Related Terms

• 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.

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.

• 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

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)

• 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

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

• 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

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

• 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.

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.

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

3. 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. View Abstract

4. 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. View Abstract

5. 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. View Abstract

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

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

8. 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. View Abstract

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

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13. 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. View Abstract

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

15. 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. View Abstract