Oleander

by MedlinePlus

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

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 evidence

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.

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).

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-inflammatory, anti-parasitic, asthma, bacterial infections, cachexia (weight loss/wasting from some diseases), cardiac abnormalities, cathartic, corns, diuretic (increase urine flow), epilepsy (seizure), eye diseases, heart disease, hemorrhoids, indigestion, inflammation, insecticide, leprosy, malaria, menstrual stimulant, neurologic disorders, pregnancy termination, psoriasis, 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

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.

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. Digoxin interacts with many drugs, including acarbose, acetazolamide, activated charcoal, amiodarone, atorvastatin, azithromycin, azosemide, bepridil, beta-adrenergic blockers, bumetanide, canrenoate, cascara sagrada, cholestyramine, clarithromycin, cyclophosphamide, cyclosporine, diltiazem, erythromycin, ethacrynic acid, furosemide, hydroxychloroquine, indomethacin, itraconazole, kaolin, lornoxicam, metoclopramide, mibefradil, nefazodone, nifedipine, nilvadipine, nisoldipine, nitrendipine, paromomycin, penicillamine, piretanide, propafenone, propantheline, quinidine, quinine, spironolactone, succinylcholine, thiazide diuretics, torsemide, valspodar, verapamil, and vincristine.

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).

Interactions with Herbs and Dietary Supplements

Common oleander and yellow oleander contain cardiac glycoside heart-active substances. Herbs or supplements that may cause increased heart effects/damage if taken with oleander include: adonis, balloon cotton, black hellebore root/melampode, black Indian hemp, bushman's poison, cactus grandifloris, convallaria, eyebright, figwort, foxglove/digitalis, frangipani, hedge mustard, hemp root/Canadian hemp root, king's crown, lily-of-the-valley, motherwort, pheasant's eye plant, plantain leaf, pleurisy root, psyllium husks, redheaded cotton-bush, rhubarb root, rubber vine, sea-mango, senna fruit, squill, strophanthus, uzara, wallflower, wintersweet, and yellow dock root. 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, corn silk, couchgrass, dandelion, elder flower, horsetail, juniper berry, kava, shepherd's purse, uva ursi, yarrow. Laxative herbs include alder buckthorn, aloe dried leaf sap, black root, blue flag rhizome, butternut bark, dong quai, European buckthorn, eyebright, cascara bark, castor oil, chasteberry, colocynth fruit pulp, dandelion, gamboges bark, horsetail, jalap root, manna bark, plantain leaf, podophyllum root, psyllium, rhubarb, senna, wild cucumber fruit, and yellow dock root.

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