Nerium oleander 夾竹桃

POISONOUS PARTS

Whole plant.⁴

TOXICITY

• Toxic Constituents

  Cardiac glycosides such as oleandrin, odorosides and adynerin.⁵

• Toxic Dose

  Reported lethal dose: 5 leaves.⁶

• Mechanism

  Cardiac glycosides inhibit Na⁺/K⁺-ATPase of the myocardium, increase its excitability and may lead to arrhythmias.^7–9

• Poisoning Features

  Digitalis-like toxicity such as nausea, vomiting, abdominal pain, dizziness, headache, hypotension, arrhythmias, hyperkalaemia, agitation, confusion, convulsion, coma and even death.^6,10,11

• Poisoning Events

  Cases of oleander poisonings due to accidental exposure, intentional ingestion and medicinal use have been reported worldwide. In Japan, a 49-year-old female drank water extract of oleander for suicide. Toxic symptoms appeared 30 minutes after ingestion. She died 1 day after admission. In the United States, a 42-year-old female burnt oleander for the disposal of prunings and inhaled the smoke periodically for 2 hours. She had toxic symptoms for 2 days, and recovered uneventfully after hospital treatment.^12–14

CLINICAL MANAGEMENT

Supportive treatment. Multiple-dose activated charcoal therapy has been used for gastrointestinal decontamination in cardiac glycoside poisoning, and digoxin-specific antibody has been used as an antidote.^15,16

IDENTIFICATION FEATURES

Evergreen shrubs, up to 6 m tall. Leaves leathery, 5–21 × 1–3.5 cm, base cuneate or decurrent to the petiole. Flowers showy, fragrant. Sepals 3–10 mm long. Corolla purplish red, pink, white, salmon or yellow; tubes 1.2–2.2 cm long; lobes 1.3–3 cm long, single or double. Follicles 12–23 cm long. Seeds oblong, with coma.¹⁷

MEDICINAL USES

Highly toxic; use with caution. Leaves and bark used in TCM: strengthen heart, induce diuresis, dispel phlegm and reduce wheezing, relieve pain, eliminate stasis. Recommended dose: 0.3–0.9 g.^5,18,19

LABORATORY ANALYSIS

Oleandrin and odorosides can be detected by LC-MS/MS.^20,21