Aconite (Aconitum napellus)

Category

Herbs & Supplements

Synonyms

Acetylbenzoylaconin, aconite root, aconiti frus, Aconiti Herba, aconiti lateralis preparata, aconiti tuber, aconitine, aconitknollen, aconito, Aconitum angustius, Aconitum anthoroideum, Aconitum artemisiifolium, Aconitum austroyunnanense, Aconitum balfourii, Aconitum barbatum, Aconitum brachypodum, Aconitum brunneum, Aconitum carmichaelii, Aconitum chasmanthum, Aconitum chilienshanicum, Aconitum columbianum, Aconitum coreanum, Aconitum episcopale, Aconitum ferox, Aconitum flavum, Aconitum gymnandrum, Aconitum hemsleyanum, Aconitum japonicum, Aconitum karakolicum, Aconitum kongboense, Aconitum kusnezoffii, Aconitum longilobum, Aconitum moldavicum, Aconitum nagarum, Aconitum napellus, Aconitum naviculare, Aconitum ouvrardianum, Aconitum paniculigerum, Aconitum pendulum, Aconitum polyschistum, Aconitum pomeense, Aconitum pterocaule, Aconitum racemulosum, Aconitum richardsonianum, Aconitum rotundifolium, Aconitum scaposum, Aconitum sczukinii, Aconitum sessiliflorum, Aconitum sinomantanum Nakai, Aconitum soongaricum, Aconitum spicatum, Aconitum stylosum, Aconitum sungpanense, Aconitum taipeicum, Aconitum tanguticum, Aconitum transectum, Aconitum uncinatum, Aconitum vilmorinianum, Aconitum vulparia, autumn monkshood, bachnag, bear's foot, bikh, bikhroot, bish, bishma, blauer eisenhut, blue monkshood, blue monkshood herb, blue monkshood root, blue rocket, brute killer, bushi, cao wu (Chinese), chan-wu (Chinese), ch'uan wu (Chinese), cuanwu (Chinese), dudhia bish (Indian), eisenhutknollen (German), friar's cap, friar's cowl, fuchswurz (German), fu-tzu (Chinese), fu zi (Chinese), garden monkshood, garden wolfsbane (German), giftwurzel (German), helmet flower, higenamine, house bane, hsüeh shang i chih hao (Chinese), Indian aconite, kako-bushi (Japanese), kuan pai fu (Chinese), lang tu (Chinese), leopard killer, mithazahar (Indian), moenchswurz (German), monkshood, monkshood herb, monkshood root, monkshood tuber, monnikskap, monsebane, mouse-bane, mousebane, old wife's hood, pao-fuzi (Japanese), racine d'aconit (French), soldier's cap, storkjelm (German), sturmhutknollen (German), teufelswurz (German), Turk's cap, ts'ao wu (Chinese), venusvogn (Danish), visha, wolfbane, wolf's bane, wolfsbane, wolfshbone, wolfswurzel (German), wu hui (Chinese), wu t'ou (Chinese).

Background

The word Aconitum comes from the word "akone," meaning "rocky," which is the type of area where the aconite plant grows. Cured aconite preparations have a long history of use in Chinese medicine. Processed aconite was used to treat heart failure and other heart diseases. However, aconite has been repeatedly associated with cardiovascular (heart) adverse events. For this reason, the German Commission E does not recommend its use.

Aconite is well known for its extreme toxicity. The tuberous root is used in traditional medicine, although all parts of the plant are considered to be toxic. Aconite also has a near worldwide historical usage as an arrow poison and as a poison in executions, homicides, and suicides. Aconite is also said to be an ingredient of "flying ointments" used by witches to imitate the sensation of flying.

Aconite has been used in very low doses to treat neuralgia (nerve pain), sciatica, and rheumatism. Aconite is also an ingredient in homeopathic preparations used for cold and flu symptoms, heart palpitations with anxiety, acute inflammatory illness, and peripheral nerve pain. Overall, the efficacy has not been established.

Evidence

DISCLAIMER: 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.

Arrhythmia (abnormal heart rhythms): The toxic effects associated with aconitine (a poisonous alkaloid and the active principle of aconite) limit its ability to be used to treat bradycardia (slow heartbeat). Additional study is needed in this area to make a strong recommendation.
Grade: C

Heart failure: The toxic effects associated with aconite limit its ability to be used to treat heart failure, including reno-cardiovascular disease and left ventricular function. Further study is needed to confirm these results.
Grade: C

Post-operative pain (in infants): There is limited data on the use of aconite or any of its derivatives in treating pain. Homeopathic aconite may help relieve postoperative agitation, but further information is needed to confirm these results.
Grade: C

Tradition

WARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. 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. There may be other proposed uses that are not listed below.
Abortifacient (induces abortion), agitated behavior, analgesia (pain reliever), antibacterial, antifungal, anxiety, arthritis, ascites (fluid in the abdomen), asthma, blindness (amaurosis; transient monocular blindness), bronchitis, bruises, cancer, catalepsy (trancelike state), central nervous system depressant (large doses), chicken pox, cholera, chronic low back pain, CNS stimulant, common cold, convulsions, cough, croup, cystitis (bladder infection), dandruff, dengue ("break bone fever"), depression, diabetes mellitus, diarrhea, dysentery (severe diarrhea), eclampsia (pregnancy-induced high blood pressure), enlarged glands, esophagitis (inflamed esophagus), fever, fractures, glossitis (inflamed tongue), gonorrhea (STD), gout (inflamed foot), hair loss, headache, heart disease, hemorrhage, hemorrhoids, hepatitis, Hodgkin's disease, hypertension (high blood pressure), hypocalcemic tetany, immune deficiency, inflammation, inflammation (pleurodynia), inflammatory conditions (of the mouth and pharyngeal area), influenza, insomnia, intermittent claudication (pain or fatigue in arms and legs due to poor supply of oxygen to the muscles), joint pain, laryngitis, lice, malaise, mania, measles, meningitis, menstrual disorders, migraine, miscarriages, mumps, musculoskeletal disorders, myalgia (muscle pain), neck stiffness, nephritis (inflamed kidneys), neuralgia (nerve pain), neurological disorders, ophthalmologic (eye) disorders, otitis media (middle ear infection), pain, paralysis, peripheral neuropathy pain, peritonitis (infection of abdominal cavity), pertussis (whooping cough), phlegmasia alba dolens (milk leg syndrome), pleurisy (inflamed lungs), pneumonia, polydipsia (excessive thirst), prolapsed uterus, rash, rash (heat), respiratory disease, rheumatoid arthritis, roseola (viral illness), scarlet fever, sciatica, scirrhus (hard tumor), seizure disorder (epilepsy), septicemia (blood poisoning), skin pigmentation disorders (chronic exanthemata), sleep disorders, smell disorders, spine problems (myelitis), stroke, sweating, teething, testicular damage, tetanus, tonsillitis, toothache, trigeminal neuralgia (nerve pain), tuberculosis, urinary retention, vertigo, yellow fever.

Dosing

Adults (18 years and older)

There is no proven safe or effective dose for aconite. Topical (application on the skin) use is not recommended. Aconite is sometimes used in liniments (rubifacients) with belladonna. Historically, a 1.3% aconitine topical liniment has been used.

Taking 1-5 drops of a tincture of the fresh leaf by mouth four times a day to relieve pain has been used. Also, homeopathic preparations of 6c to 30c have been used. A 6c potency strength is made by diluting one part of aconite tincture to 99 parts of alcohol or water then the solution is taken and diluted again with 99 parts of alcohol or water. This process is repeated 6 additional times, resulting in a 6c potency.

Children (younger than 18 years)

There is no proven safe or effective dose for aconite, and use in children is not recommended. Homeopathic aconite has been studied in infants to help relieve postoperative agitation, but further information is needed to confirm these results.

Safety

DISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Allergies

Aconite is highly toxic and is not safe for human consumption.

Side Effects and Warnings

Based on widespread use, many experts believe aconite to be unsafe even in recommended amounts in otherwise healthy individuals. Aconite is not recommended for children because of known toxic effects; however, a homeopathic preparation containing aconite has been studied in infants with no toxicity reported.

Severe poisoning has been reported after ingestion of aconitine (found in aconite) or processed and cured aconite. Aconite is not approved by the German Commission E for use in any patients. The American Herbal Product Association rated aconite a class 3 (to be used only under the supervision of an expert qualified in the appropriate use of this substance).

Aconite may cause hypotension (low blood pressure), irregular pulse, various arrhythmias (altered heart beats), or first-degree heart block. Aconite poisoning can cause prolonged repolarization of the myocardium, which leads to triggered automaticity and ventricular tachyarrhythmias including ventricular ectopy, ventricular tachycardia (fast heart beat), and ventricular fibrillation. Aconite has also been reported to cause nausea, vomiting, epigastric pain, diarrhea, muscle cramps, retrosternal discomfort, dizziness, vertigo, variations in motor/sensory skills of limbs, ataxia (loss of coordination), paresthesia (altered sensation), "stiffness" in face, trunk and limbs, clonic convulsions, coma, leukocytosis (high white blood cell count), dimness of vision, blackouts, blurred or double vision, agitation, hyperventilation, difficulty breathing, and respiratory depression.

In theory, aconite may cause liver or kidney damage, hypersalivation, throat constriction, hypokalemia (low potassium in the blood), and hypothermia (low body temperature).

Tingling and numbness have occurred when aconite is applied to the skin (topically).

Aconite may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

Aconite is contraindicated in patients with coronary disease, cardiac dysfunction, and arrhythmias or homodynamic instability. Use cautiously in patients with suicidal tendencies due to the abuse potential associated with aconite. Avoid aconite in patients less than 18 years of age due to a lack of research in this patient population. Avoid aconite use in patients with gastrointestinal disorders, stomach ulcers, duodenal ulcers, reflux esophagitis, ulcerative colitis, spastic colitis, and diverticulosis.

Pregnancy and Breastfeeding

The use of aconite during pregnancy or breastfeeding should be avoided since it is known to be toxic even at therapeutic doses. Studies suggest it is unsafe when used orally (taken by mouth) or topically (applied to the skin) in pregnant women.

Interactions

Interactions with Drugs

Anti-arrhythmic medications may antagonize the effects of aconite and increase the risk of cardiotoxicity or other side effects. Patients taking anti-arrhythmics or other heart medication should consult with a qualified healthcare professional, including a pharmacist.

Aconitine may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

Aconitine may lower blood pressure. Caution is advised when using medications that may also lower blood pressure. Also, combined use of aconitine (an alkaloid found in aconite) with anesthetic medications or diuretic medications (those that increase urine flow) may also lower blood pressure. Caution is advised.

Theoretically, digoxin may interfere with aconitine effects on the heart. Combined use of these medications could be extremely dangerous and result in additive effects of both agents. Consult with a qualified healthcare professional, including a pharmacist.

Interactions with Herbs and Dietary Supplements

Aconitine may lower blood pressure. Caution is advised when using herbs or supplements that may also lower blood pressure. Also, combined use of aconitine (an alkaloid found in aconite) with herbs and supplements that have anesthetic effects or diuretic effects (those that increase urine flow) may also lower blood pressure. Caution is advised.

Aconitine may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar.

Theoretically, digoxin-like herbs or supplements (foxglove, Siberian ginseng) may interfere with aconite effects on the heart producing an unknown and potentially dangerous effect. Consult with a qualified healthcare professional, including a pharmacist before combining therapies.

Attribution

This information was created based on a systematic review of the scientific literature, and was peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Abrams, PharmD (University of Rhode Island); Chi Dam, PharmD (Northeastern University); Cynthia Dacey, PharmD (Natural Standard Research Collaboration); Chi Dam (Northeastern University); Nicole Giese, MS (Natural Standard Research Collaboration); Erica Rusie, PharmD (Nova Southeastern University); Elizabeth Sheehan, PharmD (Northeastern University); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Lisa Wendt, PharmD (Albany College of Pharmacy); Jen Woods, BA (Northeastern University).

Bibliography

DISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

Alibeu JP, Jobert J. [Aconite in homeopathic relief of post-operative pain and agitation in children]. Pediatrie 1990;45(7-8):465-466.

Bao YX, Yu GR, Xu JM, et al. Effect of acute higenamine administration on bradyarrhythmias and HIS bundle. A clinical study of 14 cases and animal experiment on dogs. Chin Med J (Engl.) 1982;95(10):781-784.

Ernst E. Cardiovascular adverse effects of herbal medicines: a systematic review of the recent literature. Can J Cardiol 2003;19(7):818-827.

Imazio M, Belli R, Pomari F, Cecchi E, et al. Malignant ventricular arrhythmias due to Aconitum napellus seeds. Circulation 12-5-2000;102(23):2907-2908.

Lin CC, Chan TY, Deng JF. Clinical features and management of herb-induced aconitine poisoning. Ann Emerg Med 2004;43(5):574-579.

Lowe L, Matteucci MJ, Schneir AB. Herbal aconite tea and refractory ventricular tachycardia. N Engl J Med 10-6-2005;353(14):1532.

Oberbaum M, Schreiber R, Rosenthal, C, et al. Homeopathic treatment in emergency medicine: a case series. Homeopathy 2003;92(1):44-47.

Smith SW, Shah RR, Hunt JL, et al. Bidirectional ventricular tachycardia resulting from herbal aconite poisoning. Ann Emerg Med 2005;45(1):100-101.

Tai YT, But PP, Young K, et al. Cardiotoxicity after accidental herb-induced aconite poisoning. Lancet 11-21-1992;340(8830):1254-1256.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.