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Veratrum Poisoning

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Toxicological Reviews

Abstract

Several species of the Veratrum genus are associated with toxicity in humans and animals. The principal toxins are steroid alkaloids; some have a modified steroid template, whereas others differ in their esterified acid moieties. These alkaloids act by increasing the permeability of the sodium channels of nerve cells, causing them to fire continuously. Increased stimulation, associated with the vagal nerve results in a reflex that causes the triad of responses known as the Bezold-Jarisch reflex: hypotension, bradycardia and apnoea. Clinically, various Veratrum extracts were marketed for clinical use as antihypertensive drugs, but because of their narrow therapeutic index were withdrawn from the market. Following the ingestion of Veratrum alkaloids, expected signs and symptoms include vomiting and abdominal pain, followed by cardiovascular effects such as bradycardia, hypotension and cardiac conduction abnormalities and death. Similar symptoms arise in other mammalian species ingesting these alkaloids; teratogenic effects may occur to the fetuses of animals that have grazed on Veratrum californicum. Treatment consists of supportive care, with an emphasis on haemodynamic stability with fluid replacement, atropine and vasopressors. The onset of symptoms occurs between 30 minutes and 4 hours, and the duration of the illness can range from 1 to 10 days; however, with prompt supportive care, patients typically make a full recovery within 24 hours.

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Notes

  1. The use of trade names is for product identification purposes only and does not imply endorsement.

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Acknowledgements

No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review. The author wishes to acknowledge Jill Turner from the Centre for Economic Botany at the Royal Botanic Gardens, Kew, for her assistance in sourcing lesser known research articles for this review.

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Authors and Affiliations

  1. National Poisons Centre, University of Otago, PO Box 913, Dunedin, New Zealand

    Leo J. Schep & John S. Fountain

  2. School of Pharmacy, University of Otago, Dunedin, New Zealand

    David M. Schmierer

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  1. Leo J. Schep
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Correspondence to Leo J. Schep.

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Schep, L.J., Schmierer, D.M. & Fountain, J.S. Veratrum Poisoning. Toxicol Rev 25, 73–78 (2006). https://doi.org/10.2165/00139709-200625020-00001

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