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Belladonna (Atropa belladonna L. or its variety acuminata Royle ex Lindl)


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Belladonna (Atropa belladonna L. or its variety acuminata Royle ex Lindl)

Background

Belladonna is an herb that has been used for centuries for a variety of indications, including headache, menstrual symptoms, peptic ulcer disease, inflammation, and motion sickness. Belladonna is known to contain active agents with anticholinergic properties, such as the tropane alkaloids atropine, hyoscine (scopolamine) and hyoscyamine.

There are few available studies of belladonna monotherapy for any indication. Most research has evaluated belladonna in combination with other agents such as ergot alkaloids or barbiturates, or in homeopathic (diluted) preparations. Preliminary evidence suggests possible efficacy in combination with barbiturates for the management of symptoms associated with irritable bowel syndrome. However, there is currently insufficient scientific evidence regarding the use of belladonna for this or any other indication.

There is extensive literature on the adverse effects and toxicity of belladonna, related principally to its known anticholinergic actions. Common adverse effects include dry mouth, urinary retention, flushing, papillary dilation, constipation, confusion and delirium. Many of these effects may occur at therapeutic doses.

Synonyms

Beladona, belladone, belladonnae herbae pulvis standardisatus, belladonna herbum, belladonna leaf, belladonna pulvis normatus, belladonnae folium, belladonna radix, belladonne, deadly nightshade, deadly nightshade leaf, devil's cherries, devil's herb, die belladonna, die tollkirsche, divale, dwale, dwayberry, galnebaer, great morel, herba belladonna, hoja de belladonna, naughty man's cherries, poison black cherries, powdered belladonna, Solanaceae (family) , solanum mortale, solanum somniferum, stryshon, strygium, tollekirsche, tollkirschenblatter.

Selected Combination Products : Bellergal«, Bellergal to S«, Bellergil«, Bel to Phen to Ergot S«, B&O Supprettes«, Cafergot to PB«, Distovagal«, Phenerbel to S«, PMS to Opium & Beladonna«.

Evidence

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.

Uses based on scientific evidenceGrade*Irritable bowel syndrome
Belladonna has been used historically for the treatment of irritable bowel, and in theory its mechanism of action should be effective for some of the symptoms. However, of the few studies that are available, none clearly show that belladonna alone (not as part of a mixed product) provides this effect.

C

Airway obstruction
Belladonna can cause relaxation of the airway and reduce the amount of mucus produced. A study in infants demonstrated possible beneficial effects of belladonna on airway obstruction during sleep. However, due to lack of high-quality human research in this area, there is not enough evidence to form a clear conclusion.

C

Nervous system disorders
The autonomic nervous system, which helps control basic body functions like sweating and blood flow, is affected in several disorders. To date, human studies have shown no benefit from belladonna in treating these disorders.

C

Headache
The available studies of belladonna in the treatment of headache are not well designed and do not show a clear benefit. More studies are needed to test the ability of belladonna alone (not in multi-ingredient products) to treat or prevent headache.

C

Ear infection
Little reliable research is available on the use of belladonna for ear infections. Other therapies have been shown effective and are recommended for this condition.

C

Premenstrual syndrome (PMS)
Bellergal« (a combination of phenobarbital, ergot, and belladonna) has been used historically to treat PMS symptoms. Limited study in women reports improvement in symptoms. More studies are needed before a strong recommendation can be made.

C

Radiation therapy rash (radiation burn)
There is a lack of reliable scientific evidence available for the effectiveness of belladonna for rash after radiation therapy. Further study is needed before a recommendation can be made.

C

Menopausal symptoms
Bellergal« (a combination of phenobarbital, ergot, and belladonna) has been used historically to treat hot flashes. However, in human studies belladonna supplements have not shown effectiveness.

D

* 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 against this use (it may not work);
F:
Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. 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.

Abnormal menstrual periods, anesthetic, anxiety, arthritis, asthma, bedwetting, chicken pox, colds, colitis, conjunctivitis (inflamed eyes), difficulty passing urine, diverticulitis, diuretic (use as a "water pill"), earache, encephalitis (inflammation of the brain), excessive sweating, excessive unintentional muscle movements, fever, flu, glaucoma, gout, hay fever, hemorrhoids, inflammation, kidney stones, measles, motion sickness, mumps, muscle and joint pain, dilation of the pupils, nausea and vomiting during pregnancy, pain from nerve disorders, Parkinson's disease, pancreatitis, poisoning (especially by insecticides), rash, scarlet fever, sciatica (back and leg pain), sedative, sore throat, stomach ulcers, teething, toothache, ulcerative colitis, warts, whooping cough.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the "active" ingredients. There is currently no widely used standardization for the preparation of belladonna. Doses of belladonna are often calculated in milligrams of total alkaloids. Atropa belladonna contains up to 20 different tropane alkaloid compounds. The leaves and roots have different amounts of the individual tropane alkaloids. Non-homeopathic dilutions of belladonna should be clearly labeled with the amount of the ingredient group "tropane alkaloid."

Oral (by mouth):

Traditional dosing : A traditional dose of belladonna leaf powder is 50 to 100 milligrams, with a maximum single dose of 200 milligrams (0.6 milligrams of total alkaloids, calculated as the ingredient hyoscyamine) and a maximum daily dose of 600 milligrams. A traditional dose of belladonna root is 50 milligrams, with a maximum single dose of 100 milligrams (0.5 milligrams of total alkaloids, calculated as hyoscyamine) and a maximum daily dose of 300 milligrams. A traditional dose of belladonna extract is 10 milligrams, with a maximum single dose of 100 milligrams (0.5 milligrams of total alkaloids, calculated as hyoscyamine) and a maximum daily dose of 150 milligrams. The expert German panel, the Commission E, suggests these doses mainly for the treatment of "gastrointestinal spasm." For tincture of belladonna (composed of 27 to 33 milligrams of belladonna leaf alkaloids in 100 milliliters of alcohol), informal reports suggest either a total dose of 1.5 milligrams daily (divided into 3 doses daily with a double dose at bedtime) or a dose of 0.6 to 1 milliliters (0.18 to 0.3 milligrams of belladonna leaf alkaloids) taken 3 to 4 times daily.

Irritable bowel syndrome : Studies report several doses and preparations of belladonna for irritable bowel, including: Hyoscine butylbromide (10 milligrams by mouth, taken four times daily) ; a combination preparation containing 0.25 milligrams levorotatory alkaloids of belladonna and 50 milligrams phenobarbital; and Donnatal« tablets (0.1037 milligrams hyoscyamine sulfate, 0.0194 milligrams atropine sulfate, 0.0065 milligrams hyoscine hydrobromide, 16.2 milligrams phenobarbital). One study used a higher dose (8 milligrams belladonna and 30 milligrams phenobarbital), but because belladonna is potentially dangerous in high doses, this dose may not be safe.

Nervous system disorders : One human study reports a dose of a combination formula (made of 15 milligrams belladonna, 60 milligrams ergot alkaloids, 15 milligrams propranolol, and 25 milligrams amobarbital), taken three times daily for two weeks.

Headache : Studies have used the combination product Bellergal« (40 milligrams phenobarbital, 0.6 milligrams ergotamine tartrate, 0.2 milligrams levorotatory alkaloids of belladonna), taken by mouth twice daily.

Menopausal symptoms : A study using Bellergal« Retard (total daily dose: 80 milligrams phenobarbital, 1.2 milligrams ergotamine tartrate, 0.4 milligrams levorotatory alkaloids of belladonna) for 4 weeks reports no benefit.

Premenstrual syndrome : One study used Bellergal« (40 milligrams phenobarbital, 0.6 milligrams ergotamine tartrate, 0.2 milligrams levorotatory alkaloids of belladonna) taken by mouth twice daily for 10 days before the menstrual period was expected.

Homeopathic dosing : Homeopathic doses often depend on the symptom being treated and the style of the prescribing provider. Dosing practices may therefore vary widely. Usually, a homeopathic product is diluted several times. For example, belladonna may be diluted by 100 (one teaspoon belladonna added to 99 teaspoons water) in the first round, and this new, dilute mixture may be diluted 30-fold (1 teaspoon of the dilute mixture added to 29 teaspoons water).

The naming of these dilutions follows a complicated set of definitions. As examples, when a supplement is diluted by 10 and then this mix is diluted by 30, it has a strength of 30X or 30D. When a supplement is first diluted by 100 and then diluted again by 30, it is referred to as 30C. 'Proving studies' have been conducted to observe the effects of homeopathic belladonna in healthy volunteers. These studies have used preparations of Belladonna 30CH (Deutsche Hom÷opathie Union, Karlsruhe; Germany) and Belladonna C30 (Ainsworth's Homeopathic Pharmacy; UK), dosed as 1 tablet by mouth twice daily.

Radiation burn : A study of patients treated with radiation for cancer reports a dose of Belladonna 7CH (Laboratoires Boiron; France), taken as 3 granules under the tongue twice daily, with no reduction in rash severity.

Muscle and bone aches : A belladonna plaster produced by Cuxson Gerrard (England) containing 0.25% belladonna alkaloids (hyoscine 2%, atropine 1%) is described in a case report. Long-term use may cause a rash at the site of the plaster.

By mouth:

Traditional Dosing : Informal reports describe a typical dose of 0.03 milliliters for each kilogram of weight, taken by mouth three times daily. Another dose that has been used is 0.8 milliliters for each square meter of body surface area, taken by mouth three times daily (27 to 33 milligrams of belladonna leaf alkaloids in 100 milliliters). The maximum dose is reported as 3.5 milliliters in a day. Safety and effectiveness have not been proven.

Airway obstruction : One study in infants reports using a tincture of belladonna, in a dose equal to 0.01 milligrams of atropine for each kilogram of the infant's weight, at bedtime.

Note : Death in children may occur at 0.2 milligrams of atropine for each kilogram of a child's weight. Since 2 milligrams of atropine are often found in a fruit, just 2 fruits may be deadly for a small child.

Homeopathic dosing: Homeopathic doses often depend on the symptom being treated and the style of the prescribing provider. Dosing practices may therefore vary widely. Usually, a homeopathic product is diluted several times. For example, belladonna may be diluted by 100 (one teaspoon belladonna added to 99 teaspoons water) in the first round, and this new, dilute mixture may be diluted 30-fold (1 teaspoon of the dilute mixture added to 29 teaspoons water). The naming of these dilutions follows a complicated set of definitions. As examples, when a supplement is diluted by 10 and then this mix is diluted by 30, it has a strength of 30X or 30D. When a supplement is first diluted by 100 and then diluted again by 30, it is referred to as 30C.

Ear infection : A study in children comparing homeopathic with prescription medications reports using Belladonna 30X globules (brand and dose not specified).

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

Belladonna should be avoided in people who have had significant reactions to belladonna or anticholinergic drugs, or who are allergic to belladonna or other members of the Solanaceae (nightshade) family such as bell peppers, potatoes, and eggplants. Long-term use of belladonna on the skin can lead to allergic rashes.

Side Effects and Warnings

At a dose of up to 1.5 milligrams in a day, belladonna is traditionally thought to be safe, but may cause frequent side effects such as dilated pupils, blushing of the skin, dry mouth, rapid heartbeat, confusion, nervousness, and hallucinations. High doses can cause death.

In children, death can be caused by a small amount of belladonna, as low as 0.2 milligrams of one of the active ingredients, atropine, per kilogram (2.2 pounds) of the child's weight. Therefore, 2 berries of the belladonna plant can be deadly for a small child. Several reports of accidental belladonna overdose and death are reported. In one case, the poisoning was caused by eating a rabbit that had been feeding on belladonna plant. Adults and children have died or been seriously ill after eating deadly nightshade berries ( Atropa belladonna ) or woody nightshade ( Solanum dulcamara ), a relative of belladonna. In one report, eating tomatoes grown from a plant grafted to jimson weed ( Datura stramonium ) led to death. Belladonna overdose can also occur when it is applied to the skin. Belladonna overdose is highly dangerous and should be treated by qualified medical professionals. Because belladonna can slow the movement of food and drugs through the stomach and gut, the side effects may go on long after the belladonna is swallowed.

Belladonna may cause redness of the skin, flushing, dry skin, sun sensitivity, hives and allergic rashes, even at dilute concentrations. A very serious, potentially life threatening rash called Stevens-Johnson syndrome, has been reported. This rash has red, at times blistered or painful spots on the skin, and the mouth, eyes, or genitals are sore. Severe cases may require hospitalization. Other side effects reported are headache, hyperactivity, nervousness, dizziness, lightheadedness, drowsiness or sedation, unsteady walking, confusion, hallucinations, slurred speech, exaggerated reflexes, convulsions, or coma. The eyes may be dilated or sensitive to light, and vision may be blurry. If pieces of belladonna are put into the eye, the pupils may be dilated permanently.

Cases report hyperventilation, coma with the loss of breathing, rapid or abnormal heart rate, and severe high blood pressure. Others report dry mouth, abdominal fullness, difficult urination, decreased perspiration, slow release of breast milk while nursing, muscle cramps or spasms, and tremors. Avoid belladonna if you have difficulty passing urine, enlarged prostate, or kidney stones, dry mouth, Sj÷gren syndrome, dry eyes, or glaucoma. Use caution if you have a fever. People with myasthenia gravis (a disorder of nerves and muscles) or Down's syndrome may be especially sensitive to belladonna.

Older adults and children should avoid belladonna, as there are many reports of serious effects in these age groups. Do not combine with prescribed anticholinergic agents. Check with the provider who prescribed medications to see if any of any medications are anticholinergic. People with heart disease, who have had a heart attack, fluid in the lungs, high blood pressure, or abnormal heart rhythms should avoid belladonna. Because belladonna can affect the activity of the stomach and intestines, people who have had ulcers, reflux, hiatal hernia, obstruction of the bowel, poor movement of the intestines, constipation, colitis, or an ileostomy or colostomy after surgery should avoid belladonna.

Pregnancy and Breastfeeding

Belladonna is not recommended in pregnancy and breastfeeding because of the risks of side effects and poisoning. Belladonna is listed under category C according to the U.S. Food and Drug Administration (FDA category C includes drugs for which no thorough studies have been published). In nursing women who use belladonna, belladonna ingredients are found in breast milk, therefore endangering infants.

References

1. Balzarini A, Felisi E, Martini A, et al. Efficacy of homeopathic treatment of skin reactions during radiotherapy for breast cancer: a randomised, double-blind clinical trial. Br Homeopath J 2000;89(1):8-12.

2. Bergmans M, Merkus J, Corbey R, et al. Effect of Bellergal Retard on climacteric complaints: a double-blind, placebo-controlled study. Maturitas 1987;9:227-234.

3. Bettermann H, Cysarz D, Portsteffen A, et al. Bimodal dose-dependent effect on autonomic, cardiac control after oral administration of Atropa belladonna. Auton Neurosci 2001;90 (1-2) :132-137.

4. Ceha LJ, Presperin C, Young E, et al. Anticholinergic toxicity from nightshade berry poisoning responsive to physostigmine. J Emerg Med 1997;15(1):65-69.

5. Duncan G, Collison DJ. Role of the non-neuronal cholinergic system in the eye: a review. Life Sci 2003:28;72(18-19):2013-2019.

6. Friese KH, Kruse S, Ludtke R, et al. The homoeopathic treatment of otitis media in children: comparisons with conventional therapy. Int J Clin Pharm Ther 1997;35(7):296-301.

7. Jellema K, Groeneveld GJ, van Gijn J. [Fever, large eyes and confusion; the anticholinergic syndrome] Ned Tijdschr Geneeskd 2002:146(46):2173-2176.

8. Kahn A., Rebuffat E, Sottiaux M, et al. Prevention of airway obstructions during sleep in infants with breath-holding spells by means of oral belladonna: a prospective double-blind crossover evaluation. Sleep 1991;14(5):432-438.

9. King JC. Anisotropine methylbromide for relief of gastrointestinal spasm: double-blind crossover comparison study with belladonna alkaloids and phenobarbital. Curr Ther Res Clin Exp 1966;8(11):535-541.

10. Lichstein J, Mayer JD. Drug therapy in the unstable bowel (irritable colon). A 15-month double-blind clinical study in 75 cases of response to a prolonged-acting belladonna alkaloid-phenobarbital mixture or placebo. J Chron Dis 1959;9(4):394-404.

11. Rhodes JB, Abrams JH, Manning RT. Controlled clinical trial of sedative-anticholinergic drugs in patients with the irritable bowel syndrome. J Clin Pharmacol 1978;18(7):340-345.

12. Ritchie JA, Truelove SC. Treatment of irritable bowel syndrome with lorazepam, hyoscine butylbromide, and ispaghula husk. Br Med J 1979;1(6160):376-378.

13. Robinson K, Huntington KM, Wallace MG. Treatment of the premenstrual syndrome. Br J Obstet Gynaecol 1977;84(10):784-788.

14. Shanafelt TD, Barton DL, Adjei AA, et al. Pathophysiology and treatment of hot flashes. Mayo Clin Proc. 2002 Nov;77(11):1207-18.

15. Stieg RL. Double-blind study of belladonna-ergotamine-phenobarbital for interval treatment of recurrent throbbing headache. Headache 1977;17(3):120-124.

16. Walach H, Koster H, Hennig T, et al. The effects of homeopathic belladonna 30CH in healthy volunteers: a randomized, double-blind experiment. J Psychosom Res 2001;50(3):155-160.

17. Whitmarsh TE, Coleston-Shields DM, Steiner TJ. Double-blind randomized placebo-controlled study of homoeopathic prophylaxis of migraine. Cephalalgia 1997;17(5):600-604.

November 01, 2003

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