Oleander (Nerium oleander, Thevetia peruviana)

Oleander (Nerium oleander, Thevetia peruviana)

Background

The term "oleander" refers to two plant species, Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) , which grow in temperate climates throughout the world. Both species contain chemicals called "cardiac glycosides" that have effects similar to the heart drug digoxin. Both species can be toxic when taken by mouth, with many documented reports of deaths.

Synonyms

Adelfa, adynerin, ahouai (Antilles), ahousin, Anvirzel®, Apocyanaceae (family) , ashwahan, ashwamarak (Sanskrit), be-still nuts (Hawaii), boissaisi (Haiti), cardenolides, cardiac glycosides, cascaveleira (Brazil), Cerebra thevetia (India), cerebrine, cerebrose, common oleander, corrigen, dehydroadynerigen, digitoxigenin, exile, folinerin, horse poison,joro- joro (Dutch Guiana), karier, karavira, kohilphin, kokilpal (India), laurier blane (Haiti), laurier bol, laurier desjundins, laurier rose, lorier bol, lucky seed (Jamaica), neriantin, neridiginoside, neridlenone A, neriifolin, neriine, nerin, nerioside, neritaloside, Nerium indicum , Nerium odorum, nerizoside, NOAG-II, odoroside H, oleanderblatter, oleandri folium, oleandrigenin, oleandrin, oleandrinogen, oleandroside, olinerin, peruvoside, pila kaner (India), pink oleander, rosa francesa, rosagenin, rosebay, rose laurel, rosen lorbeer, ruvoside, soland, strospeside, Thevetia nerifolia, Thevetia neriifolia , thevetin A, thevetin B, thevetine, L-thevetose, thevetoxin, triterpenes, white oleander, Yee tho (Thailand), yellow oleander.

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*Congestive heart failure
The term "oleander" refers to two plants, Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) . Both plants contain heart-active "cardiac glycoside" chemicals (similar to the prescription drug digoxin), and have been associated with serious side effects in humans, including death. The plants have been used to treat heart failure in China and Russia for decades, but scientific evidence supporting use is limited to small, poorly designed studies. Human research began in the 1930s, but was largely abandoned due to serious gastrointestinal and heart toxicity. It should be noted that the drug digoxin may improve symptoms of congestive heart failure, but does not improve mortality (length of life).

C

Cancer
Laboratory studies of oleander suggest possible anti-cancer effects, although reliable research in humans has not yet been performed. There are reports that long-term use of oleander may have positive effects in patients with leiomyosarcoma, Ewing's sarcoma, prostate or breast cancer. More research is needed before a recommendation can be made.

C

* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence 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 menstruation, alcoholism, anorexia, anti-fertility, anti-parasitic, asthma, bacterial infections, cachexia (weight loss/wasting from some diseases), cathartic, corns, diuretic (increase urine flow), epilepsy (seizure), eye diseases, heart disease, hemorrhoids, indigestion, inflammation, insecticide, leprosy, malaria, menstrual stimulant, neurologic disorders, pregnancy termination, psychiatric disorders, rat poison, ringworm, sinus problems, snake bites, skin diseases, skin eruptions, swelling, venereal disease, vomiting, warts, weight gain.

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 no widely accepted standardization for oleander.

Adults (18 years and older)

Congestive heart failure : Safety has not been established for any dose of oleander. Peruvoside, a heart-active substance in yellow oleander kernels (similar to the drug digoxin) has been studied taken as 1.8 to 3.2 milligrams by mouth, as an initial dose, followed by an average daily dose of 0.6 milligrams per day.

Children (younger than 18 years)

Oleander is not recommended for use in children due to risk of toxicity or death, and lack of scientific data.

Safety

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

Allergies

People with allergy/hypersensitivity to oleander or other cardiac glycosides such as digoxin or digitoxin may have reactions to oleander. Skin contact with sap from oleander leaves may cause rash/dermatitis.

Side Effects and Warnings

Common oleander contains a strychnine-like toxin, and a heart-active cardiac glycoside substance (similar to the prescription drug digoxin) that may cause the heart to beat rapidly, abnormally, or to stop beating. Common oleander has been used as rat poison, insecticide and fish poison, and is toxic to mammals including humans. Animals (sheep) have died after eating as little as 2-3 leaves of Nerium oleander (common oleander) . Children may die after eating a single leaf of common oleander. Eating the leaves, flowers or bark of common oleander may cause nausea, vomiting, stomach cramps and pain, fatigue, drowsiness, unsteadiness, bloody diarrhea, abnormal heart rhythms, seizures, liver or kidney damage, or unconsciousness. Death may occur within one day. Reports of toxicity and deaths in children and adults have been reported for decades in Australia, India, Sri Lanka and the United States.

Fruits of Thevetin peruviana (yellow oleander) are thought to be even more toxic to mammals, including humans. Based on human studies of intentional overdose (suicide attempts), eating eight or more seeds of yellow oleander may be fatal.

Additional side effects of oleander ingestion include irritation and redness of lips, gums, tongue, nausea, vomiting, depression, irritability, fast breathing, sweating, stomach pain, diarrhea, headache, confusion, visual disturbances, and constricted pupils. Abnormal blood tests, including tests of liver and kidney function (potassium, bilirubin, creatinine, and blood urea) have been reported in humans.

Pregnancy and Breastfeeding

Oleander is toxic and should be avoided by pregnant or breastfeeding women.

References

1. Arao T, Fuke C, Takaesu H, Nakamoto M, Morinaga Y, Miyazaki T. Simultaneous determination of cardenolides by sonic spray ionization liquidchromatography-ion trap mass spectrometry--a fatal case of oleander poisoning. J Anal Toxicol. 2002 May-Jun;26(4):222-7.

2. Bose TK, Basu RK, Biswas B, et al. Cardiovascular effects of yellow oleander ingestion. J Indian Med Assoc 1999;97 (10) :407-410.

3. de Silva HA, Fonseka MM, Pathmeswaran A, Alahakone DG, Ratnatilake GA,Gunatilake SB, Ranasinha CD, Lalloo DG, Aronson JK, de Silva HJ. Multiple-dose activated charcoal for treatment of yellow oleander poisoning: a single-blind, randomised, placebo-controlled trial. Lancet. 2003 Jun 7;361(9373):1935-8.

4. Eddleston M, Ariaratnam CA, Sjostrom L, et al. Acute yellow oleander (Thevetia peruviana) poisoning: cardiac arrhythmias, electrolyte disturbances, and serum cardiac glycoside concentrations on presentation to hospital. Heart 2000;83(3):301-306.

5. Eddleston M. Patterns and problems of deliberate self-poisoning in the developing world. QJM 2000;93(11):715-731.

6. Eddleston M, Warrell DA. Management of acute yellow oleander poisoning. QJM 1999;92(9):483-485.

7. Eddleston M, Persson H. Acute plant poisoning and antitoxin antibodies. J Toxicol Clin Toxicol. 2003;41(3):309-15.

8. Fonseka MM, Seneviratne SL, de Silva CE, Gunatilake SB, de Silva HJ. Yellow oleander poisoning in Sri Lanka: outcome in a secondary care hospital. Hum Exp Toxicol. 2002 Jun;21(6):293-5.

9. Le Couteur DG, Fisher AA. Chronic and criminal administration of Nerium oleander. J Toxicol Clin Toxicol. 2002;40(4):523-4.

10. Lim DC, Hegewald K, Dandamudi N. A suicide attempt with an oleander cocktail. Chest 1999;116(4):405S-406S.

11. Monzani V, Rovellini A, Schinco G, et al. Acute oleander poisoning after a self-prepared tisane. J Toxicol Clin Toxicol 1997;35(6):667-668.

12. Ni D, Madden TL, Johansen M, Felix E, Ho DH, Newman RA. Murine pharmacokinetics and metabolism of oleandrin, a cytotoxic component of Nerium oleander. J Exp Ther Oncol. 2002 Sep-Oct;2(5):278-85.

13. Nishioka S, Resende ES. Transitory complete atrioventricular block associated to ingestion of Nerium oleander. Rev Assoc Med Bras 1995;41(1):60-62.

January 01, 2004