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Oleander (Nerium oleander, Thevetia peruviana)

Be aware that the U.S. Food and Drug Administration does not strictly
regulate herbs and dietary supplements. There is no guarantee of
strength, purity or safety of products containing or claiming to
contain oleander. Decisions to use herbs or supplements should be
carefully considered. Individuals using prescription drugs should
discuss taking herbs or supplements with their pharmacist or health
care provider before starting.

Evidence

Scientists have studied oleander for the following health problems:

Congestive heart failure Oleander is used in countries outside the
United States for treating symptoms of congestive heart failure; it
is similar to the drug digoxin. However, scientific studies in humans
are lacking, and safe doses have not been established. Cancer There
is evidence from laboratory experiments that oleander may have
anti-tumor properties. However, there are no studies in humans
evaluating this claim. Therefore, it is not clear what effect oleander
has in treating or preventing cancers.

Unproven Uses

Oleander has been suggested for many other uses, based on tradition or
on scientific theories. However, these uses have not been thoroughly
studied in humans, and there is limited scientific evidence about
safety or effectiveness. Some of these suggested uses are for
conditions that are potentially very serious and even
life-threatening. You should consult a health care provider before
taking oleander for any unproven use.

Abnormally low weight Abortion Alcoholism Anorexia Antifertility
Asthma Bacterial infections Cathartic Corns Diuretic Emetic
Epilepsy Eye diseases Heart tonic Hemorrhoids Indigestion
Inflammation Insecticide Leprosy Malaria Menstrual cramps
Menstrual stimulant Nerve disorders Parasites Psychiatric disorders
Rat poison Ringworm Sinus problems Skin diseases Snakebites
Swelling Venereal disease Warts Weight gain

Potential Dangers

Allergies

People with known allergy should avoid oleander. Signs of allergy may
include rash, itching or shortness of breath. Skin irritation may
occur from contact with freshly cut oleander leaves.

Side Effects

Oleander is generally considered unsafe for internal use. Extracts
from oleander have been used as rat poison, insecticide and fish
poison and are toxic to humans. Accidental deaths and suicides have
occurred after taking oleander by mouth. The cause of death is
probably related to oleander?s effects on the heart. Possible
benefits must be weighed carefully with the risk of toxicity.

When using oleander, some people may experience stomach discomfort,
including pain, anorexia, diarrhea, vomiting or nausea. Liver and
kidney damage has also been reported. Oleander may have significant
adverse effects on the heart, resulting in complete heart block,
extremely slow heart rhythms, irregular rhythms or rapid, pounding
heartbeat. Potassium levels in the body may become dangerously high
with oleander. Depression, difficulty breathing, vision abnormalities
and ringing in the ears have also occurred. Other side effects may
include nerve pain, weakness and fatigue, irritability, altered level
of consciousness, dizziness, seizures, headaches, sweating and neck
stiffness. Skin irritation may occur after contact with sap from
freshly cut oleander leaves. These adverse effects may be the result
of oleander allergies.

Pregnancy And Breast-Feeding

Oleander cannot be recommended during pregnancy and breast-feeding
because of the risk of birth defects or spontaneous abortion.


Interactions

Interactions with drugs, supplements and other herbs have not been
thoroughly studied. The interactions listed below have been reported
in scientific publications. If you are taking prescription drugs,
speak with your health care provider or pharmacist before using herbs
or dietary supplements.

Interactions With Drugs

Oleander has similar cardiac glycoside properties to digoxin
(Lanoxin), and the adverse effects of oleander on the heart are
likely to be increased if it is taken with digoxin or digitoxin. Many
drugs interact with digoxin, and because of the similarities between
oleander and digoxin, these drugs may also increase the toxicity of
oleander. Examples include erythromycin, tetracycline, quinine,
laxatives, antiarrhythmic agents and diuretics. Oleander toxicity may
also be increased if used with drugs that lower potassium levels,
such as some diuretics or laxatives.

Interactions With Herbs And Dietary Supplements

Oleander may have an increased risk of toxic effects if used with
other herbs that possess glycoside properties, such as foxglove.
Additionally, these toxic effects may be increased if used with other
supplements that affect the heart, such as calcium; those that cause
potassium loss, such as licorice (Glycyrrhiza glabra); or herbs with
laxative properties, such as senna; or herbs with diuretic
(urine-producing) properties, such as horsetail.


Dosing

The doses listed below are based on scientific research, publications
or traditional use. Because most herbs and supplements have not been
thoroughly studied or monitored, safety and effectiveness may not be
proven. Brands may be made differently, with variable ingredients
even within the same brand. Combination products often contain small
amounts of each ingredient and may not be effective. Appropriate
dosing should be discussed with a health care provider before
starting therapy; always read the recommendations on a product?s
label. The dosing for unproven uses should be approached cautiously,
because scientific information is limited in these areas.

There are no standard or well-studied doses of oleander, and many
different doses are used traditionally.

Adults (Aged 18 Or Older)

Because of the risks of toxicity, no specific dose of oleander can be
recommended. Studies have used 1.8 to 3.2 milligrams as an initial
dose of oleander by mouth, followed by 0.6 milligrams daily by mouth.
However, safety has not been established.

Children (Younger Than 18)

There are not enough scientific data to recommend oleander for use in
children, and oleander is not recommended because of the risk of
significant toxicity and death.


Summary

Oleander has been suggested as a treatment for many conditions and has
been most studied as a treatment for symptoms of congestive heart
failure. However, there is not enough scientific evidence to support
the use of oleander for any medical condition. Oleander may be
associated with significant toxicity, especially with harmful effects
on the heart. It may interact with many drugs, herbs or supplements.
It should be avoided in pregnant or breast-feeding women and in
children. Consult your health care provider immediately if you have
any side effects.

The information in this monograph was prepared by the professional
staff at Natural Standard, based on thorough systematic review of
scientific evidence. The material was reviewed by the Faculty of the
Harvard Medical School with final editing approved by Natural
Standard.


Resources

1.Natural Standard: An organization that produces scientifically based
reviews of complementary and alternative medicine (CAM) topics
2.National Center for Complementary and Alternative Medicine (NCCAM):
A division of the U.S. Department of Health & Human Services
dedicated to research

Selected Scientific Studies: Oleander

Natural Standard reviewed more than 150 articles to prepare the
professional monograph from which this version was created.

Some of the more recent English-language studies are listed below:

1.Bose TK, Basu RK, Biswas B, et al. Cardiovascular effects of yellow
oleander ingestion. J Indian Med Assoc 1999;97(10):407-410.
2.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.
3.Eddleston M. Patterns and problems of deliberate self-poisoning in
the developing world. QJM 2000;93(11):715-731.
4.Eddleston M, Warrell DA. Management of acute yellow oleander
poisoning. QJM
1999;92(9):483-485.
5.Lim DC, Hegewald K, Dandamudi N. A suicide attempt with an oleander
****tail. Chest 1999;116(4):405S-406S.
6.Monzani V, Rovellini A, Schinco G, et al. Acute oleander poisoning
after a self-prepared tisane. J Toxicol Clin Toxicol
1997;35(6):667-668.
7.Nishioka S, Resende ES. Transitory complete atrioventricular block
associated to ingestion of Nerium oleander. Rev Assoc Med Bras
1995;41(1):60-62.
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