Oleander (Nerium oleander, Thevetia peruviana)

Category

Herbs & Supplements

Synonyms

Adelfa, adynerin, ahouai (Antilles), ahousin, Anvirzel®, Apocyanaceae (family), ashwahan, ashwamarak (Sanskrit), be-still nuts (Hawaiian), betulin, betulinic acid, boissaisi (Haitian), cardenolides, cardiac glycosides, cascaveleira (Brazilian), Cerebra thevetia (Indian), cerebrine, cerebrose, common oleander, corrigen, dehydroadynerigen, digitoxigenin, dogbane, exile, folinerin, horse poison, joro-joro (Dutch Guiana), karavira, karier, kohilphin, kokilpal (Indian), L-thevetose, laurier blane (Haitian), laurier bol, laurier desjundins, laurier rose, lorier bol, lucky seed (Jamaican), 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, oleanolic acid, olinerin, peruvoside, pila kaner (Indian), pink oleander, rosa francesa, rosagenin, rosebay, rose laurel, rosen lorbeer, ruvoside, soland, strospeside, Thevetia nerifolia, Thevetia neriifolia, thevetin A, thevetin B, thevetine, thevetoxin, triterpenes, white oleander, yee tho (Thai), yellow oleander.

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.

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.

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

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).
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.
Abnormal menstruation, alcoholism, anti-fertility, anti-parasitic, asthma, bacterial infections, cachexia (weight loss/wasting from some diseases), cardiac abnormalities, cathartic, corns, diuretic (increase urine flow), dysmenorrhea (painful menstruation), epilepsy (seizure), eye diseases, heart disease, hemorrhoids, indigestion, inflammation, insecticide, leprosy, loss of appetite, malaria, neurologic disorders, pregnancy termination, psoriasis, psychiatric disorders, rat poison, sinus problems, skin diseases, skin eruptions, snake bites, swelling, venereal disease, vomiting, warts, weight gain.

Dosing

Adults (18 years and older)

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 at 1.8 to 3.2 milligrams by mouth, as an initial dose, followed by an average daily dose of 0.6 milligrams per day for congestive heart failure.

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

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

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.

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 two to three 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, 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, and 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.

It is possible that plants grown in the same soil as oleander plants or in soil exposed to oleander may contain trace amounts of oleander.

Pregnancy and Breastfeeding

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

Interactions

Interactions with Drugs

Based on animal and human studies, common oleander and yellow oleander contain cardiac glycoside heart-active substances similar to the drug digoxin. There may be an increased risk of unwanted side effects or damage to the heart if taken with other heart-active drugs, such as digoxin (Lanoxin®) or anti-arrhythmics.

Because oleander is similar to the drug digoxin, it may share some of the same interactions, although this has not been thoroughly studied.

Low potassium levels in the blood may increase the dangerous side effects of oleander. Therefore, oleander should be used cautiously with drugs that may lower potassium levels, such as laxatives or some diuretics (drugs that increase urine flow).

Oleander may interact with abortifacients, antibiotics, antidepressants, blood pressure-lowering drugs, antineoplastics, contraceptives, hormonal drugs, immunosuppressants, and neurologic drugs.

Interactions with Herbs and Dietary Supplements

Common oleander and yellow oleander contain cardiac glycoside heart-active substances and interact with other herbs or supplements with similar effects such as hawthorn. Notably, bufalin/Chan Suis is a Chinese herbal formula that has been reported as toxic or fatal when taken with cardiac glycosides.

Toxic effects of oleander on the heart may be increased if used with calcium supplements or herbs that lower potassium levels, such as licorice. Potassium levels theoretically may be reduced by herbs and supplements with laxative properties such as senna or psyllium or herbs and supplements with diuretic properties (increasing urine flow) such as artichoke, celery, or dandelion.

Oleander may interact with abortifacients, antibiotics, antidepressants, blood pressure-lowering herbs and supplements, antineoplastics, contraceptives, hormonal herbs and supplements, immunosuppressants, and neurologic herbs and supplements.

Attribution

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Abrams, PharmD (University of Rhode Island); Ethan Basch, MD (Memorial Sloan-Kettering Cancer Center); Steve Bent, MD (University of California, San Francisco); Caroyln Carley, PharmD (Northeastern University); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Nicole Giese, MS (Natural Standard Research Collaboration); Michael Rotblatt, MD, PharmD (University of California, Los Angeles); Erica Seamon, PharmD (Natural Standard Research Collaboration); Scott W. Shurmur, MD (University of Nebraska Medical School); Philippe Szapary, MD (University of Pennsylvania); Sarah Taylor, PharmD (University of Pittsburgh); 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); Jen Woods, BS (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.

Arao T, Fuke C, Takaesu H, et al. 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.

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

de Silva HA, Fonseka MM, Pathmeswaran A, et al. 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.

Downer J, Craigmill A, Holstege D. Toxic potential of oleander derived compost and vegetables grown with oleander soil amendments. Vet Hum Toxicol 2003 Aug;45(4):219-21.

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.

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

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

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

Juurlink DN, Sivilotti ML. Multidose activated charcoal for yellow oleander poisoning. Lancet 2003 Aug 16;362(9383):581; author reply 581.

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

Mekhail T, Kaur H, Ganapathi R, et al. Phase 1 trial of Anvirzel in patients with refractory solid tumors. Invest New Drugs 2006;24(5):423-427.

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.

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

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

Wojtyna W, Enseleit F. A rare cause of complete heart block after transdermal botanical treatment for psoriasis. Pacing Clin Electrophysiol 2004 Dec;27(12):1686-8.

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.