aconite

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

Aconite is carefully prepared to reduce toxicity while maintaining medicinal efficacy. Minute doses treat nerve pain, joint pains, and other conditions in Traditional Chinese Medicine, Homeopathy, and Indian medicine systems. Aconite has pain-relieving and anti-inflammatory properties and improves digestive function and cardiac muscle contractility. The therapeutic window is narrow, however, using aconite is risky and dangerous due to its toxicity even in 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 lower toxicity and are more medicinal. Aconite alkaloids are toxic to the nervous system, cardiac, and muscle tissue.

Aconitine molecules bind to open voltage-sensitive sodium channels and prevent deactivation. The persistent activation of sodium channels interferes with neurotransmitter release and regulation of electrical activity, affecting nerve function, neuromuscular transmission, and causing irregular heart rhythm, muscle dysfunction, gastrointestinal effects, and fatality. Benzoylaconine alkaloids appear to have antiarrhythmic effects and increase oxygen uptake by the heart and other organs.

Studies show aconitine, in tiny doses, reduces pain signals and inflammation. However, the risks outweigh the benefits. Inadequately processed aconite or a small overdose can be life-threatening. 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 and painful menstruation

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

What are the side effects of aconite?

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, ventricular tachycardia, and ventricular fibrillation.

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.

What are the dosages of aconite?

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, numbness in the face, tongue, and limbs, 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.

What drugs interact with aconite?

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, and stimulant drugs.

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

Always tell your doctor, pharmacist, or health care provider about all prescription and over-the-counter medications you use, including the dosage for each, and keep a list of this information. If you have any questions about the medication, check with your doctor or health care provider.

Pregnancy and breastfeeding

• Aconite is toxic and unsafe. Do not use orally or topically 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.

What else should I know about aconite?

• 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 within hours.
• Despite its high toxicity, aconite is available as an herbal product or as an ingredient in herbal products. Check labels of herbal products and avoid using any that contains aconite.
• Herbal products are not regulated by the FDA. Products may differ in formulations, strengths, and labels may not always match contents. Exercise caution when buying herbal products.
• Store herbal products safely out of reach of children.
• In case of overdose, seek immediate medical care or contact Poison Control.

Summary

Aconite is an herb with pain-relieving and anti-inflammatory properties and improves digestive function and cardiac muscle contractility. It has been used to treat various conditions, including arrhythmia, neuralgia, migraine, rheumatism, joint pains, edema, asthma, abdominal pains, and gynecological disorders. Common side effects of aconite include nausea, vomiting, dizziness, weakness, acidosis, hypokalemia, hypotension, palpitations, and others.