Tox in The Land: #NaturalAbortion. The facts you didn't see on TikTok this summer!

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Penny royal tea

Source: https://en.wikipedia.org/wiki/Mentha_pulegium

#Pennyroyaltea (Pennyroyal)

  • Derived from leaves of Mentha pulegium

  • Used as an insect repellent, mint flavoring in tea, abortifacient

  • Available as a tea or a concentrated oil

  • Oil is highly toxic (can cause death with ingestion of 15 mL)

  • Mechanism of toxicity

    • Pulegone is toxic to multiple organs as an enzyme inhibitor

    • Pulegone is also converted to toxic metabolites that deplete glutathione stores in the liver

    • Menthofurane is a hepatotoxic metabolite that inhibits CYP2A6 and contributes to centrilobular hepatic necrosis

    • Pulegone and its metabolites may also cause lung necrosis

  • Toxic effects

    • Nausea, vomiting, abdominal pain

    • Liver failure

    • Renal insufficiency

    • Cardiopulmonary collapse

    • Syncope

    • Seizure

    • Coma

    • Death

  • Treatment

    • No antidote

    • N-acetylcysteine has been given to patients given similar mechanism to Tylenol toxicity

Source: https://en.wikipedia.org/wiki/Mugwort

#Mugwort

  • Derived from the leaves of Artemisia vulgaris

  • Used to induce menstruation, as an abortifacient, treat digestive problems, antioxidant, insecticide

  • Available as dried leaves, oil, tinctures, teas, pills

  • Toxicity

    • Generally well tolerated

    • Can be toxic when the oil is ingested

    • Oil contains high concentrations of camphor (10-47%) and thujone (9-21%)

    • Can lead to nausea, vomiting, headache

    • Neurotoxic and can lead to seizures

Caulophyllum thalictroides

Source: https://en.wikipedia.org/wiki/Caulophyllum_thalictroides

#BlueCohosh

  • Derived from the roots or rhizomes of Caulophyllum thalictroides

  • Traditionally used to induce labor and menstruation, as an abortifacient, anti-inflammatory, anti-pyretic

  • Available as root powders, capsules and liquid extracts

  • Toxicity

    • Contains alkaloids like N-methylcytosine, which has nicotinic effects

    • Nicotinic toxicity – tachycardia, diaphoresis, abdominal pain, muscle weakness, fasciculations

    • Contains saponins, which are glycosides that constrict coronary vessels

    • Case studies have reported association with perinatal stroke, acute MI, heart failure and multiple organ injury

Actaea racemosa

Source: ://en.wikipedia.org/wiki/Actaea_racemosa

#BlackCohosh

  • Derived from the roots or rhizomes of Actaearacemosa

  • Also known as black root, black snakeroot, bugbane

  • Claimed to have estrogen-like effects

  • Used primarily for menopausal symptoms, to induce labor, and as abortifacient

  • Very limited evidence supporting these claims

  • Available as a tincture or capsule

  • Toxicity

    • Nausea, vomiting

    • Hepatotoxicity

    • ~2-12 weeks latency period

    • Hepatotoxicity ranges from moderate elevations in liver enzymes to acute hepatic failure and death

    • Exact mechanism is unknown, but may be immunologically mediated

POST BY: VICTORIA ADOMSHICK (MS4, CWRU)

FACULTY EDITING BY: DR. LAUREN PORTER (MEDICAL TOXICOLOGIST)

References

  1. Anderson IB, Mullen WH, Meeker JE, Khojasteh-BakhtSC, Oishi S, Nelson SD, Blanc PD. Pennyroyal toxicity: measurement of toxic metabolite levels in two cases and review of the literature. Ann Intern Med. 1996 Apr 15;124(8):726-34. doi: 10.7326/0003-4819-124-8-199604150-00004. PMID: 8633832.

  2. Khojasteh-Bakht SC, Koenigs LL, Peter RM, Trager WF, Nelson SD. (R)-(+)-Menthofuran is a potent, mechanism-based inactivator of human liver cytochrome P450 2A6. Drug MetabDispos. 1998 Jul;26(7):701-4. PMID: 9660853.

  3. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Black Cohosh. [Updated 2020 Nov 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547990/

  4. Lontos S, Jones RM, Angus PW, Gow PJ. Acute liver failure associated with the use of herbal preparations containing black cohosh. Med J Aust. 2003;179:390–1.

  5. Rader JI, Pawar RS. Primary constituents of blue cohosh: quantification in dietary supplements and potential for toxicity. Anal Bioanal Chem. 2013 May;405(13):4409-17. doi: 10.1007/s00216-013-6783-7. Epub 2013 Feb 19. PMID: 23420136.

  6. Abiri R, Silva ALM, de Mesquita LSS, de Mesquita JWC, Atabaki N, de Almeida EB Jr, Shaharuddin NA, Malik S. Towards a better understanding of Artemisia vulgaris: Botany, phytochemistry, pharmacological and biotechnological potential. Food Res Int. 2018 Jul;109:403-415.

  7. Siegel E, Wason S. Camphor toxicity. Pediatr Clin North Am. 1986 Apr;33(2):375-9. doi: 10.1016/s0031-3955(16)35008-8. PMID: 3515302.

  8. Pelkonen O, Abass K, Wiesner J. Thujone and thujone-containing herbal medicinal and botanical products: toxicological assessment. Regul Toxicol Pharmacol. 2013 Feb;65(1):100-7. doi: 10.1016/j.yrtph.2012.11.002. Epub 2012 Nov 28. PMID: 23201408.

ToxLauren McCafferty