Aconite- Guidelines for Using Aconite - Uses and Benefits

Taxonomic Class

Ranunculaceae

Common Trade Names

No commercially prepared products are available in the United States.

Common Forms

Available as a liniment, tea, or tincture.

Source

Active components are obtained from leaves, flowers, and roots of Aconitum napellus. An erect perennial herb with tuberous roots, aconite is native to mountainous regions in Europe, Japan, China, India, and North America.

Chemical Components

Aconite contains the alkaloids aconine, aconitine, napelline, picraconitine, and others responsible for the plant's primary toxicities. Potency depends on the plant's alkaloid content, which varies with the season and the altitude at which the plant is cultivated. The leaves and roots usually have the highest alkaloid content.

Other components found in the plant include malonic acid, succinic acid, itaconic acid, aconitic acid, sugars, starches, fats, and resin.

Actions

Aconite's action is primarily cardiotoxic because of its effect on the inward sodium channels. It prolongs cardiac repolarization, and as a result, various arrhythmias-primarily ventricular-can occur.

In one study, aconite (0.6 mg/kg) administered intraperitoneally to a rabbit damaged the myelin sheath of the visceral pathway, spinal cord, and peripheral nerves . Because the drug can be absorbed through the skin, picking the flowers or other parts of the A. napellus plant can cause toxicity.

Reported Uses

The first reported therapeutic use of aconite in the United States was in tincture preparations in the 1800s. It was believed to be useful for treating fever, headache, inflammation, and neuralgia. Few sources now promote this plant for therapeutic use because of its potential for serious toxicity. In some countries, aconite is incorporated into topical liniments that are claimed to create congestion in local blood vessels and subsequent redness of the skin.

Some literature suggests using aconite in the treatment of hypertension.

Animal models suggest that aconite possesses antibacterial, antifungal, and antitumor activity, but these effects have not been demonstrated in humans.

Dosage

No forms of this plant are recommended for human consumption.

Adverse Reactions

CNS: paresthesia, weakness.

CV: arrhythmias (ventricular tachycardia), bradycardia.

EENT: blurred vision, mydriasis, numbness of the oral mucosa, increased salivation, throat tightness.

GI: diarrhea, nausea, vomiting.

Metabolic: acidosis, hypokalemia.

Other: death.

Interactions

Antiarrhythmics, antihypertensives, beta blockers, calcium channel blockers, diuretics: May increase toxicity. Avoid administration with aconite.

Contraindications And Precautions

Aconite is contraindicated for all conditions, especially in patients with arrhythmias, CV disease, or hemodynamic instability; in those with known hypersensitivity to the plants; and in those who are pregnant or breast - feeding.

Special Considerations

Alert Ventricular tachycardia may occur. Aconite-induced arrhythmias are usually unresponsive to traditional antiarrhythmics, cardioversion, and pacing. In most cases, by pass machines were used until the arrhythmia resolved on its own or death occurred .

Alert Death has resulted from as little as 5 ml of aconite tincture, 2 mg of pure aconite, 1 g of crude plant parts, or 6 g of cured aconite; no known antidote exists.

Instruct the patient to avoid consuming any part of the plant.

Inform the patient that aconite should remain in the garden. The plant should be handled only with gloves that retard absorption of plant oils through the skin.

Points of Interest

Aconite extract has been implicated in numerous suicides and was once used as a poison for arrows .

The results of feline studies indicate that atropine may antagonize cardiac depressive and hypersalivation effects related to aconite. Human data are inconclusive.

Commentary

Case reports and available clinical information about aconite toxicity and fatalities clearly illustrate the danger of this herb . Aconite has no therapeutic value and poses a grave danger to patients who use it even in small quantities.