Nerium oleander
Oleander/Drug Interactions:
AbortifacientsAbortifacients: Although folkloric use of oleander as an abortifacient is not supported by scientific research, there is a case report of a mother who consumed two yellow oleander seed kernels 12 hours before giving birth (9). Antiarrhythmic agentsAntiarrhythmic agents: The cardiac glycoside content of oleander elicits significant AV nodal blocking effects and lowers the threshold for ventricular arrhythmia (18; 19). Any co-administered anti-arrhythmic agent with similar properties may have additive and potentially adverse effects. AntibioticsAntibiotics: Oleandromycin isolated from Nerium oleander possesses in vitro antibiotic properties (6). Antidepressant agentsAntidepressant agents: Four cardiac glycosides isolated from Nerium oleander (nerizoside, delta dehydroadynerigen, neritaloside, and odoroside) have all demonstrated CNS depressant activity in mice. An extract of yellow oleander, cerebrin, is also thought to have strychnine-like actions (10; 11) as is rosagenin, a component of oleander (6). AntihypertensivesAntihypertensives: Because hypotension has been reported with oleander ingestion (12), combined used with antihypertensives may cause synergistic effects. Antineoplastic agentsAntineoplastic agents: Oleandrin and oleandrigenin have been shown to possess cytotoxic properties (61; 17) Cardiac glycosides (digoxin, digitoxin)Cardiac glycosides (digoxin, digitoxin): Both N. oleander (common oleander) and T. peruviana (yellow oleander) are rich in cardiac glycosides, and the cardiac glycoside effects would likely be additive (and potential toxicity augmented) when ingested by patients also receiving digoxin. In a review of oleander ingestion by children in Australia in the 1970s, of the two children exhibiting significant cardiac toxicity following oleander ingestion, one was a young girl already receiving digoxin for congenital heart disease (6). Both peruvoside and oleandrin (present in oleander) have similar structures to digoxin and produce similar effects in the body (7). ContraceptivesContraceptives: Although folkloric use of oleander as an abortifacient is not supported by scientific research, there is a case report of a mother who consumed two yellow oleander seed kernels 12 hours before giving birth (9). DiureticsDiuretics: In theory, due to potassium depletion caused by some diuretics, the risk of cardiac toxicity due to oleander may be increased with concurrent use.Hormonal agentsHormonal agents: Although folkloric use of oleander as an abortifacient is not supported by scientific research, there is a case report of a mother who consumed two yellow oleander seed kernels 12 hours before giving birth (9). ImmunosuppressantsImmunosuppressants: An additional report indicates that AnvirzelT appears to also contain polysaccharides that have positive immunomodulatory effects (13). LaxativesLaxatives: Due to potassium depletion caused by some laxatives, the risk of cardiac toxicity may be increased with concomitant use (theoretical).Potassium depleting drugsPotassium depleting drugs: In theory, due to potassium depletion caused by some diuretics, the risk of cardiac toxicity from oleander may be increased with concurrent use.Neurologic agentsNeurologic agents: Four cardiac glycosides isolated from Nerium oleander (nerizoside, delta dehydroadynerigen, neritaloside, odoroside) have all demonstrated CNS depressant activity in mice. An extract of yellow oleander, cerebrin, is also thought to have strychnine-like actions (10; 11) as is rosagenin, a component of oleander (6). Oleander/Herb/Supplement Interactions:
AbortifacientsAbortifacients: Although folkloric use of oleander as an abortifacient is not supported by scientific research, there is a case report of a mother who consumed two yellow oleander seed kernels 12 hours before giving birth (9). AntiarrhythmicsAntiarrhythmics: The cardiac glycoside content of oleander elicits significant AV nodal blocking effects and lowers the threshold for ventricular arrhythmia (18; 19). Any co-administered anti-arrhythmic agent with similar properties may have additive and potentially adverse effects. AntibacterialsAntibacterials: Oleandromycin isolated from Nerium oleander possesses in vitro antibiotic properties (6). AntidepressantsAntidepressants: Four cardiac glycosides isolated from Nerium oleander (nerizoside, delta dehydroadynerigen, neritaloside, odoroside) have all demonstrated CNS depressant activity in mice. An extract of yellow oleander, cerebrin, also is thought to have strychnine-like actions (10; 11) as is rosagenin, a component of oleander (6). AntineoplasticsAntineoplastics: Oleandrin and oleandrigenin have been shown to possess cytotoxic properties (61; 17) CalciumCalcium: In theory, combination use of calcium supplements with oleander may result in an increased risk of cardiac toxicity.Cardiac glycosidesCardiac glycosides: A number of other plant species have been found to contain cardiac glycosides or demonstrate cardiac glycoside activity. Ingestion of these species concomitantly with oleander may augment effects and toxicity (39; 62; 63). ContraceptivesContraceptives: Although folkloric use of oleander as an abortifacient is not supported by scientific research, there is a case report of a mother who consumed two yellow oleander seed kernels 12 hours before giving birth (9). DiureticsDiuretics: In theory, due to potassium depletion caused by some diuretics herbs, such as horsetail, the risk of cardiac toxicity due to oleander may be increased with concurrent use.Hormonal herbs and supplementsHormonal herbs and supplements: Although folkloric use of oleander as an abortifacient is not supported by scientific research, there is a case report of a mother who consumed two yellow oleander seed kernels 12 hours before giving birth (9). HypotensivesHypotensives: Because hypotension has been reported with oleander ingestion (12), combined used with hypotensives may cause a synergistic effect. ImmunostimulantsImmunostimulants: One indicates that AnvirzelT appears to contain polysaccharides that have positive immunomodulatory effects (13). ImmunosuppressantsImmunosuppressants: One report indicates that AnvirzelT appears to contain polysaccharides that have positive immunomodulatory effects (13). LaxativesLaxatives: In theory, due to potassium depletion caused by some laxative agents, such as senna, the risk of cardiac toxicity may be increased with combination use.LicoriceLicorice: In theory, due to potassium depletion, the risk of cardiac toxicity may be increased with combination use.Neurologic herbs and supplementsNeurologic herbs and supplements: Four cardiac glycosides isolated from Nerium oleander (nerizoside, delta dehydroadynerigen, neritaloside, odoroside) have all demonstrated CNS depressant activity in mice. An extract of yellow oleander, cerebrin, also is thought to have strychnine-like actions (10; 11) as is rosagenin, a component of oleander (6). Oleander/Food Interactions:
Insufficient available evidence.Oleander/Lab Interactions:
BilirubinBilirubin: In four cases of oleander-induced renal toxicity, bilirubin was found to be elevated (10). Blood ureaBlood urea: In four cases of oleander-induced renal toxicity, blood urea was found to be elevated (10). CreatinineCreatinine: In one case-report, after exposure to oleander tea, a 33 year-old woman had a serum potassium concentration of 6.7meq/L and a serum creatinine of 2.3mg/L, both of which returned to normal after supportive treatment (53). In four cases of oleander-induced renal toxicity, creatinine was found to be elevated (10). Digoxin and digitoxin assaysDigoxin and digitoxin assays: Several studies address the cross-reactivity of the cardiac glycosides contained in common and yellow oleander with digoxin and digitoxin assays. In general, cardiac glycosides contained within oleander have been shown to react with fluorescence polarization assays for digoxin, but not digoxin chemiluminescent assays. Cardiac glycosides contained in oleander have demonstrated high cross-reactivity with digitoxin fluorescence polarization immunoassays, but not with monoclonal chemiluminescent assays for digitoxin. The cross reactivity of oleandrin, a major cardiac glycoside component of common oleander, varies with different digoxin assays. In general, the presence of cardiac glycosides can be confirmed in a qualitative sense with digoxin assays, but quantitation is not possible due to unstable binding of oleander containing cardiac glycosides with digoxin assays. Quantitation does appear to be potentially possible with selected digitoxin fluorescence polarization assays. The existence of oleandrigenin, an additional cardiac glycoside present in common oleander, has been confirmed by high performance liquid chromatography analysis of an oleander ingestion patient (39; 47; 48; 64; 49; 50; 52; 65; 66; 67). Serum potassiumSerum potassium: Hyperkalemia may result from oleander ingestion due to inhibition of the sodium potassium intracellular ATPase pump. In one study, higher serum potassium levels at presentation following oleander ingestion were associated with greater risk of mortality (38; 68; 51; 69; 70; 15; 71; 53; 67). Serum phosphateSerum phosphate: A case report cites severe hypophosphatemia in a 24 year-old man who had ingested six ground leaves of Nerium oleander. This hypophosphatemia was refractory to initial treatment, but improved almost immediately upon administration of digoxin FAB antibodies (31). Urine outputUrine output: Four patients with oleander-induced renal toxicity developed scant urination (less than 300mL daily) (10).