aconite

Aconite is the common name of Aconitum species of plants belonging to the buttercup family (Ranunculaceae). Aconite grows in the temperate regions of the northern hemisphere, in Asia, Europe and America. There are more than 300 species in the Aconitum genus, some of which are grown as ornamental plants and many are used medicinally, although all parts of the aconite plants, particularly the roots and rhizomes, and even the nectar, are extremely poisonous. Aconite poisoning sometimes occurs because of being mistaken for horse-radish root.

Aconite is carefully prepared to reduce toxicity while maintaining medicinal efficacy. Minute doses are used to treat nerve pain, joint pains and several other conditions in Traditional Chinese Medicine, Homeopathy and Indian medicine systems. Aconite has pain-relieving (analgesic) and anti-inflammatory properties and improves digestive function and contractility of the cardiac muscle (cardiotonic). The safety margin of the therapeutic window is very narrow, however, the use of aconite is risky and dangerous because of its toxicity with even low doses.

The principal toxic compounds in aconite are diester diterpene alkaloids (DDAs) such as aconitine, mesaconitine and hypaconitine. Aconite also contains monoester diterpene alkaloids (MDAs) such as benzoylaconine, benzoylmesaconine and benzoylhypaconine, which have a comparatively lower toxicity and are of more medicinal value. The aconite alkaloids are toxic to the nervous system, cardiac and muscle tissue.

Aconitine molecules bind to the open state of voltage-sensitive sodium channels and prevent their deactivation. The persistent activation of sodium channels interferes with neurotransmitter release and regulation of electrical activity, affecting nerve function and neuromuscular transmission, and leading to irregular heart rhythm (arrhythmia), muscle dysfunction, gastrointestinal and other effects that can lead to fatality. The benzoylaconine alkaloids appear to have antiarrhythmic effect and increase oxygen uptake by the heart and other organs.

Studies show aconitine, in minuscule dosage, reduces conduction of pain signals and inflammation. The risks associated with the herb, however, are far greater than the benefits. Inadequately processed aconite or a small overdose can have life-threatening or fatal consequences. Aconite formulations are sold as processed roots, tinctures, pastes, tablets or capsules. Aconite has been used to treat:

• Arrhythmia
• Trigeminal and intercostal nerve pain (neuralgia)
• Migraine
• Rheumatism
• Joint pains
• Swelling from water retention (edema)
• Asthma
• Abdominal pains
• Gynecological disorders such as:
  • Irregular menstruation
  • Painful menstruation (dysmenorrhea)
• General debilitation

Poisoning, including fatalities, has often occurred from accidental or intentional consumption of aconite, and with medicinal use. Approximately 5,000 cases of aconite poisoning incidents were reported in China, Germany, Japan, and other countries during 1993–2005. Cleopatra is reported to have used aconite to murder her brother (and husband) and in 2010, a British woman was found guilty of murdering her husband with aconite. Aconite was also used to make poisoned arrows for hunting (Chinese, Japanese Ainu, Aleuts) and warfare (Chinese).

Common side effects of aconite include:

• Nausea
• Vomiting
• Dizziness
• Weakness
• High acidity of body fluids (acidosis)
• Low blood potassium (hypokalemia)
• Low blood pressure (hypotension)
• Palpitations
• Life-threatening disturbances of heart rhythms including:
  • Premature ventricular contractions
  • Rapid ventricular contraction (ventricular tachycardia)
  • Rapid and irregular ventricular rhythm (ventricular fibrillation)
• Breathing difficulties
• Numbness of face, tongue and limbs
• Muscle weakness
• Convulsions
• Coma
• Death

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

There is no reliable information on a safe dosage of aconite. Aconite is toxic and unsafe for both oral ingestion and topical application. Avoid use.

Overdose

Aconite overdose can cause nausea, vomiting, face, tongue and limb numbness, convulsions, muscle dysfunction, palpitations, irregular heart rhythm, low blood pressure, breathing difficulties, shock, coma and death. There is no known antidote for aconite and overdose must be treated with symptomatic and vital supportive measures.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Aconite has no known severe or serious interactions with other drugs.
• Moderate interactions of aconite include:
  • Antiplatelet and anticoagulant drugs
  • Stimulant drugs
• Aconite has no known mild interactions with other drugs.

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• Aconite is toxic and unsafe. Do not take orally or use as a topical application on your skin if you are pregnant or breastfeeding.
• Do not take any herbal product without first checking with your healthcare provider, if you are pregnant or breastfeeding.

• Natural products are not necessarily safe. Aconite is toxic and lethal. Do not take aconite orally or apply topically. Just one to two grams of aconite root can kill a person rapidly within a few hours.
• Despite its high toxicity, aconite is available as an herbal product or as an ingredient in herbal products. Check labels of herbal products you use, and avoid using any that contains aconite.
• Herbal products are not regulated by the FDA. Products may differ in formulations and strengths, and labels may not always match contents. Exercise caution when you buy any herbal product.
• Store herbal products safely out of reach of children.
• In case of overdose, seek immediate medical care or contact Poison Control.