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PLANTS-CAULOPHYLLUM

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Caulophyllum thalictroides is an American indigenous plant that was used by the Indians as a childbirth aid, and as a treatment for rheumatism, cramps, epilepsy, and uterine inflammation. It contains a number of alkaloids, saponins, and glycosides (Anon, 1986).

Specific Substances

    1) Blau Cohosch (German)
    2) Blue Cohosh
    3) Blue Ginseng
    4) Blueberry Root
    5) Cohoche Bleu (French)
    6) Leontice thalictroides (Linn.)
    7) Leontopetalon thalictroides (Hill)
    8) Papoose Root
    9) Squaw Root
    10) Yellow Ginseng

Available Forms Sources

    A) SOURCES
    1) HOW SUPPLIED: The plant is available in capsule, tincture, tablet, and powder form.
    2) Caulophyllum thalictroides (blue cohosh) contains several alkaloids and glycosides, with the alkaloid methylcytisine and the glycoside caulosaponin contributing the most to its physiological activity (Tyler, 1993).
    3) The leaves, roots, and seeds of this plant contain the toxin (Anon, 1986; Lampe & McCann, 1985). The parts generally recommended for use by herbalists are the roots and rhizomes (the underground portions) (Tyler, 1982; (Anon, 2000)).
    4) Strong heating destroys the toxicity of the seeds, and the roasted seeds have been used as a coffee substitute.
    B) USES
    1) It purportedly possesses antispasmodic, emmenagogue, uterine tonic and antirheumatism properties. Traditionally used for amenorrhea, threatened miscarriage, false labor, rheumatic pains, and specific conditions associated with uterine atony ((Anon, 2000)).
    2) Caulosaponin constricts coronary blood vessels which could be toxic in small animals; therefore, caulophyllum cannot be considered harmless nor is it recommended for medical self treatment (Tyler, 1993).

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) Few cases of human poisoning have been reported. The primary symptoms expected would be irritation of the eyes, skin, and gastrointestinal tract.
    B) The crude drug from this plant does have pharmacologic activity on smooth muscle and there is the potential for coma, seizures, red cell hemolysis, muscular weakness, irritability, restlessness, cardiovascular abnormalities, or respiratory failure.
    C) The symptoms seen in an overdose would be a combination of the nicotine-like actions of methylcytisine and the action of the saponins. Cases of these more serious symptoms could not be found in the literature.
    D) Myocardial infarction was reported in a newborn following the use of caulophyllum by the mother for several weeks before delivery.
    0.2.4) HEENT
    A) This plant material (especially the roots) may be irritating to the eyes (Ferguson & Edwards, 1954).
    0.2.5) CARDIOVASCULAR
    A) Although coronary artery contraction has been seen in animal models, it has not been reported in humans. Elevation in blood pressure may occur secondary to the nicotinic effect of methylcytisine
    B) Myocardial infarction has been reported in a newborn following the use of caulophyllum by the mother.
    0.2.8) GASTROINTESTINAL
    A) Nausea, vomiting, abdominal pain, and diarrhea are the primary symptoms associated with ingestion.
    0.2.12) FLUID-ELECTROLYTE
    A) Monitor fluid and electrolyte loss if the vomiting and diarrhea is extensive.
    0.2.14) DERMATOLOGIC
    A) Irritation of the skin and mucous membranes may occur after handling this plant.
    0.2.20) REPRODUCTIVE
    A) The crude drug derived from this plant has an oxytocic effect and until more studies are done, should not be taken during pregnancy. The oxytocic properties are produced by the caulosaponin portion of the plant ((Anon, 2000)).

Laboratory Monitoring

    A) There is no specific blood or urine tests. Monitor fluid and electrolytes if vomiting and diarrhea are extensive.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) ACTIVATED CHARCOAL: Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
    B) CATHARTICS are NOT indicated with this ingestion due to the frequent occurrence of diarrhea.
    0.4.4) EYE EXPOSURE
    A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.
    0.4.5) DERMAL EXPOSURE
    A) OVERVIEW
    1) DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

Range Of Toxicity

    A) ANIMAL DATA - The LD50 of a crude alcoholic extract was 11.8 milligrams/kilogram in mice, and 20.3 milligrams/kilograms in rats.
    B) Although a lethal dose has not been established, caulosaponin is reportedly a cardiotoxin which causes constriction of coronary blood vessels, produces intestinal spasms, and has oxytocic properties.
    C) A 21-year-old female 6 weeks pregnant drank 15 cups/day of slippery elm tea, along with 10-20 doses/day of tincture of blue cohosh for four days and developed symptoms of nicotinic toxicity which resolved with supportive care.

Clinical Effects

Summary Of Exposure

    A) Few cases of human poisoning have been reported. The primary symptoms expected would be irritation of the eyes, skin, and gastrointestinal tract.
    B) The crude drug from this plant does have pharmacologic activity on smooth muscle and there is the potential for coma, seizures, red cell hemolysis, muscular weakness, irritability, restlessness, cardiovascular abnormalities, or respiratory failure.
    C) The symptoms seen in an overdose would be a combination of the nicotine-like actions of methylcytisine and the action of the saponins. Cases of these more serious symptoms could not be found in the literature.
    D) Myocardial infarction was reported in a newborn following the use of caulophyllum by the mother for several weeks before delivery.

Heent

    3.4.1) SUMMARY
    A) This plant material (especially the roots) may be irritating to the eyes (Ferguson & Edwards, 1954).
    3.4.3) EYES
    A) When instilled into rabbit eyes, the saponins proved to be very irritating (Ferguson & Edwards, 1954).

Cardiovascular

    3.5.1) SUMMARY
    A) Although coronary artery contraction has been seen in animal models, it has not been reported in humans. Elevation in blood pressure may occur secondary to the nicotinic effect of methylcytisine
    B) Myocardial infarction has been reported in a newborn following the use of caulophyllum by the mother.
    3.5.2) CLINICAL EFFECTS
    A) VASOCONSTRICTION
    1) ANIMAL DATA - Ferguson & Edwards (1954) found a compound in this plant that contracted the coronary vessels of the rat heart, and the carotid arteries of cattle and frogs. There have not been coronary problems reported in human cases.
    2) More recently, caulosaponin is reportedly the cardiotoxic agent that causes constriction of the coronary blood vessels ((Anon, 2000)).
    B) MYOCARDIAL INFARCTION
    1) CASE REPORT - Jones & Lawson (1998) reported that a newborn experienced a myocardial infarction after exposure to blue cohosh (3 tablets/daily for 3 weeks) by the mother to act as an oxytocic. No other drug use was reported. The child was born in pulmonary distress with poor peripheral pulses and an EKG which showed an acute anterolateral myocardial infarction. The infant recovered after several weeks, but at 2 years the child had persistent cardiomegaly which required digoxin.

Gastrointestinal

    3.8.1) SUMMARY
    A) Nausea, vomiting, abdominal pain, and diarrhea are the primary symptoms associated with ingestion.
    3.8.2) CLINICAL EFFECTS
    A) ABDOMINAL PAIN
    1) The seeds and leaves contain methylcytisine and some glycosides and may cause severe abdominal pain. Although the seeds taste bitter, children have been poisoned following the ingestion of the bright blue seeds. Irritation of the mucous membranes may also occur ((Anon, 2000)).

Hematologic

    3.13.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) HEMOLYSIS
    a) Ferguson & Edwards (1954) tested the saponin component in vitro and found it to lyse red blood cells at a concentration of 1:10,000. This hemolysis has not been reported in human cases.

Dermatologic

    3.14.1) SUMMARY
    A) Irritation of the skin and mucous membranes may occur after handling this plant.
    3.14.2) CLINICAL EFFECTS
    A) SKIN IRRITATION
    1) The dried root of blue cohosh should be handled carefully because it is irritating to mucous membranes (Duke, 1985; Lloyd, 1887).
    B) DERMATITIS
    1) Dermatitis may occur from handling the plant (Weiner, 1980).
    3.14.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) IRRITATION
    a) The saponins proved to be very irritating when injected subcutaneously into the rabbit's ear (Ferguson & Edwards, 1954).

Reproductive

    3.20.1) SUMMARY
    A) The crude drug derived from this plant has an oxytocic effect and until more studies are done, should not be taken during pregnancy. The oxytocic properties are produced by the caulosaponin portion of the plant ((Anon, 2000)).
    3.20.2) TERATOGENICITY
    A) LACK OF INFORMATION
    1) At the time of this review, no data were available to assess the teratogenic potential of this agent.
    3.20.3) EFFECTS IN PREGNANCY
    A) LACK OF INFORMATION
    1) There is no data on the actual risk of taking this agent during pregnancy. The crude drug has an oxytocic effect and until more data is available, it should not be used in pregnancy (Tyler, 1993; (Anon, 2000)).
    2) It acts as an abortifacient and effects the menstrual cycle ((Anon, 2000)).
    3) Pulmonary distress and myocardial infarction was reported in a newborn following the use of caulophyllum by the mother for three weeks prior to delivery (Jones & Lawson, 1998).
    3.20.4) EFFECTS DURING BREAST-FEEDING
    A) LACK OF INFORMATION
    1) Scientific evidence for safe use has not been determined ((Anon, 2000)).

Carcinogenicity

    3.21.3) HUMAN STUDIES
    A) LACK OF INFORMATION
    1) At the time of this review, no data were available to assess the carcinogenic or mutagenic potential of this agent.

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) There is no specific blood or urine tests. Monitor fluid and electrolytes if vomiting and diarrhea are extensive.
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) Monitor fluid and electrolytes if the vomiting and diarrhea are extensive (Lampe & McCann, 1985).

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) There is no specific blood or urine tests. Monitor fluid and electrolytes if vomiting and diarrhea are extensive.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) SUMMARY
    1) The primary symptoms following a significant ingestion are vomiting and diarrhea. Activated charcoal may be useful if the patient has not begun vomiting.
    B) ACTIVATED CHARCOAL
    1) PREHOSPITAL ACTIVATED CHARCOAL ADMINISTRATION
    a) Consider prehospital administration of activated charcoal as an aqueous slurry in patients with a potentially toxic ingestion who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion. Administration in the prehospital setting has the potential to significantly decrease the time from toxin ingestion to activated charcoal administration, although it has not been shown to affect outcome (Alaspaa et al, 2005; Thakore & Murphy, 2002; Spiller & Rogers, 2002).
    1) In patients who are at risk for the abrupt onset of seizures or mental status depression, activated charcoal should not be administered in the prehospital setting, due to the risk of aspiration in the event of spontaneous emesis.
    2) The addition of flavoring agents (cola drinks, chocolate milk, cherry syrup) to activated charcoal improves the palatability for children and may facilitate successful administration (Guenther Skokan et al, 2001; Dagnone et al, 2002).
    2) CHARCOAL DOSE
    a) Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).
    1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).
    b) ADVERSE EFFECTS/CONTRAINDICATIONS
    1) Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
    2) Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).
    6.5.2) PREVENTION OF ABSORPTION
    A) ACTIVATED CHARCOAL
    1) CHARCOAL ADMINISTRATION
    a) Consider administration of activated charcoal after a potentially toxic ingestion (Chyka et al, 2005). Administer charcoal as an aqueous slurry; most effective when administered within one hour of ingestion.
    2) CHARCOAL DOSE
    a) Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).
    1) Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).
    b) ADVERSE EFFECTS/CONTRAINDICATIONS
    1) Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
    2) Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).
    6.5.3) TREATMENT
    A) SUPPORT
    1) There is no specific antidote. Treatment is symptomatic and supportive.
    B) FLUID/ELECTROLYTE BALANCE REGULATION
    1) Monitor fluid and electrolytes, replace as required (Lampe & McCann, 1985).
    C) SEIZURE
    1) Seizures have NOT been reported in human cases, but are a potential concern.
    2) SUMMARY
    a) Attempt initial control with a benzodiazepine (eg, diazepam, lorazepam). If seizures persist or recur, administer phenobarbital or propofol.
    b) Monitor for respiratory depression, hypotension, and dysrhythmias. Endotracheal intubation should be performed in patients with persistent seizures.
    c) Evaluate for hypoxia, electrolyte disturbances, and hypoglycemia (or, if immediate bedside glucose testing is not available, treat with intravenous dextrose).
    3) DIAZEPAM
    a) ADULT DOSE: Initially 5 to 10 mg IV, OR 0.15 mg/kg IV up to 10 mg per dose up to a rate of 5 mg/minute; may be repeated every 5 to 20 minutes as needed (Brophy et al, 2012; Prod Info diazepam IM, IV injection, 2008; Manno, 2003).
    b) PEDIATRIC DOSE: 0.1 to 0.5 mg/kg IV over 2 to 5 minutes; up to a maximum of 10 mg/dose. May repeat dose every 5 to 10 minutes as needed (Loddenkemper & Goodkin, 2011; Hegenbarth & American Academy of Pediatrics Committee on Drugs, 2008).
    c) Monitor for hypotension, respiratory depression, and the need for endotracheal intubation. Consider a second agent if seizures persist or recur after repeated doses of diazepam .
    4) NO INTRAVENOUS ACCESS
    a) DIAZEPAM may be given rectally or intramuscularly (Manno, 2003). RECTAL DOSE: CHILD: Greater than 12 years: 0.2 mg/kg; 6 to 11 years: 0.3 mg/kg; 2 to 5 years: 0.5 mg/kg (Brophy et al, 2012).
    b) MIDAZOLAM has been used intramuscularly and intranasally, particularly in children when intravenous access has not been established. ADULT DOSE: 0.2 mg/kg IM, up to a maximum dose of 10 mg (Brophy et al, 2012). PEDIATRIC DOSE: INTRAMUSCULAR: 0.2 mg/kg IM, up to a maximum dose of 7 mg (Chamberlain et al, 1997) OR 10 mg IM (weight greater than 40 kg); 5 mg IM (weight 13 to 40 kg); INTRANASAL: 0.2 to 0.5 mg/kg up to a maximum of 10 mg/dose (Loddenkemper & Goodkin, 2011; Brophy et al, 2012). BUCCAL midazolam, 10 mg, has been used in adolescents and older children (5-years-old or more) to control seizures when intravenous access was not established (Scott et al, 1999).
    5) LORAZEPAM
    a) MAXIMUM RATE: The rate of intravenous administration of lorazepam should not exceed 2 mg/min (Brophy et al, 2012; Prod Info lorazepam IM, IV injection, 2008).
    b) ADULT DOSE: 2 to 4 mg IV initially; repeat every 5 to 10 minutes as needed, if seizures persist (Manno, 2003; Brophy et al, 2012).
    c) PEDIATRIC DOSE: 0.05 to 0.1 mg/kg IV over 2 to 5 minutes, up to a maximum of 4 mg/dose; may repeat in 5 to 15 minutes as needed, if seizures continue (Brophy et al, 2012; Loddenkemper & Goodkin, 2011; Hegenbarth & American Academy of Pediatrics Committee on Drugs, 2008; Sreenath et al, 2009; Chin et al, 2008).
    6) PHENOBARBITAL
    a) ADULT LOADING DOSE: 20 mg/kg IV at an infusion rate of 50 to 100 mg/minute IV. An additional 5 to 10 mg/kg dose may be given 10 minutes after loading infusion if seizures persist or recur (Brophy et al, 2012).
    b) Patients receiving high doses will require endotracheal intubation and may require vasopressor support (Brophy et al, 2012).
    c) PEDIATRIC LOADING DOSE: 20 mg/kg may be given as single or divided application (2 mg/kg/minute in children weighing less than 40 kg up to 100 mg/min in children weighing greater than 40 kg). A plasma concentration of about 20 mg/L will be achieved by this dose (Loddenkemper & Goodkin, 2011).
    d) REPEAT PEDIATRIC DOSE: Repeat doses of 5 to 20 mg/kg may be given every 15 to 20 minutes if seizures persist, with cardiorespiratory monitoring (Loddenkemper & Goodkin, 2011).
    e) MONITOR: For hypotension, respiratory depression, and the need for endotracheal intubation (Loddenkemper & Goodkin, 2011; Manno, 2003).
    f) SERUM CONCENTRATION MONITORING: Monitor serum concentrations over the next 12 to 24 hours. Therapeutic serum concentrations of phenobarbital range from 10 to 40 mcg/mL, although the optimal plasma concentration for some individuals may vary outside this range (Hvidberg & Dam, 1976; Choonara & Rane, 1990; AMA Department of Drugs, 1992).
    7) OTHER AGENTS
    a) If seizures persist after phenobarbital, propofol or pentobarbital infusion, or neuromuscular paralysis with general anesthesia (isoflurane) and continuous EEG monitoring should be considered (Manno, 2003). Other anticonvulsants can be considered (eg, valproate sodium, levetiracetam, lacosamide, topiramate) if seizures persist or recur; however, there is very little data regarding their use in toxin induced seizures, controlled trials are not available to define the optimal dosage ranges for these agents in status epilepticus (Brophy et al, 2012):
    1) VALPROATE SODIUM: ADULT DOSE: An initial dose of 20 to 40 mg/kg IV, at a rate of 3 to 6 mg/kg/minute; may give an additional dose of 20 mg/kg 10 minutes after loading infusion. PEDIATRIC DOSE: 1.5 to 3 mg/kg/minute (Brophy et al, 2012).
    2) LEVETIRACETAM: ADULT DOSE: 1000 to 3000 mg IV, at a rate of 2 to 5 mg/kg/min IV. PEDIATRIC DOSE: 20 to 60 mg/kg IV (Brophy et al, 2012; Loddenkemper & Goodkin, 2011).
    3) LACOSAMIDE: ADULT DOSE: 200 to 400 mg IV; 200 mg IV over 15 minutes (Brophy et al, 2012). PEDIATRIC DOSE: In one study, median starting doses of 1.3 mg/kg/day and maintenance doses of 4.7 mg/kg/day were used in children 8 years and older (Loddenkemper & Goodkin, 2011).
    4) TOPIRAMATE: ADULT DOSE: 200 to 400 mg nasogastric/orally OR 300 to 1600 mg/day orally divided in 2 to 4 times daily (Brophy et al, 2012).

Eye Exposure

    6.8.1) DECONTAMINATION
    A) EYE IRRIGATION, ROUTINE: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).

Dermal Exposure

    6.9.1) DECONTAMINATION
    A) DECONTAMINATION: Remove contaminated clothing and wash exposed area thoroughly with soap and water for 10 to 15 minutes. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).

Enhanced Elimination

    A) LACK OF INFORMATION
    1) No studies have addressed the utilization of extracorporeal elimination techniques in poisoning with this agent.

Range Of Toxicity

Summary

    A) ANIMAL DATA - The LD50 of a crude alcoholic extract was 11.8 milligrams/kilogram in mice, and 20.3 milligrams/kilograms in rats.
    B) Although a lethal dose has not been established, caulosaponin is reportedly a cardiotoxin which causes constriction of coronary blood vessels, produces intestinal spasms, and has oxytocic properties.
    C) A 21-year-old female 6 weeks pregnant drank 15 cups/day of slippery elm tea, along with 10-20 doses/day of tincture of blue cohosh for four days and developed symptoms of nicotinic toxicity which resolved with supportive care.

Therapeutic Dose

    7.2.1) ADULT
    A) GENERAL
    1) The dose of the crude drug recommended by the United States Dispensatory was from 0.5 to 1 gram (Osol & Farrar, 1955).
    B) HOW SUPPLIED -
    1) Dried Rhizome/Root - 0.3 to 1.0 g or by decoction three times daily ((Anon, 2000)).
    2) Liquid Extract (1:1 in 70% alcohol) - 0.5 to 1.0 milliliters three times daily ((Anon, 2000)).

Minimum Lethal Exposure

    A) GENERAL/SUMMARY
    1) Minimum lethal human exposure is unknown.
    B) ANIMAL DATA
    1) The LD50 of a crude alcoholic extract was 11.8 milligrams/kilogram in mice, and 20.3 milligrams/kilograms in rats (Ferguson & Edwards, 1954).

Maximum Tolerated Exposure

    A) GENERAL/SUMMARY
    1) Caulosaponin may act as a cardiotoxin which causes constriction of coronary blood vessels, has produced intestinal spasm and abdominal pain, and has been used in childbirth as an oxytocic agent ((Anon, 2000)).
    B) CASE REPORTS
    1) MYOCARDIAL INFARCTION - A newborn developed an acute anterolateral myocardial infarction after the use of blue cohosh (3 tablets daily for 3 weeks rather than 1 tablet/daily as recommended) by the mother as an oxytocic (Jones & Lawson, 1998). No other risk factors or drugs used by the mother were found. The infant recovered, but developed persistent cardiomegaly.
    2) NICOTINIC EFFECTS - A 21-year-old female 6 weeks pregnant drank 15 cups/day of slippery elm tea, along with 10-20 doses/day of tincture of blue cohosh for four days as an abortifacient and developed symptoms of nicotinic toxicity which resolved with supportive care (Rao et al, 1998).

Pharmacology Toxicology

Pharmacologic Mechanism

    A) It appears that the aerial portion of the plant has antiinflammatory action ((Anon, 2000)).
    B) There is no evidence of documented antirheumatic properties ((Anon, 2000)).

Toxicologic Mechanism

    A) METHYLCYTISINE - has an action somewhat similar to nicotine. It may produce hypertension, stimulation of the smooth muscle of the small intestine, and hyperglycemia. Methylcytisine has about one fortieth the activity of nicotine (Scott & Chen, 1943; Tyler, 1993).
    B) The two glycosides caulosaponin and caulophyllosaponin may act as uterine stimulants and have a vasoconstrictor action on coronary blood vessels (Ferguson & Edwards, 1954). Caulosaponin has caused intestinal spasms in small animals (Tyler, 1993; (Anon, 2000)).
    C) Some Caulophyllum species have been studied for their antimicrobial activity (Anisimov, 1972).
    D) It is most likely that the saponins act on the intestines to produce gastroenteritis symptoms (Lampe & McCann, 1985).

References

General Bibliography

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    24) Lampe KF & McCann MA: AMA Handbook of Poisonous and Injurious Plants, American Medical Association, Chicago, IL, 1985.
    25) Lloyd: Dermatitis Venenata: An Account of the Action of External Irritants upon the Skin, Cupples and Hurd, Boston, MA, 1887.
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