Generic Name: pennyroyal

Category

Herbs & Supplements

Synonyms

Aloe herbal horse spray, brotherwort, chasse-puces, churchwort, Cunila pulegioides, dictamne de Virginie, European pennyroyal, flea mint, fleabane, fretillet, Hedeoma phlebitides, herbal horsespray, herbe aux puces, herbe de Saint-Laurent, Labiatae (family), la menthe pouliot (French), Lamiacea (family), Lurk-in-the-Ditch, Melissa pulegioides, mentha pouillot, Miracle Coat spray-on dog shampoo, mock pennyroyal, mosquito plant, Old World pennyroyal, pennyroyal essential oil, petit baume, piliolerial, poley, pouliot royal, pudding herb, pudding grass, pulegium, pulegium oil, Pulegium regium, Pulegium vulgare, pulioll-royall, run-by-the-ground, squaw balm, squawmint, stinking balm, tickweed.

Background

The essential oil of pennyroyal is considered toxic. Death has been reported after the consumption of small amounts. A characteristic noted in most cases of pennyroyal overdose is a strong minty smell on the patient's breath.

A possible role for N-acetylcysteine (NAC) in the management of pennyroyal overdose has been suggested. However, this application has not been confirmed by animal or human studies.

The essential oil of pennyroyal may act as an emmenagogue (menstrual flow stimulant) and induce abortion. However, it may do so at lethal or near-lethal doses, making this action unpredictable and dangerous. Future research to determine the safety and efficacy of the less toxic parts of the pennyroyal plant on the menstrual cycle is needed before a recommendation can be made.

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.

Abortifacient (uterus contraction stimulant/abortion inducer): Folkloric use and several human case reports describe the use of the essential oil of pennyroyal to cause abortion. However, it may do so at deadly or toxic doses, making this an unpredictable and dangerous use.
Grade: C

Menstrual flow stimulant (emmenagogue): Folkloric use and several human case reports describe the use of the essential oil of pennyroyal as an emmenagogue (menstrual flow stimulant). However, it may do so at lethal or near-lethal doses, making this action unpredictable and dangerous.
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.
Acaricidal (lethal to mites), acne, antiseptic, anti-spasm, anxiety, asthma, bruises and burns, cancer, chest congestion, colds, colic, cough, cramps, diarrhea, digestion, diuretic (increasing urine flow), dizziness, dysentery, fever, flavoring agent, flea control, flu, fragrance (detergents, perfumes, soaps), fumigant, gallbladder disorders, gas, gout, hallucinations, headache, hysteria, immortality, indigestion, insect repellant, intestinal disorders, itchy eyes, joint problems, kidney disease, leprosy, liver disease, mouth sores, muscle pain, nosebleeds, pneumonia, potpourri, pregnancy, premenstrual syndrome, preparing the uterus for labor, purifier (water, blood), refrigerant, respiratory ailments, sedative, skin ailments (itching, burning, bruising), snake bites (venomous), stimulant, stomach pain, sunstroke, sweating, syncope, toothache, uterine fibroids, whooping cough.

Dosing

Adults (over 18 years old)

No safe dose of pennyroyal has been established. Extracts, oils, teas, and infusions have been taken by mouth, but may be toxic. Topical preparations have also been applied to the skin. Pennyroyal has been used as an herbal flea collar for animals by hanging a bag of pennyroyal from a regular collar or using a pennyroyal garland. Safety and effectiveness of these preparations have not been proven.

Children (under 18 years old)

Pennyroyal is not recommended in children due to a lack of scientific study and potential toxicity.

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

Allergic reactions, such as rash, to pennyroyal or to its components, including pulegone, may occur.

Side Effects and Warnings

Pennyroyal herb and volatile oils have been associated with multiple reports of toxicity and adverse effects, including seizures, loss of consciousness, and death. In animals, pennyroyal (taken by mouth or placed on the skin) has been associated with liver, lung, and brain toxicity. Even small amounts of pennyroyal may be associated with death. Cases of human overdose and death have been reported in infants, children, and adults.

Pennyroyal oil toxicity may cause nausea, vomiting, abdominal pain, burning in the throat, difficulty swallowing, diarrhea, excessive sweating, chills, fever, headache, ringing in the ears, dizziness, extreme thirst, muscle spasms, restlessness, tremor, excessive talkativeness, hallucinations, agitation, drowsiness, fatigue, confusion, mania, seizures, organ failure (brain, liver, lung, kidney, heart), altered (low or high) heart rate, altered (low or high) blood pressure, slow breathing, coma, loss of consciousness, and death. Symptoms in pennyroyal overdose may mimic that of acetaminophen (Tylenol®) overdose, and the use of N-acetylcysteine (an antidote used for acetaminophen toxicity) treatment may prove beneficial, although this is not well proven.

Other side effects may include contact dermatitis, rash (when placed on the skin), malaise, lethargy, agitation, abnormal sensations, or change (increase or decrease) in pupil size. There are reports that pennyroyal may cause abortion. Pennyroyal has been used historically as an emmenagogue (menstrual stimulant) and may cause menstrual bleeding. There are reports that large amounts of pennyroyal may be irritating to the urinary tract. Pennyroyal may cause hypoglycemia (low blood sugar), hemolytic anemia (low red blood cell count due to destruction of cells), disseminated intravascular coagulation (widespread abnormal clotting and/or bleeding), and metabolic acidosis.

Pregnancy and Breastfeeding

Pennyroyal should be avoided during pregnancy or breastfeeding, due to the risk of uterine contractions, stimulation of menstruation, and abortion.

Many tinctures contain high levels of alcohol, and should be avoided during pregnancy.

Interactions

Interactions with Drugs

Pennyroyal may interact with hormonal drugs and decrease the effectiveness of fertility agents. Pennyroyal has been reported to cause uterine contractions, stimulation of menstruation, and abortion.

In theory, the toxicity of pennyroyal may be increased when combined with acetaminophen (Tylenol®). Pennyroyal may lower glutathione (a liver substance), which may increase the risk of acetaminophen toxicity. Pennyroyal may increase the risk of liver damage caused by other drugs.

Pennyroyal may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood, and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a healthcare provider, including a pharmacist, about possible interactions.

Pennyroyal 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.

Pennyroyal may have antihistamine effects and may cause increased effects if combined with drugs that have antihistamine action, such as diphenhydramine (Benadryl®), fexofenadine (Allegra®), or loratidine (Claritin®).

Many tinctures contain high levels of alcohol and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).

Pennyroyal may interact with drugs that lower the seizure threshold; use cautiously.

Interactions with Herbs and Dietary Supplements

Pennyroyal may increase the risk of liver damage when combined with some herbs or supplements, such as kava.

Pennyroyal has been found to inhibit the absorption of iron in meals.

Pennyroyal may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of these herbs or supplements may be increased in the blood and may cause increased effects or potentially serious adverse reactions. It may also alter the effects that other herbs or supplements possibly have on the P450 system, such as St. John's wort.

Pennyroyal may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar, such as American ginseng.

Pennyroyal and black cohosh have been taken together to induce abortion, and this combination has been associated with toxicity and death.

Pennyroyal and blue cohosh have traditionally been taken together to normalize the menstrual cycle in women. In theory, the combination of the two herbs may act together to increase menstrual flow. Notably, blue cohosh has been associated with multiple dangerous effects including stroke.

Severe psychotic episodes and seizures have been reported in a young pregnant woman after ingesting an unknown dose of pennyroyal and "Widow Welch's Female Pills," a combination of ferrous sulfate, sulfur, licorice (Glycyrrhiza glabra), and turmeric (Curcuma longa). The exact cause is unknown.

Attribution

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Paul Hammerness, MD (Harvard Medical School); Richard Liebowitz, MD (Duke University); Mary McGarry, RPh (Natural Standard Research Collaboration); Carolyn Williams Orlando, MA (American Botanical Council); David Sollars MAc, HMC (New England School of Acupuncture); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Mamta Vora, PharmD (Northeastern University); Wendy Weissner, BA (Natural Standard Research Collaboration).

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.

Anderson IB, Nelson SD, Blanc PD. Pennyroyal metabolites in human poisoning. Ann Intern Med 1997;126(3):250-251.

Anderson IB, Mullen WH, Meeker JE, et al. Pennyroyal toxicity: measurement of toxic metabolite levels in two cases and review of the literature. Ann Intern Med 4-15-1996;124(8):726-734.

Bakerink JA, Gospe SM Jr, Dimand RJ, et al. Multiple organ failure after ingestion of pennyroyal oil from herbal tea in two infants. Pediatrics 1996;98(5):944-947.

Black DR. Pregnancy unaffected by pennyroyal usage. J Am Osteopath Assoc 1985;85(5):282.

Buechel DW, Haverlah VC, Gardner ME. Pennyroyal oil ingestion: report of a case. J Am Osteopath Assoc 1983;82(10):793-794.

Carmichael PG. Pennyroyal metabolites in human poisoning. Ann Intern Med 2-1-1997;126(3):250-251.

Ciganda C, Laborde A. Herbal infusions used for induced abortion. J Toxicol Clin Toxicol 2003;41(3):235-239.

Conway GA, Slocumb JC. Plants used as abortifacients and emmenagogues by Spanish New Mexicans. J Ethnopharmacol 1979;1(3):241-261.

Giorgi DF, Lobel D, Morasco R, et al. N-acetylcysteine for pennyroyal oil toxicity. Vet Human Toxicol 1994;36(4):358.

Gordon WP, Huitric AC, Seth CL, et al. The metabolism of the abortifacient terpene, (R)-(+)-pulegone, to a proximate toxin, menthofuran. Drug Metab Dispos 1987;15(5):589-594.

Khojasteh-Bakht SC, Chen W, Koenigs LL, et al. Metabolism of (R)-(+)-pulegone and (R)-(+)-menthofuran by human liver cytochrome P-450s: evidence for formation of a furan epoxide. Drug Metab Dispos 1999;27(5):574-580.

Mack RB. "Boldly they rode ... into the mouth of hell." Pennyroyal oil toxicity. NC Med J 1997;58(6):456-457.

Martins HM, Martins ML, Dias MI, et al. Evaluation of microbiological quality of medicinal plants used in natural infusions. Int J Food Microbiol 8-15-2001;68(1-2):149-153.

Mazur LJ, De Ybarrondo L, Miller J, et al. Use of alternative and complementary therapies for pediatric asthma. Tex Med 2001;97(6):64-68.

Sullivan JB Jr, Rumack BH, Thomas H Jr, et al. Pennyroyal oil poisoning and hepatotoxicity. JAMA 12-28-1979;242(26):2873-2874.

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.