A case of nondigitalis cardiac glycoside toxicity

Toxicity of herbal medications suggested as treatment for COVID-19: A narrative review

OBJECTIVES

In the absence of a definitive cure, herbal medications are gaining increasing popularity in the general public for treatment of coronavirus disease 2019 (COVID-19). Although many herbal preparations are safe and can be used without complication, serious toxicities do occur. This article focuses on the major characteristics and toxicities of herbal preparations that have been proposed as treatments for COVID-19.

METHODS

A review was performed focusing on herbal preparations that have gained popularity as potential treatments for COVID-19. Some of these preparations have been directly recommended by government agencies, whereas others have gained popularity through various other news sources.

RESULTS

The herbal preparations covered in this paper include the cardiac glycoside oleandrin, plants of the Datura genus, and herbs commonly used in traditional Chinese Medicine including plants of the Aconitum genus, bitter apricot seeds, ephedra, and licorice root.

CONCLUSION

Although herbal preparations have been reported to aid in the treatment of COVID-19 with success, few clinical trials have been performed to evaluate their efficacy and instead rely mainly on in vitro studies and anecdotal reports. Furthermore, many of the herbal preparations suggested carry significant toxicities, and frontline healthcare workers should be aware of the common symptoms and toxidromes that result from these poisonings.

[A non-fatal Nerium oleander self-poisoning: case report and discussion]

Nerium oleander is potentially lethal plants after ingestion. We report a case of poisoning by these plants. Our patient complained of nausea, vomiting, and diarrhoea. He had bradycardia during first twelve hours. He was discharge after 3 days. All parts of these plants are toxic and contain a variety of cardiac glycosides including oleandrin. In most cases, clinical management of poisoning by N. oleander involves administration of activated charcoal and supportive care. Digoxin specific Fab fragments are an effective treatment.

Phase 1 trial of Anvirzel™ in patients with refractory solid tumors

Anvirzel is an aqueous extract of the plant Nerium oleander which has been utilized to treat patients with advanced malignancies. The current study reports a phase 1 trial to determine the maximum tolerated dose (MTD) and safety of Anvirzel in patients with advanced, refractory solid tumors. Patients were randomized to receive this agent by intramuscular injection at doses of 0.1, 0.2, 0.4 ml/m2/day with subsequent patients receiving 0.8 or 1.2 ml/m2/day sequentially. Eighteen patients were enrolled and completed at least one treatment cycle of three weeks. Most patients developed mild injection site pain (78%). Other toxicities included fatigue, nausea, and dyspnea. Traditional dose limiting toxicity was not seen, but the MTD was defined by injection volume as 0.8 ml/m2/day. No objective anti-tumor responses were seen. Anvirzel can be safely administered at doses up to 1.2 ml/m2/day, with the amount administered intramuscularly limited by volume. The recommended phase II dose level is 0.8 ml/m2/day.

ECG Manifestations: The Poisoned Patient

Despite that drugs have widely varying indications for therapeutic use, many unrelated drugs share a common cardiac pharmacologic effect if taken in overdose. The purpose of this article is to group together agents that cause similar electrocardiographic effects,review their pharmacologic actions, and discuss the electrocardiographic findings reported in the medical literature.

Poisoning by plant material: review of human cases and analytical determination of main toxins by high-performance liquid chromatography-(tandem) mass spectrometry

The authors have reviewed the main toxic plants responsible for human deaths throughout the world. Forty plants (genera or species) were listed in order to establish an inventory of the active molecules that could be identified, the already published analytical methods and the reported human fatal cases. In a second step, the authors have developed a general method for the detection of various toxins in whole blood by high-performance liquid chromatography coupled to mass spectrometry or tandem mass spectrometry. Sample preparation was realized by liquid-liquid extraction at pH 9.5 for oleandrine, taxol and the alkaloids. These latter compounds were divided into two groups following their chemical properties and could be subsequently purified by acid/base clean up. Cyanogenic compounds and atractyloside were isolated by precipitation of the protein content with acetone and purified for atractyloside by washing with chloroform. Separation of the drugs occurred under reversed-phase conditions on a C18 analytical column 150x2 mm I.D. (5 microm particle size) using two different mobile phases. The first one, formiate buffer 2 mM acidified at pH 3.0, was used for the separation of atractyloside, oleandrine, taxol, the cyanogenic molecules and some alkaloids. The second mobile phase, formiate buffer 10 mM made basic at pH 8.2 was used for the majority of other alkaloids. A gradient elution mode was chosen using acetonitrile or acetonitrile-methanol (50:50, v/v) as the eluting solvent. Detection under positive ionization mode was the mode of choice for all compounds except for atractyloside (negative ions) and for taxol (mixed mode available). Application to real forensic cases has been demonstrated.