American hellebore (Veratrum viride)
Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.
While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.
American false hellebore, American white hellebore, cevadine, corn lily, cryptenamine, cyclopamine, false hellebore, germidine, germitrine, green corn lily, green false hellebore, green hellebore, green veratrum, hellebore, Indian poke, itch weed, jervine, jervine alkaloids, Liliaceae (family), Melanthiaceae (subfamily), muldamine, O-acetyljervine, protoveratrine, poison lily, proveratrine, swamp hellebore, verat-v., veratramine, veratridine, Veratrum viride, Veratrone®, veriloid, Vergitryl®, Vertavis®, white American hellebore.
Note: Much of the toxicological data in this monograph is based on the European white hellebore (Veratrum album), as both American hellebore and European white hellebore contain jervine alkaloids, the constituents responsible for the plants' toxic cardiovascular effects.
American hellebore is a perennial plant native to the swampy areas and moist meadows of the eastern and western United States. The root and rhizome of American hellebore has been used historically for fever, pain, and high blood pressure, with a decoction (boiled in water) of the root being used for chronic coughs and constipation. Historically, the whole plant was not routinely used medicinally, only the root and rhizome. Although American hellebore was formerly used as a tea or tincture, potentially toxic and irritating constituents preclude its modern day use by ingestion.
The toxic effects associated with American hellebore limit its ability to be used as an agent to treat hypertension (high blood pressure), related kidney/heart diseases, and hypertension associated with pre-eclampsia in pregnancy.
Currently, there is a lack of scientific information regarding the safety or effectiveness of American hellebore as a whole plant, or homeopathically. Most studies have investigated the isolated jervine alkaloids.
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.
Cardiovascular and renal dysfunction
Isolated jervine alkaloids found in American hellebore have been studied for cardiovascular and renal (kidney) dysfunction. Additional study is needed before a firm recommendation can be made.
Hypertension (high blood pressure)
Isolated jervine alkaloids found in American hellebore have been used to treat hypertension, however other herbs and prescription drugs that can treat this condition have fewer toxic side effects. Additional study is needed in this area.
Isolated jervine alkaloids found in American hellebore may be beneficial for pre-eclampsia/pregnancy-induced hypertension, but other herbs and prescription drugs that can treat this condition have fewer toxic side effects. Additional study is needed in this area.
*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).
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 health care professional.
Antioxidant, arrhythmia (abnormal heart rhythms), bruises, cardiac conditions, cerebrovascular accident (stroke), diaphoretic (promotes sweating), emetic (induces vomiting), expectorant, fever reducer, fractures, heart rate reduction (homeopathic), lice, mental illness, pain, pesticide, skin care (topical rubefacient), snake bite, sprains.
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.
Adults (18 years and older)
There is currently a lack of available scientific information about safe or effective dosing of American hellebore in adults. Most preparations used in studies contain isolated jervine alkaloids from American hellebore (Vertavis®, Veratrone®), and no doses of whole American hellebore have been noted.
Children (younger than 18 years)
There is currently a lack of available scientific information about safe or effective dosing of American hellebore in children.
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.
Avoid in individuals with a known allergy or hypersensitivity to plants in the lily family (Liliaceae) or a known allergy to American hellebore or any related species of Veratrum.
Side Effects and Warnings
It appears that American hellebore is not well tolerated in humans. Even at recommended doses, American hellebore may cause toxicity that may result in death. The isolated chemical constituents (steroidal alkaloids) have been reported to cause arrhythmias (irregular heartbeat), bradycardia (slowed heart rate), hypotension (low blood pressure), headache, nausea, vomiting, diarrhea, gastrointestinal upset and altered renal (kidney) function. Patients with cardiovascular disorders should use caution when taking American hellebore.
Homeopathic American hellebore may be safe for use, but currently there is a lack of available information regarding side effects.
Pregnancy and Breastfeeding
American hellebore should be avoided in pregnant and breastfeeding women since it may be toxic even at therapeutic doses.
Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. 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.
Interactions with Drugs
The use of American hellebore or its alkaloidal constituents could cause bradycardia (slowed heart rate) and combination with anti-arrhythmic drugs may be unsafe. Caution is advised.
American hellebore or its alkaloidal constituents may lower blood pressure. Patients taking medications that lower blood pressure (antihypertensives) should consult with a qualified healthcare professional, including a pharmacist.
American hellebore or its alkaloidal constituents may cause a decrease in glomerular filtration rate (GFR) and effective renal blood flow. Thus, American hellebore may interact with certain medications that increase urine flow (diuretics) such as chlorothiazide (Diuril®). Preparations of American hellebore may also interact with drugs that are excreted through the kidneys or that are potentially toxic to the kidneys.
Isolated constituents found in American hellebore may have beta-agonist and/or beta-adrenergic blocking activity. Caution is advised in patients with cardiovascular disease or those taking beta-agonist or beta-blocker drugs.
Interactions with Herbs and Dietary Supplements
The use of American hellebore or its alkaloidal constituents could cause bradycardia (slowed heart rate) and combination with anti-arrhythmic herbs and supplements may be unsafe. Caution is advised.
American hellebore or its alkaloidal constituents may lower blood pressure. Patients taking herbs and supplements that lower blood pressure (antihypertensives) should consult with a qualified healthcare professional, including a pharmacist.
American hellebore or its alkaloidal constituents may cause a decrease in glomerular filtration rate (GFR) and effective renal blood flow. Thus, American hellebore may interact with certain herbs and supplements that increase urine flow (diuretics). Preparations may also interact with herbs and supplements that are excreted through the kidneys or that are potentially toxic to the kidneys.
This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).
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.
Barrow JG, Sikes CR. The use of purified veratrum viride alkaloids in the treatment of essential hypertension. Am Heart J 1951;41(5):742-748. View Abstract
Royce SW. Hypertension in childhood; treatment of acute nephritis with a derivative of veratrum viride. Calif.Med 1956;84(5):347-350. View Abstract
Brunner D, Aaltman S, Schindel L. Hypertension treatment with alkaloids of Veratrum viride and Veratrum album alone or in combination with hexamethonium salts. Acta Med Scand 1955;151(6):487-498. View Abstract
Faust FB. Veratrum viride in the treatment of essential hypertension; a report of 40 cases. J Lancet 1951;71(2):65-68. View Abstract
Gaillard, Y. and Pepin, G. LC-EI-MS determination of veratridine and cevadine in two fatal cases of Veratrum album poisoning. J Anal.Toxicol. 2001;25(6):481-485. View Abstract
Gebhardt R. Antioxidative, antiproliferative and biochemical effects in HepG2 cells of a homeopathic remedy and its constituent plant tinctures tested separately or in combination. Arzneimittelforschung 2003;53(12):823-830. View Abstract
Joiner C, Kauntze R. Arterial hypertension treated with Rauwolfia serpentina and veratrum viride. Lancet 5-29-1954;266(6822):1097-1099. View Abstract
Kauntze R, Trounce J. Treatment of arterial hypertension with veriloid (Veratrum viride). Lancet 12-1-1951;2(22):1002-1008. View Abstract
Meilman E, Krayer, O. Clinical studies on veratrum alkaloids; the action of protoveratrine and veratridine in hypertension. Circulation 1950;1(2):204-213. View Abstract
Mills LC, Moyer JH. Treatment of hypertension with orally and parenterally administered purified extracts of veratrum viride; comparison with ganglionic (Hexamethonium) and adrenergic blocking agents. AMA.Arch Intern Med 1952;90(5):587-601. View Abstract
Prince, L. A. and Stork, C. M. Prolonged cardiotoxicity from poison lilly (Veratrum viride). Vet.Hum.Toxicol. 2000;42(5):282-285. View Abstract
Shapiro AP, Brust AA, Ferris EB. A comparative study of the effects of Veratrum viride and tetraethylammonium chloride in hypertension. Ann Intern Med 1952;36(3):807-810. View Abstract
Tosun F, et al. The Evaluation of Plants from Turkey for in Vitro Antimycobacterial Activity. 2005;43(1):58-63. Pharmaceutical Biology 2005;43(1):58-63.
Van Wassenhoven M. Towards an evidence-based repertory: clinical evaluation of Veratrum album. Homeopathy 2004;93(2):71-77.
Zagler B, Zelger A, Salvatore C, et al. Dietary poisoning with Veratrum album--a report of two cases. Wien.Klin.Wochenschr. 2005;117(3):106-108. View Abstract
Copyright © 2013 Natural Standard (www.naturalstandard.com)
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
March 22, 2017