosa isolates ^{28Reference 28Stojanović-Radić et al. · 2016In vitroPotential of Ocimum basilicum L. and Salvia officinalis L. essential oils against biofilms of P. aeruginosa clinical isolates — in vitroView study →}. Sage extracts acted synergistically with amoxicillin and chloramphenicol, cutting antibiotic MICs several-fold against most tested bacteria ^{29Reference 29Stefanović et al. · 2012In vitroSynergistic antibacterial activity of Salvia officinalis and Cichorium intybus extracts and antibiotics — in vitroView study →}.

A 2023 study reported strong anti-Helicobacter pylori activity for the total ethanolic extract, approaching clarithromycin in potency, with carnosic acid the best-fitting inhibitor in silico ^{30Reference 30Alomar et al. · 2023In vitroAnti-Helicobacter pylori and anti-inflammatory potential of Salvia officinalis metabolites — in vitro and in silicoView study →}.

The lozenge study also recorded a fall in throat viral load ^{21Reference 21Weishaupt et al. · 2023Clinical trialReduction of viral load in patients with acute sore throats: results from an observational clinical trial with echinacea/salvia lozenges — observational, n=74View study →}.

All antibacterial and antifungal data are in vitro. There are no systemic human antimicrobial trials, and the effective concentrations may not be reached in the body from normal use.

8. Anticancer

Ethanol and acetone extracts of sage leaf and root inhibited the growth of hepatocellular carcinoma (HepG2) cells and induced apoptosis ^{31Reference 31Jiang et al. · 2017In vitroAntiproliferative effects of extracts from Salvia officinalis L. and Salvia miltiorrhiza Bunge on hepatocellular carcinoma cells — in vitroView study →}.

Three sage compounds, cirsiliol, luteolin and carnosol, inhibited STAT3 signalling, with additive effects alongside the drug gefitinib ^{32Reference 32Yanagimichi et al. · 2021In vitroAnalyses of putative anti-cancer potential of three STAT3 signalling inhibitory compounds derived from Salvia officinalis — in vitroView study →}.

Brazilian sage extracts were selectively cytotoxic to several tumour cell lines ^{33Reference 33Garcia et al. · 2016In vitroPharmacological perspectives from Brazilian Salvia officinalis (Lamiaceae): antioxidant and antitumor in mammalian cells — in vitroView study →}.

No animal-tumour or human data exist. The findings are from cell lines, at concentrations well above what dietary or medicinal use would produce.

Mechanisms

Sage’s two fractions act differently. Extracts and terpenoid-rich oils inhibit acetylcholinesterase and butyrylcholinesterase, the enzymes that break down acetylcholine, which has been studied as the basis of the memory findings ^{5,6Reference 5Kennedy et al. · 2006RCTEffects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trialView study →Reference 6Kennedy et al. · 2011RCTMonoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trialView study →}. The volatile monoterpenes also reduce inflammatory signalling in gum cells ^{22Reference 22Ehrnhöfer-Ressler et al. · 2013In vitroIdentification of 1,8-cineole, borneol, camphor, and thujone as anti-inflammatory compounds in a Salvia officinalis L. infusion using human gingival fibroblasts — in vitroView study →}.

The phenolics, led by rosmarinic acid, carnosic acid and carnosol, are antioxidants, and luteolin glycosides show mild oestrogenic activity in vitro ^{1,14Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →Reference 14Rahte et al. · 2013In vitroSalvia officinalis for hot flushes: towards determination of mechanism of activity and active principles — in vitroView study →}. At high doses, α-thujone blocks the GABA-A receptor, which is the basis of its toxicity ^{35Reference 35Höld et al. · 2000Höld, K. M., et al. (2000). α-Thujone (the active component of absinthe): γ-aminobutyric acid type-A receptor modulation and metabolic detoxification — animal. Proc Natl Acad Sci USA, 97(8), 3826–3831. https://pubmed.ncbi.nlm.nih.gov/10725394/View study →}.

Mechanism	Drives	Key compounds
Acetylcholinesterase / butyrylcholinesterase inhibition	cognitive & memory	terpenoid fraction of extract and oil
Free-radical scavenging, lipid-peroxidation inhibition	antioxidant	rosmarinic acid, carnosic acid, carnosol
NF-κB ↓, COX-2 ↓, cytokine suppression	anti-inflammatorysore throat	1,8-cineole, borneol, camphor
Oestrogen-receptor activation (mild, in vitro)	menopausal hot flushes	galuteolin, luteolin-7-O-glucuronide
PPAR-γ agonism, pancreatic-lipase inhibition	glycaemic & lipid control	phenolic acids, flavonoids
GABA-A receptor blockade (high dose)	thujone toxicity (safety)	α-thujone

Clinical Trials

A search of ClinicalTrials.gov (July 2026) identified registered Salvia officinalis trials in cognition, menopausal hot flushes and oral and throat health. One menopause sage-tablet trial (NCT02032862) was terminated for insufficient recruitment.

Completed	Planned	Terminated	Preclinical
~8	1	1	~100s

Last checked: July 2026.

Dosage

Standardised leaf extract — 333 mg as a single dose for memory in older adults; 500 mg three times daily for two to three months for blood lipids and sugar ^{3,15,16Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →Reference 15Kianbakht et al. · 2011RCTAntihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomised double-blind placebo-controlled clinical trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}.
Throat spray — a 15% sage-extract spray, used as needed ^{19Reference 19Hubbert et al. · 2006RCTEfficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled studyView study →}.
Tea — see the traditional doses below. Tea strength varies widely between products ^{23Reference 23Walch et al. · 2011Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea)View study →}.

Indication	Preparation	Dose	Est. dried-herb equivalent	Source
Cognition (older adults)	Standardised leaf extract	333 mg single dose (167–1,332 mg tested)	—	^{3Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →}
Mood and performance (young adults)	Dried sage leaf	300 or 600 mg single dose	0.3–0.6 g	^{5Reference 5Kennedy et al. · 2006RCTEffects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trialView study →}
Cognition (chronic)	Combined S. officinalis / S. lavandulifolia extract	600 mg/day, 29 days	—	^{7Reference 7Wightman et al. · 2021RCTThe acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humansView study →}
Alzheimer’s disease	Leaf extract	Fixed daily dose, 4 months	—	^{8Reference 8Akhondzadeh et al. · 2003RCTSalvia officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double-blind, randomised and placebo-controlled trialView study →}
Menopausal hot flushes	Fresh-sage leaf tablet	1 tablet once daily, 8 weeks	—	^{11Reference 11Bommer et al. · 2011Clinical trialFirst-time proof of sage’s tolerability and efficacy in menopausal women with hot flushes — clinical trialView study →}
Hot flushes on androgen-deprivation therapy	Leaf extract	150 mg three times daily	—	^{13Reference 13Vandecasteele et al. · 2012Clinical trialEvaluation of the efficacy and safety of Salvia officinalis in controlling hot flashes in prostate cancer patients treated with androgen deprivation — clinical trialView study →}
Hyperlipidaemia / type 2 diabetes	Leaf extract	500 mg three times daily, 2–3 months	—	^{15,16Reference 15Kianbakht et al. · 2011RCTAntihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomised double-blind placebo-controlled clinical trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}
PCOS	Leaf extract	330 mg daily, 8 weeks	—	^{18Reference 18Maleki-Hajiagha et al. · 2025RCTExploring the therapeutic impact of Salvia officinalis on lipid and oxidative stress markers in patients with polycystic ovary syndrome — a randomised placebo-controlled clinical trialView study →}
Acute pharyngitis	15% sage-extract throat spray (140 µL extract per dose)	Topical, as needed	— (topical)	^{19Reference 19Hubbert et al. · 2006RCTEfficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled studyView study →}

Traditional Dosage

System	Preparation	Dose
Western herbal (Bone & Mills)	Dried leaf infusion	1–4 g, up to 3× daily
Western herbal	Liquid extract (1:2)	1–4 mL up to 3× daily
Western herbal	Tincture (1:5, 45% ethanol)	2–6 mL up to 3× daily
Western herbal (topical)	Infusion as gargle / mouthwash	~3 g leaf in 150 mL water, as needed for sore throat/gingivitis

Safety & Pregnancy

Sage is safe as a culinary herb and an ordinary tea. The substantive caution is thujone, which concentrates in the essential oil.

Safety at a Glance

Moderate toxicity

Safe as food and tea. Trials of leaf extract at up to 1,500 mg a day for up to four months reported no significant adverse effects ^{3,8,16Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →Reference 8Akhondzadeh et al. · 2003RCTSalvia officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double-blind, randomised and placebo-controlled trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}.
Thujone. Neurotoxic and seizure-provoking in large amounts. Avoid the concentrated essential oil and prolonged high doses ^{34,35Reference 34Pelkonen et al. · 2013ReviewThujone and thujone-containing herbal medicinal and botanical products: toxicological assessment — reviewView study →Reference 35Höld et al. · 2000Höld, K. M., et al. (2000). α-Thujone (the active component of absinthe): γ-aminobutyric acid type-A receptor modulation and metabolic detoxification — animal. Proc Natl Acad Sci USA, 97(8), 3826–3831. https://pubmed.ncbi.nlm.nih.gov/10725394/View study →}.
Oils vary. Some commercial sage oils are thujone-rich and others contain none, so the risk of an oil depends on its analysis ^{2,36Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →Reference 36Rasmussen et al. · 2020A rapid GC-FID method for determination of sabinene, β-pinene, α-thujone and β-thujone in the essential oil of kitchen sage (Salvia officinalis L.)View study →}.
Drug interactions. Additive effects with cholinergic or blood-sugar-lowering drugs are possible, though none has been documented ^{16Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}.
Pregnancy & breastfeeding. Avoid medicinal-strength sage and the essential oil ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}.

Full Safety & Interactions Detail

Culinary and tea use. Sage is safe as a culinary herb and ordinary tea. Human trials of leaf extracts at up to 1,500 mg a day for up to four months reported no significant adverse effects ^{3,8,16Reference 3Scholey et al. · 2008RCTAn extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trialView study →Reference 8Akhondzadeh et al. · 2003RCTSalvia officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double-blind, randomised and placebo-controlled trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}.

Thujone. Thujone is the main safety concern. In animals it blocks the GABA-A receptor and causes excitation and convulsions in a dose-dependent way ^{34,35Reference 34Pelkonen et al. · 2013ReviewThujone and thujone-containing herbal medicinal and botanical products: toxicological assessment — reviewView study →Reference 35Höld et al. · 2000Höld, K. M., et al. (2000). α-Thujone (the active component of absinthe): γ-aminobutyric acid type-A receptor modulation and metabolic detoxification — animal. Proc Natl Acad Sci USA, 97(8), 3826–3831. https://pubmed.ncbi.nlm.nih.gov/10725394/View study →}. The best estimates of an acceptable daily intake from herbal preparations and diet are 3–7 mg of thujone a day ^{34Reference 34Pelkonen et al. · 2013ReviewThujone and thujone-containing herbal medicinal and botanical products: toxicological assessment — reviewView study →}. Avoid the concentrated essential oil and prolonged high doses. In animals, the oral LD50 of sage oil is 2.6 g/kg ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}.

Variable oils. Thujone content differs widely between sage chemotypes and commercial oils. Some oils are thujone-dominant and others contain none, which makes essential-oil dosing unpredictable ^{2,36Reference 2Craft et al. · 2017The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analyticalView study →Reference 36Rasmussen et al. · 2020A rapid GC-FID method for determination of sabinene, β-pinene, α-thujone and β-thujone in the essential oil of kitchen sage (Salvia officinalis L.)View study →}.

Drug interactions. Sage extracts inhibit acetylcholinesterase and may lower blood sugar and lipids, so additive effects with cholinergic or antidiabetic drugs are possible ^{5,16Reference 5Kennedy et al. · 2006RCTEffects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trialView study →Reference 16Kianbakht et al. · 2013RCTImproved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trialView study →}. Thujone is broken down mainly by CYP2A6, then CYP3A4 and CYP2B6, which raises a possibility of metabolic interactions ^{34Reference 34Pelkonen et al. · 2013ReviewThujone and thujone-containing herbal medicinal and botanical products: toxicological assessment — reviewView study →}.

In mice, two weeks of sage tea raised the liver enzyme CYP2E1 and worsened liver injury from carbon tetrachloride, a toxin that CYP2E1 activates ^{39Reference 39Lima et al. · 2007AnimalDrinking of Salvia officinalis tea increases CCl(4)-induced hepatotoxicity in mice — mouse in vivoView study →}. No human drug-interaction study has been done, and no clinically significant interaction has been documented.

Pregnancy & Lactation

Caution in pregnancy Caution while breastfeeding

Avoid medicinal-strength sage and its essential oil in pregnancy and while breastfeeding. Camphor and thujone are considered the most toxic compounds in sage and may harm the fetus and newborn ^{1Reference 1Ghorbani et al. · 2017ReviewPharmacological properties of Salvia officinalis and its components — reviewView study →}.

Sage is also used traditionally to reduce milk supply, which is another reason to avoid concentrated preparations while breastfeeding.

Culinary amounts are regarded as safe.

References

Ghorbani, A., & Esmaeilizadeh, M. (2017). Pharmacological properties of Salvia officinalis and its components — review. J Tradit Complement Med, 7(4), 433–440. https://pubmed.ncbi.nlm.nih.gov/29034191/
Craft, J. D., Satyal, P., & Setzer, W. N. (2017). The chemotaxonomy of common sage (Salvia officinalis) based on the volatile constituents — analytical. Medicines (Basel), 4(3), 47. https://pubmed.ncbi.nlm.nih.gov/28930262/
Scholey, A. B., et al. (2008). An extract of Salvia (sage) with anticholinesterase properties improves memory and attention in healthy older volunteers — randomised controlled trial. Psychopharmacology (Berl), 198(1), 127–139. https://pubmed.ncbi.nlm.nih.gov/18350281/
Tildesley, N. T., et al. (2005). Positive modulation of mood and cognitive performance following administration of acute doses of Salvia lavandulifolia essential oil to healthy young volunteers — clinical trial. Physiol Behav, 83(5), 699–709. https://pubmed.ncbi.nlm.nih.gov/15639154/
Kennedy, D. O., et al. (2006). Effects of cholinesterase-inhibiting sage (Salvia officinalis) on mood, anxiety and performance on a psychological stressor battery — randomised controlled trial. Neuropsychopharmacology, 31(4), 845–852. https://pubmed.ncbi.nlm.nih.gov/16205785/
Kennedy, D. O., et al. (2011). Monoterpenoid extract of sage (Salvia lavandulifolia) with cholinesterase-inhibiting properties improves cognitive performance and mood in healthy adults — randomised controlled trial. J Psychopharmacol, 25(8), 1088–1100. https://pubmed.ncbi.nlm.nih.gov/20937617/
Wightman, E. L., et al. (2021). The acute and chronic cognitive effects of a sage extract: a randomised, placebo-controlled study in healthy humans. Nutrients, 13(1), 218. https://pubmed.ncbi.nlm.nih.gov/33466627/
Akhondzadeh, S., et al. (2003). Salvia officinalis extract in the treatment of patients with mild to moderate Alzheimer’s disease: a double-blind, randomised and placebo-controlled trial. J Clin Pharm Ther, 28(1), 53–59. https://pubmed.ncbi.nlm.nih.gov/12605619/
Miroddi, M., et al. (2014). Systematic review of clinical trials assessing pharmacological properties of Salvia species on memory, cognitive impairment and Alzheimer’s disease. CNS Neurosci Ther, 20(6), 485–495. https://pubmed.ncbi.nlm.nih.gov/24836739/
Moss, L., et al. (2010). Differential effects of the aromas of Salvia species on memory and mood — randomised controlled trial. Hum Psychopharmacol, 25(5), 388–396. https://pubmed.ncbi.nlm.nih.gov/20589925/
Bommer, S., Klein, P., & Suter, A. (2011). First-time proof of sage’s tolerability and efficacy in menopausal women with hot flushes — clinical trial. Adv Ther, 28(6), 490–500. https://pubmed.ncbi.nlm.nih.gov/21630133/
Moradi, M., et al. (2023). The effect of Salvia officinalis on hot flashes in postmenopausal women: a systematic review and meta-analysis. Int J Community Based Nurs Midwifery, 11(3), 169–181. https://pubmed.ncbi.nlm.nih.gov/37489230/
Vandecasteele, K., et al. (2012). Evaluation of the efficacy and safety of Salvia officinalis in controlling hot flashes in prostate cancer patients treated with androgen deprivation — clinical trial. Phytother Res, 26(2), 208–213. https://pubmed.ncbi.nlm.nih.gov/21630361/
Rahte, S., et al. (2013). Salvia officinalis for hot flushes: towards determination of mechanism of activity and active principles — in vitro. Planta Med, 79(9), 753–760. https://pubmed.ncbi.nlm.nih.gov/23670626/
Kianbakht, S., et al. (2011). Antihyperlipidemic effects of Salvia officinalis L. leaf extract in patients with hyperlipidemia: a randomised double-blind placebo-controlled clinical trial. Phytother Res, 25(12), 1849–1853. https://pubmed.ncbi.nlm.nih.gov/21506190/
Kianbakht, S., & Dabaghian, F. H. (2013). Improved glycemic control and lipid profile in hyperlipidemic type-2 diabetic patients consuming Salvia officinalis L. leaf extract: a randomised placebo-controlled clinical trial. Complement Ther Med, 21(5), 441–446. https://pubmed.ncbi.nlm.nih.gov/24050577/
Kianbakht, S., et al. (2016). Salvia officinalis (sage) leaf extract as add-on to statin therapy in hypercholesterolemic type-2 diabetic patients: a randomised clinical trial. Int J Mol Cell Med, 5(3), 141–148. https://pubmed.ncbi.nlm.nih.gov/27942500/
Maleki-Hajiagha, A., et al. (2025). Exploring the therapeutic impact of Salvia officinalis on lipid and oxidative stress markers in patients with polycystic ovary syndrome — a randomised placebo-controlled clinical trial. BMC Complement Med Ther, 25(1), 114. https://pubmed.ncbi.nlm.nih.gov/40141012/
Hubbert, M., et al. (2006). Efficacy and tolerability of a spray with Salvia officinalis in the treatment of acute pharyngitis — a randomised, double-blind, placebo-controlled study. Eur J Med Res, 11(1), 20–26. https://pubmed.ncbi.nlm.nih.gov/16504956/
Schapowal, A., et al. (2009). Echinacea/sage or chlorhexidine/lidocaine for treating acute sore throats: a randomised double-blind trial. Eur J Med Res, 14(9), 406–412. https://pubmed.ncbi.nlm.nih.gov/19748859/
Weishaupt, R., et al. (2023). Reduction of viral load in patients with acute sore throats: results from an observational clinical trial with echinacea/salvia lozenges — observational, n=74. Complement Med Res, 30(4), 299–306. https://pubmed.ncbi.nlm.nih.gov/36889292/
Ehrnhöfer-Ressler, M. M., et al. (2013). Identification of 1,8-cineole, borneol, camphor, and thujone as anti-inflammatory compounds in a Salvia officinalis L. infusion using human gingival fibroblasts — in vitro. J Agric Food Chem, 61(14), 3451–3459. https://pubmed.ncbi.nlm.nih.gov/23488631/
Walch, S. G., et al. (2011). Antioxidant capacity and polyphenolic composition as quality indicators for aqueous infusions of Salvia officinalis L. (sage tea). Front Pharmacol, 2, 79. https://pubmed.ncbi.nlm.nih.gov/22194722/
Mervić, M., et al. (2022). Comparative antioxidant, anti-acetylcholinesterase and anti-α-glucosidase activities of Mediterranean Salvia species — in vitro. Plants (Basel), 11(5), 625. https://pubmed.ncbi.nlm.nih.gov/35270095/
Kolac, U. K., et al. (2017). The anti-inflammatory and antioxidant effects of Salvia officinalis on lipopolysaccharide-induced inflammation in rats — animal model. J Med Food, 20(12), 1193–1200. https://pubmed.ncbi.nlm.nih.gov/29131698/
Margetts, G., et al. (2022). Evidence for anti-inflammatory effects and modulation of neurotransmitter metabolism by Salvia officinalis L. — in vitro. BMC Complement Med Ther, 22(1), 131. https://pubmed.ncbi.nlm.nih.gov/35550086/
Bonesi, M., et al. (2017). Anti-inflammatory and antioxidant agents from Salvia genus (Lamiaceae): an assessment of the current state of knowledge — review. Antiinflamm Antiallergy Agents Med Chem, 16(2), 70–86. https://pubmed.ncbi.nlm.nih.gov/28464779/
Stojanović-Radić, Z., et al. (2016). Potential of Ocimum basilicum L. and Salvia officinalis L. essential oils against biofilms of P. aeruginosa clinical isolates — in vitro. Cell Mol Biol (Noisy-le-grand), 62(9), 27–33. https://pubmed.ncbi.nlm.nih.gov/27585258/
Stefanović, O. D., et al. (2012). Synergistic antibacterial activity of Salvia officinalis and Cichorium intybus extracts and antibiotics — in vitro. Acta Pol Pharm, 69(3), 457–463. https://pubmed.ncbi.nlm.nih.gov/22594260/
Alomar, H. A., et al. (2023). Anti-Helicobacter pylori and anti-inflammatory potential of Salvia officinalis metabolites — in vitro and in silico. Metabolites, 13(1), 136. https://pubmed.ncbi.nlm.nih.gov/36677061/
Jiang, Y., et al. (2017). Antiproliferative effects of extracts from Salvia officinalis L. and Salvia miltiorrhiza Bunge on hepatocellular carcinoma cells — in vitro. Biomed Pharmacother, 85, 57–67. https://pubmed.ncbi.nlm.nih.gov/27930987/
Yanagimichi, M., et al. (2021). Analyses of putative anti-cancer potential of three STAT3 signalling inhibitory compounds derived from Salvia officinalis — in vitro. Biochem Biophys Rep, 25, 100882. https://pubmed.ncbi.nlm.nih.gov/33392396/
Garcia, C. S., et al. (2016). Pharmacological perspectives from Brazilian Salvia officinalis (Lamiaceae): antioxidant and antitumor in mammalian cells — in vitro. An Acad Bras Cienc, 88(1), 281–292. https://pubmed.ncbi.nlm.nih.gov/26839997/
Pelkonen, O., et al. (2013). Thujone and thujone-containing herbal medicinal and botanical products: toxicological assessment — review. Regul Toxicol Pharmacol, 65(1), 100–107. https://pubmed.ncbi.nlm.nih.gov/23201408/
Höld, K. M., et al. (2000). α-Thujone (the active component of absinthe): γ-aminobutyric acid type-A receptor modulation and metabolic detoxification — animal. Proc Natl Acad Sci USA, 97(8), 3826–3831. https://pubmed.ncbi.nlm.nih.gov/10725394/
Rasmussen, L. H., et al. (2020). A rapid GC-FID method for determination of sabinene, β-pinene, α-thujone and β-thujone in the essential oil of kitchen sage (Salvia officinalis L.). J Chromatogr B, 1149, 122159. https://pubmed.ncbi.nlm.nih.gov/32447252/
North Carolina Extension Gardener Plant Toolbox (n.d.). Salvia officinalis — description, native range, size and plant traits — species database. NC State University. https://plants.ces.ncsu.edu/plants/salvia-officinalis/
Li, X., & Hedge, I. C. (1994). Salvia officinalis Linnaeus — species description — flora. In Wu, Z. Y., & Raven, P. H. (eds.), Flora of China, Vol. 17. http://www.efloras.org/florataxon.aspx?flora_id=2&taxon_id=200020236
Lima, C. F., Fernandes-Ferreira, M., & Pereira-Wilson, C. (2007). Drinking of Salvia officinalis tea increases CCl(4)-induced hepatotoxicity in mice — mouse in vivo. Food and Chemical Toxicology. https://pubmed.ncbi.nlm.nih.gov/17084954/