Related Terms

• Alkaloids, B. homochelidonine, benzylisoquinoline alkaloids, berbine, blood root, chelerythrine, chelilutine, chelirubine, coon root, Papaveraceae (family), paucon, pauson, protopine, pseudochelerythrine, puccoon, puccoon-root, red Indian paint, red puccoon, red resin, red root, redroot, SaE, Sangrovit®, sanguilutine, Sanguinaria canadensis, sanguinaria dentifrice, sanguinaria extract, sanguinarin, sanguinarine, sanguinarine chloride, sanguinarine hydroxide, sanguinarine nitrate, sanguinarine sulfate, sanguinarium, sanguiritrin, sanguirubine, sangvinarin, snakebite, sweet slumber, tetterwort, white puccoon.

• Note: This monograph also discusses sanguinarine, an alkaloid of bloodroot, which is also found in other plants such as Mexican prickly poppy (Argemone mexicana), Chelidonium majus, and Macleaya cordata. However, Mexican sanguinaria extract (Polygonum aviculare L.) is not included, as it is not known to contain sanguinarine or other major constituents of bloodroot.

Background

• Bloodroot (Sanguinaria canadensis) has been used historically by some Native American tribes as a medicinal agent to stimulate the digestive system and induce vomiting. It has also been used as an antimicrobial. More recently, the main active constituent of bloodroot, sanguinarine, has been added to dentifrices (used to clean teeth) to reduce plaque and treat gingivitis and periodontal disease. More research is needed in this area to determine sanguinarine's efficacy for these conditions, although there is some concern that chronic oral use of sanguinarine may cause leukoplakia (precancerous white patches in the mouth) and oral dysplastic lesions (abnormal mouth wounds).

• In a report from 2003, the U.S. Food and Drug Administration (FDA) Dental Plaque Subcommittee of the Nonprescription Drugs Advisory Committee concluded "...that sanguinaria extract at 0.03-0.075% concentration is safe, but there are insufficient data available to permit final classification of its effectiveness in an oral rinse or dentifrice dosage form as an [over the counter] antigingivitis/antiplaque active ingredient." However, expert opinion considers bloodroot unsafe when used internally. In 2005, legal action was taken against an unlicensed practitioner for prescribing bloodroot to several women with breast cancer who suffered disfigurement and tissue damage after topically using the cream.

Scientific Evidence

Tradition/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 health care professional.

• Analgesic (pain reliever), anesthesia, antibacterial, antifungal, anti-inflammatory, antimicrobial, antioxidant, antiseptic, asthma, athlete's foot, bacterial skin infections, bronchitis, burn wound healing, cancer, cough, croup, diuretic, dysentery (severe diarrhea), dyspepsia (upset stomach), eczema, edema, emetic (induces vomiting), emmenagogue (induces menstruation), expectorant, gastrointestinal conditions, halitosis (bad breath), heart disease, hypotension (low blood pressure), insect repellent, leprosy, liver tonic, migraine headaches, mouth and throat infections, muscle weakness, palpitations, parasites, pesticide, respiratory stimulant, rheumatic pain, ringworm, sedative, skin disorders, sore throat, tonic (gastrointestinal), tuberculosis, varicose ulcers.

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.

Adults (18 years and older):

• There is no proven safe or effective dose for bloodroot in adults. For gingivitis prevention, oral rinses containing 300 micrograms/milliliter of sanguinaria extract have been used twice daily for up to six months. For periodontal disease, oral rinses containing 0.01% sanguinarine have been used daily for up to six weeks to reduce plaque formation in patients with established and developing plaque and periodontal disease.

Children (younger than 18 years):

• There is no proven safe or effective dose for bloodroot in children.

Safety

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.

Allergies

• Avoid in individuals with a known allergy or hypersensitivity to bloodroot (Sanguinaria canadensis) or its constituents.

Side Effects and Warnings

• In a report from 2003, the U.S. Food and Drug Administration (FDA) Dental Plaque Subcommittee of the Nonprescription Drugs Advisory Committee concluded "...that sanguinaria extract at 0.03-0.075% concentration is safe, but there are insufficient data available to permit final classification of its effectiveness in an oral rinse or dentifrice dosage form as an [over the counter] antigingivitis/antiplaque active ingredient." However, expert opinion considers bloodroot unsafe when used internally. In 2005, legal action was taken against an unlicensed practitioner for prescribing bloodroot to several women with breast cancer who suffered disfigurement and tissue damage after topically using the cream. Bloodroot can be toxic even at low doses.

• Use cautiously in patients taking anti-H. pylori or antimicrobial agents.

• Use cautiously in patients taking opioids or CNS depressants, as sanguinarine is a morphine-like alkaloid that may cause sedation, faintness, vertigo, and possibly impair decision-making and increase response time.

• Use sanguinarine-containing dentifrices cautiously in patients using tobacco products as sanguinarine may cause leukoplakia (precancerous white patches in the mouth) or dysplastic lesions (abnormal wounds).

• Avoid sanguinarine-containing dentifrices in patients with oral lesions (wounds in the mouth), as sanguinarine may irritate or cause oral lesions.

Pregnancy and Breastfeeding

• Traditionally, bloodroot was used to stimulate menstruation, and should therefore not be used during pregnancy. Bloodroot is not recommended in breastfeeding women due to a lack of available scientific evidence.

Interactions

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

• Methanol extracts of Sanguinaria canadensis rhizomes may inhibit the growth of Helicobacter pylori. Sanguinarine may also have antibacterial, antifungal, and antiprotozoal activity. Caution is advised when taking bloodroot with any agents with similar effects.

• Bloodroot contains sanguinarine, a morphine-like alkaloid that may cause sedation, faintness, vertigo, and possibly impair decision-making and increase response time. These effects may be more pronounced when bloodroot is used with agents that act similarly.

• Sanguinarine 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 qualified healthcare professional, including a pharmacist, about possible interactions.

• Bloodroot may interact with hormonal agents.

• Large doses of bloodroot may cause nausea, vomiting, central nervous system sedation, low blood pressure, shock, coma, and death. Caution is advised when taking agents that may contribute to these adverse effects, such as sedatives or blood pressure lowering agents.

• Bloodroot may cause tissue damage when applied to the skin, which may cause other topical medications used at the same time to be absorbed systemically, possibly resulting in unwanted adverse effects. Caution is advised when using bloodroot on the skin along with other topical agents.

Interactions with Herbs and Dietary Supplements

• Methanol extracts of Sanguinaria canadensis rhizomes may inhibit the growth of Helicobacter pylori. Sanguinarine may also have antibacterial, antifungal, and antiprotozoal activity. Caution is advised when taking bloodroot with any herbs or supplements with similar effects.

• Sanguinarine 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 other herbs or supplements may become too high in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

• Bloodroot may interact with hormonal agents.

• Bloodroot contains sanguinarine, a morphine-like alkaloid that may cause sedation, faintness, vertigo, and possibly impair decision-making and increase response time. These effects may be more pronounced when bloodroot is used with herbs or supplements that act similarly, such as opioids or central nervous system depressing herbs or supplements.

• Large doses of bloodroot may cause nausea, vomiting, central nervous system sedation, low blood pressure, shock, coma, and death. Caution is advised when taking herbs and supplements that may contribute to these adverse effects, such as herbs with sedative effects or blood pressure lowering effects.

• Bloodroot may cause tissue damage when applied to the skin, which may cause other topical medications used at the same time to be absorbed systemically, possibly resulting in unwanted adverse effects. Caution is advised when using bloodroot on the skin along with other topical herbs or supplements.

Author Information

• 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).

References

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.

1. Allen CL, Loudon J, Mascarenhas AK. Sanguinaria-related leukoplakia: epidemiologic and clinicopathologic features of a recently described entity. Gen.Dent. 2001;49(6):608-614. View Abstract

2. Cullinan MP, Powell RN, Faddy MJ, et al. Efficacy of a dentifrice and oral rinse containing sanguinaria extract in conjunction with initial periodontal therapy. Aust.Dent.J. 1997;42(1):47-51. View Abstract

3. Eversole LR, Eversole GM, Kopcik J. Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions. Oral Surg.Oral Med.Oral Pathol.Oral Radiol.Endod. 2000;89(4):455-464. View Abstract

4. Frankos VH, Brusick DJ, Johnson EM, et al. Safety of Sanguinaria extract as used in commercial toothpaste and oral rinse products. J.Can.Dent.Assoc. 1990;56(7 Suppl):41-47. View Abstract

5. Harkrader RJ, Reinhart PC, Rogers JA, et al. The history, chemistry and pharmacokinetics of Sanguinaria extract. J.Can.Dent.Assoc. 1990;56(7 Suppl):7-12. View Abstract

6. Harper DS, Mueller LJ, Fine JB, et al. Effect of 6 months use of a dentifrice and oral rinse containing sanguinaria extract and zinc chloride upon the microflora of the dental plaque and oral soft tissues. J.Periodontol. 1990;61(6):359-363. View Abstract

7. Kopczyk RA, Abrams H, Brown AT, et al. Clinical and microbiological effects of a sanguinaria-containing mouthrinse and dentifrice with and without fluoride during 6 months of use. J.Periodontol. 1991;62(10):617-622. View Abstract

8. Kuftinec MM, Mueller-Joseph LJ, Kopczyk RA. Sanguinaria toothpaste and oral rinse regimen clinical efficacy in short- and long-term trials. J.Can.Dent.Assoc. 1990;56(7 Suppl):31-33. View Abstract

9. Laster LL, Lobene RR. New perspectives on Sanguinaria clinicals: individual toothpaste and oral rinse testing. J.Can.Dent.Assoc. 1990;56(7 Suppl):19-30. View Abstract

10. Mahady GB, Pendland SL, Stoia A, et al. In vitro susceptibility of Helicobacter pylori to isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis canadensis. Phytother.Res. 2003;17(3):217-221. View Abstract

11. Newton SM, Lau C, Gurcha SS, et al. The evaluation of forty-three plant species for in vitro antimycobacterial activities; isolation of active constituents from Psoralea corylifolia and Sanguinaria canadensis. J.Ethnopharmacol. 2002;79(1):57-67. View Abstract

12. Southard GL, Parsons LG, Thomas LG, et al. Effect of sanguinaria extract on development of plaque and gingivitis when supragingivally delivered as a manual rinse or under pressure in an oral irrigator. J Clin Periodontol. 1987;14(7):377-380. View Abstract

13. Vrba J, Kosina P, Ulrichova J, et al. Involvement of cytochrome P450 1A in sanguinarine detoxication. Toxicol Lett 7-15-2004;151(2):375-387. View Abstract

14. Walker C. Effects of sanguinarine and Sanguinaria extract on the microbiota associated with the oral cavity. J.Can.Dent.Assoc. 1990;56(7 Suppl):13-30. View Abstract

15. Weide R, Engelhart S, Farber H, et al. [Severe lead poisoning due to Ayurvedic indian plant medicine]. Dtsch.Med.Wochenschr. 11-14-2003;128(46):2418-2420. View Abstract