Pe Min Kan Wan [Discontinued] by Plum Flower

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Angina. Although there has been interest in using oral chrysanthemum for angina, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Asthenopia (eye strain). Oral chrysanthemum has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with asthenopia shows that taking one of three doses of a combination tablet containing chrysanthemum extract 75 mg, 125 mg, or 175 mg with various other ingredients orally once daily for 90 days modestly improves symptoms of eye fatigue, such as tearing, soreness, dryness, and foreign body sensation, when compared with placebo. There were also improvements in macular function. The other ingredients included black currant extract 100-233 mg, goji berry extract 75-175 mg, lutein ester 12-28 mg, and zeaxanthin 1.2-2.8 mg (106306).
• Common cold. Although there has been interest in using oral chrysanthemum for the common cold, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Diabetes. Although there has been interest in using oral chrysanthemum for diabetes, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Headache. Although there has been interest in using oral chrysanthemum for headache, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• HIV/AIDS. Although there has been interest in using oral chrysanthemum for HIV/AIDS, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Hyperlipidemia. Although there has been interest in using oral chrysanthemum for hyperlipidemia, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Hypertension. Although there has been interest in using oral chrysanthemum for hypertension, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose.
• Osteoarthritis. It is unclear if oral chrysanthemum is beneficial in patients with osteoarthritis. Details: Clinical research in patients with mild knee osteoarthritis shows that taking a specific chrysanthemum extract (GreenCross Wellbeing Corporation) 250 mg orally daily for 12 weeks reduces certain pain scores by 30% when compared with baseline. This was also statistically significant when compared with the 14% reduction in those taking placebo. However, other pain scores and stiffness scores were not different between groups. In addition, the clinical significance of these potential improvements is unclear (106308).
• Stroke. It is unclear if oral chrysanthemum is beneficial in patients with stroke. Details: Preliminary clinical research in adults with ischemic stroke shows that taking chrysanthemum extract 200 mg orally twice daily for 4 days improves stroke symptom scores when compared with control (110511).
• Ulcerative colitis. Although there has been interest in using oral chrysanthemum for ulcerative colitis, there is insufficient reliable information about the clinical effects of chrysanthemum for this purpose. More evidence is needed to rate chrysanthemum for these uses.

(Read more about CHRYSANTHEMUM)

POSSIBLY EFFECTIVE

• Psoriasis. Clinical research shows that topical isatis leaf extract may reduce the severity of nail psoriasis. Details: A small clinical study in patients with fingernail psoriasis shows that using a specific product containing indigo naturalis, an isatis leaf extract, in olive oil (Lindioil), 0.05-0.1 mL topically to nail folds and to skin beneath the edge of the nail twice daily for 24 weeks, improves fingernail psoriasis severity by 50% to 80% when compared with treatment with a solution containing calcipotriol (Daivonex scalp solution) 50 mcg/mL (88276). Another small clinical study in this population shows that applying 0.05 mL of this same product to the fingernails twice daily for 12 weeks improves fingernail psoriasis severity by 50% to 59%, compared with 16% to 23% in those using the olive oil vehicle as a control (108089).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. It is unclear if topical isatis can improve the appearance of aging skin. Details: A small clinical study in healthy females aged 37-59 years shows that twice daily facial application of a cream containing isatis leaf extract for 8 weeks improves the visual appearance of wrinkles and roughness scores when compared with baseline (108088). It is unclear if the improvement from baseline differed between those receiving the isatis leaf extract cream and those receiving a placebo cream.
• Diarrhea. Although there is interest in using oral isatis for diarrhea, there is insufficient reliable information about the clinical effects of isatis for this condition.
• Hepatitis. Although there is interest in using oral isatis for hepatitis, there is insufficient reliable information about the clinical effects of isatis for this condition.
• Prostate cancer. Although there is interest in using oral isatis for the treatment of prostate cancer, there is insufficient reliable information about the clinical effects of isatis for this purpose.
• Respiratory tract infections. Although there is interest in using oral isatis for respiratory tract infections, there is insufficient reliable information about the clinical effects of isatis for this purpose.
• Ulcerative colitis. Although there is interest in using oral isatis for ulcerative colitis, there is insufficient reliable information about the clinical effects of isatis for this condition. More evidence is needed to rate isatis for these uses.

(Read more about ISATIS)

There is insufficient reliable information available about the effectiveness of Japanese mint.

(Read more about JAPANESE MINT)

POSSIBLY EFFECTIVE

• Gingivitis. Magnolia bark extract might modestly reduce gum bleeding and inflammation when added to gum or toothpaste. Details: One clinical study shows that chewing gum containing magnolia bark extract plus xylitol for 5 minutes three times daily for 30 days reduces gingival bleeding by 33%, compared with 24% after chewing gum containing xylitol alone (92459). Another clinical study in adults with gingivitis shows that using a fluoride toothpaste containing magnolia extract 0.3% twice daily reduces gingivitis severity by about 0.27 points on the gingival index after 3 months, compared to 0.15 points for patients using the toothpaste without magnolia extract (92464).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Aging skin. Although there is interest in using topical magnolia for aging skin, there is insufficient reliable information about the clinical effects of magnolia for this purpose.
• Allergic rhinitis (hay fever). Although there is interest in using oral magnolia for hay fever, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Anxiety. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in healthy females with mild anxiety shows that taking a proprietary blend of magnolia and phellodendron bark extract (Relora, Next Pharmaceuticals), standardized to 1.5% honokiol and 0.1% berberine, 250 mg three times daily for 6 weeks reduces temporary feelings of stress-induced anxiety almost 2-fold when compared with placebo. However, taking this product does not seem to improve long-standing feelings of stress-induced anxiety (34246). It is unclear if this effect is due to magnolia, other ingredients, or the combination. Additionally, this study was funded by the supplement manufacturer.
• Dental plaque. It is unclear if oral magnolia is beneficial in patients with dental plaque. Details: Clinical research in adults with gingivitis shows that using a toothpaste containing 0.3% magnolia extract twice daily modestly reduces plaque severity by about 0.41 points on the mean plaque index after 3 months, compared to a 0.27 point reduction for patients using the toothpaste without magnolia extract (92464). While statistically significant, this improvement might not be clinically meaningful.
• Diabetes. Although there is interest in using oral magnolia for diabetes, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Headache. Although there is interest in using oral magnolia for headache, there is insufficient reliable information about the clinical effects of magnolia for this condition.
• Menopausal symptoms. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized clinical study in postmenopausal patients shows that taking a specific combination of magnolia, Vitex agnus-castus, soy isoflavones, vitamin D, and lactobacillus (Estromineral Serena Plus, Meda Pharma SpA) daily for one year decreases the frequency and intensity of hot flashes and improves sleep quality and the ability to fall asleep when compared with soy isoflavones alone (95031). Additionally, a small clinical study shows that taking this same product daily for one year improves vasomotor symptoms, mood disorders, somatic symptoms, sleep disorders, blood pressure, and glycemic control when compared to baseline (110708). However, the validity of these findings is limited by a lack of control group. Overall, it is unclear if the effects of this magnolia-containing product in postmenopausal patients are due to magnolia, other ingredients, or the combination.
• Obesity. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in overweight females who report stress eating shows that taking a specific product containing a combination of bark extracts of magnolia plus phellodendron (Relora, Next Pharmaceuticals, Inc.) 250 mg three times daily for 6 weeks seems to prevent weight gain, compared with a 1.5 kg weight gain in those taking placebo (14349). This finding is limited because differences between groups were not statistically compared. Furthermore, it's unclear if this product induces weight loss.
• Postpartum depression. It is unclear if oral magnolia tea is beneficial for preventing postpartum depression. Details: A small clinical study in healthy postpartum patients shows that drinking 1 cup of magnolia tea daily for 3 weeks may improve depressive symptoms and sleep efficiency when compared with usual care alone. Magnolia tea (plant part unspecified) was steeped in 300 mL of hot water for 12 minutes prior to consumption (105089).
• Stress. Oral magnolia has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small low-quality clinical trial in moderately stressed healthy adults shows that taking a proprietary blend of magnolia and phellodendron bark extract (Relora, Next Pharmaceuticals) 250 mg twice daily for 4 weeks improves overall mood and decreases stress when compared with placebo (94904). It is unclear if this effect is due to magnolia, other ingredients, or the combination. Additionally, this study was funded by the supplement manufacturer. More evidence is needed to rate magnolia for these uses.

(Read more about MAGNOLIA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Mosquito repellent. Clinical research shows that applying patchouli oil 20% to the skin provides complete protection against mosquitos for 123 minutes. When added to a mixture of turmeric oil and Zanthoxylum limonella oil, complete protection lasted for 390 minutes, indicating synergistic activity (100669).
• Stress. Preliminary clinical research in nurses shows that inhalation of patchouli oil for 20 minutes once daily for 2 doses reduces self-reported stress scores and increases compassion satisfaction scores when compared with placebo inhalation. Inhalation of patchouli oil did not appear to affect self-reported burnout or markers of stress such as blood pressure and heart rate (104776). More evidence is needed to rate patchouli oil for these uses.

(Read more about PATCHOULI OIL)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. It is unclear if oral perilla is beneficial in patients with age-related cognitive decline. Details: Preliminary clinical research in healthy elderly adults shows that taking perilla seed oil 7 mL orally daily for 12 months does not improve cognitive function scores when compared with placebo. However, the study may have been inadequately powered to detect a difference between groups (110612). Other preliminary clinical research in healthy adults at least 60 years of age shows that taking perilla seed oil 1.47 mL orally daily for 12 months does not improve cognitive function scores when compared with baseline. However, taking perilla seed oil 1.47 mL plus ponkan powder 1.12 grams modestly improved cognitive function scores (110615).
• Allergic rhinitis (hay fever). It is unclear if oral perilla is beneficial in patients with allergic rhinitis. Details: Preliminary clinical research in patients with seasonal allergic rhinoconjunctivitis shows that taking perilla extract 50 or 200 mg orally daily for 21 days decreases symptoms such as itchy nose, watery eyes, itchy eyes, and total symptoms when compared with placebo (68658).
• Asthma. It is unclear if oral perilla is beneficial in patients with asthma. Details: Two very small clinical studies in adults with mild asthma show that taking perilla seed oil 10-20 grams orally daily for 4 weeks modestly improves peak expiratory flow, forced vital capacity, and forced expiratory volume in 1 second when compared with baseline and placebo (1338,65485).
• Cancer. Although there has been interest in using oral perilla for cancer, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Canker sores. It is unclear if oral perilla is beneficial in patients with canker sores. Details: Preliminary clinical research in patients with recurrent canker sores shows that using perilla seed oil as the only type of cooking oil for 8 months does not decreases the incidence of canker sores any better than using soybean oil (68676).
• Common cold. Although there has been interest in using oral perilla for the common cold, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Constipation. It is unclear if oral perilla is beneficial in patients with constipation. Details: Preliminary clinical research shows that taking a specific perilla leaf extract (Benegut, Vital Solutions GmbH) 150 mg orally twice daily for 4 weeks does not improve bloating, abdominal discomfort, gas, feelings of fullness, or stool frequency when compared with placebo in healthy adults who complain of gastrointestinal discomfort and reduced bowel movements (94312).
• Cough. Although there has been interest in using oral perilla for cough, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Dementia. It is unclear if oral perilla is beneficial in patients with dementia. Details: Preliminary clinical research in patients with mild to moderate dementia shows that taking perilla seed oil 1 gram orally three times daily for 6 months does not improve cognitive function when compared with placebo (101808).
• Depression. Although there has been interest in using oral perilla for depression, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Headache. Although there has been interest in using oral perilla for headache, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Nausea and vomiting. Although there has been interest in using oral perilla for nausea and vomiting, there is insufficient reliable information about the clinical effects of perilla for this purpose.
• Osteoporosis. Although there has been interest in using oral perilla for osteoporosis, there is insufficient reliable information about the clinical effects of perilla for this purpose. More evidence is needed to rate perilla for these uses.

(Read more about PERILLA)

There is insufficient reliable information available about the effectiveness of Siberian cocklebur.

(Read more about SIBERIAN COCKLEBUR)

POSSIBLY SAFE ...when used orally and appropriately, short-term. A specific extract of chrysanthemum (GreenCross Wellbeing Corporation) has been used with apparent safety at a dose of 250 mg daily for up to 12 weeks (106308). There is insufficient reliable information available about the safety of chrysanthemum when used topically.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about CHRYSANTHEMUM)

POSSIBLY SAFE ...when used topically and appropriately, short-term. A specific product containing indigo naturalis, an isatis leaf extract, in olive oil (Lindioil), applied topically in doses of 0.05-0.1 mL to the skin around the fingernails twice daily, has been used with apparent safety for 24 weeks (88276,108089). There is insufficient reliable information available about the safety of isatis when used orally.

PREGNANCY AND LACTATION:
Insufficient reliable information is available; avoid using.

(Read more about ISATIS)

POSSIBLY SAFE ...when the oil is used orally and appropriately (2). ...when used topically and appropriately (2). There is insufficient reliable information available about the safety of Japanese mint for its other uses.

CHILDREN: LIKELY UNSAFE
when the oil is used topically on the faces of infants and children, particularly in the nasal area, it can trigger glottal or bronchial spasm, asthma-like attacks, or even respiratory failure (2). There is insufficient reliable information available about Japanese mint used for medicinal purposes; avoid using.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about JAPANESE MINT)

POSSIBLY SAFE ...when used orally and appropriately, short-term. A specific product containing magnolia extract and phellodendron extract (Relora, Next Pharmaceuticals, Inc.) has been used with apparent safety in clinical trials at a dose of 250 mg two to three times daily for up to 6 weeks (14349,34246,94904). ...when used topically in a toothpaste for up to 6 months (92464).

PREGNANCY: UNSAFE
when the magnolia flower bud is used orally due to reports of uterine stimulant activity (11953). There is insufficient reliable information available about the safety of using magnolia bark during pregnancy; avoid using.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about MAGNOLIA)

LIKELY SAFE ...when used orally in amounts commonly found in foods. Patchouli oil has Generally Recognized As Safe (GRAS) status for use as a food additive in the US (4912). There is insufficient reliable information available about the safety of patchouli oil when used orally in medicinal amounts or when used topically or by inhalation.

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PATCHOULI OIL)

POSSIBLY SAFE ...when perilla oil or extract is used orally and appropriately. There is some evidence that perilla can be safely used for up to 12 months (1338,68676,94312,105525).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about PERILLA)

LIKELY UNSAFE ...when the seeds and seedlings of Siberian cocklebur are used orally. Fatalities have been reported (27827,27828). There is insufficient reliable information available about the safety of Siberian cocklebur fruit when used orally for medicinal purposes in adults.

CHILDREN: POSSIBLY UNSAFE
when the fruit of Siberian cocklebur is used orally. A case report describes fatal poisoning in a 20-month old child given Siberian cocklebur fruit over a 2-month period (27815).

CHILDREN: LIKELY UNSAFE
when the seeds and seedlings of Siberian cocklebur are used orally. Fatalities and liver failure necessitating liver transplant have been reported (27827,27828,99948).

PREGNANCY AND LACTATION: LIKELY UNSAFE
when the seeds and seedlings of Siberian cocklebur are used orally (27827,27828).

(Read more about SIBERIAN COCKLEBUR)

(Read more about CHRYSANTHEMUM)

(Read more about ISATIS)

(Read more about JAPANESE MINT)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, magnolia might have additive effects and increase the risk of bleeding when used with anticoagulant or antiplatelet drugs.  Details In vitro research shows that the chemicals magnolol and honokiol, isolated from magnolia bark, inhibit platelet aggregation that is experimentally induced by collagen and arachidonic acid. However, they do not inhibit platelet aggregation that is induced by adenosine diphosphate, platelet-activating factor, or thrombin (18273). This interaction has not been reported in humans.

CNS DEPRESSANTS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = D Theoretically, concomitant use of large doses of magnolia bark and CNS depressants might have additive effects.  Details In vitro and animal research shows that constituents extracted from magnolia bark, especially honokiol and magnolol, have sedative effects. These effects may be due to the inhibition of catecholamine release and modulation of gamma-aminobutyric acid-A (GABA-A) receptors (11946,11952).

(Read more about MAGNOLIA)

(Read more about PATCHOULI OIL)

(Read more about PERILLA)

ANTIDIABETES DRUGS Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Likely •  Level of Evidence = B Siberian cocklebur seedlings and seeds have caused severe hypoglycemia in humans. Hypoglycemia occurs soon after consumption and worsens with time in most cases (27828,99948). Do not use Siberian cocklebur in people taking medications that also lower blood glucose.  Details Some antidiabetes drugs include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), and others.

NEPHROTOXIC DRUGS Interaction Rating = Major Do not take this combination. Severity = High •  Occurrence = Likely •  Level of Evidence = B Siberian cocklebur can adversely affect the kidney (27828,99948). Theoretically, combining Siberian cocklebur with potentially nephrotoxic drugs might have additive harmful effects on kidney function.  Details Some potentially nephrotoxic drugs include cyclosporine (Neoral, Sandimmune); aminoglycosides including amikacin (Amikin), gentamicin (Garamycin, Gentak, others), and tobramycin (Nebcin, others); nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen (Advil, Motrin, Nuprin, others), indomethacin (Indocin), naproxen (Aleve, Anaprox, Naprelan, Naprosyn), piroxicam (Feldene); and numerous others.

(Read more about SIBERIAN COCKLEBUR)

General ...There is currently a limited amount of information on the adverse effects of chrysanthemum. A thorough evaluation of safety outcomes has not been conducted.
Most Common Adverse Effects:
Topically: Allergic reactions, contact dermatitis, eczema, urticaria.
Serious Adverse Effects (Rare):
Topically: Asthma.

Immunologic ...Topically and via occupational exposure, chrysanthemum can cause allergic reactions. Chrysanthemum allergy symptoms can include urticaria, contact dermatitis, eczema, actinic reticuloid photosensitivity dermatitis, pollinosis, rhinoconjunctivitis, and asthma (5552,5554,5556,5557,6958,42842,42845,42849,42859,42867,42893,42872,42873,42874)(42879,42880,42881,42882,42883,42887,42888). There are numerous case reports and studies showing that allergies to Chrysanthemum are very common, with an estimated 60% of Europeans being allergic (19149,42847,42856,42854).

(Read more about CHRYSANTHEMUM)

General ...Orally and topically, no adverse effects have been reported. However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about ISATIS)

General ...Japanese mint can cause stomach upset when taken orally, dermatitis when used topically, and flushing, headache and allergic reactions when inhaled (2,11,18).

Dermatologic ...Topically, Japanese mint may cause contact dermatitis (11,18).

Pulmonary/Respiratory ...Topically, use of Japanese mint oil on the face in children can trigger glottal or bronchial spasm, asthma-like attacks, or respiratory failure (18). When inhaled, the vapor from Japanese mint oil can cause flushing, headache, or worsening bronchial asthma spasms (11,18).

(Read more about JAPANESE MINT)

General ...Orally, magnolia seems to be well tolerated.
Most Common Adverse Effects:
Topically: Contact dermatitis.

Dermatologic ...Topically, magnolia bark has been associated with reports of allergic contact dermatitis (92463,92468,95030,110709). In several cases, the use of anti-aging facial creams containing magnolia bark extract was associated with allergic contact dermatitis of the face (92463,92468,95030). In one case, the use of a vaginal gel containing magnolia bark extract was associated with allergic contact dermatitis of the vulva (110709). Symptoms typically resolve with the use of topical corticosteroids and discontinuation of magnolia bark extract (95030,110709). Patch testing suggests that the magnolia bark extract constituents magnolol and honokiol are responsible for this adverse effect (110709).

Endocrine ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported thyroid dysfunction (14349). However, it's not known if this side effect is related to magnolia or some other factor.

Gastrointestinal ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported heartburn (14349). However, it's not known if this side effect is related to magnolia or some other factor.

Neurologic/CNS ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported shaking hands and perilabial numbness. Another patient reported fatigue and headache (14349). However, it's not known if these side effects are related to magnolia or some other factor.

Psychiatric ...In a clinical trial of an oral combination product containing extracts of magnolia and phellodendron, one patient reported sexual dysfunction (14349). However, it's not known if this side effect is related to magnolia or some other factor.

(Read more about MAGNOLIA)

General ...No adverse effects have been reported (104776). However, a thorough evaluation of safety outcomes has not been conducted.

(Read more about PATCHOULI OIL)

General ...Orally, perilla seems to be well tolerated. Topically, there is currently a limited amount of information on the adverse effects of perilla.
Most Common Adverse Effects:
Topically: Dermatitis.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis.

Dermatologic ...Topically, perilla may cause contact dermatitis (6,68664,94313).

Immunologic ...Orally, many cases of anaphylaxis have been reported in adults and children who consumed perilla seeds (94313,110611). Some research suggests that oleosin is the major constituent responsible for perilla allergies (110611).

Pulmonary/Respiratory ...Occupational asthma has been reported from breathing in smoke from roasted perilla seeds (94313).

(Read more about PERILLA)

General ...Siberian cocklebur is generally regarded as unsafe for use. Any benefits of therapy might not outweigh the risk of toxicity. Orally, Siberian cocklebur seeds and seedlings can cause various adverse effects. Initial effects include abdominal pain, nausea, vomiting, hypoglycemia, elevated liver function tests, increased risk of bleeding, drowsiness, dizziness, dyspnea, sweating, fever, and palpitations (27827,27828,99948). In some cases, symptoms have progressed to metabolic acidosis, worsening changes in blood sugar, arrhythmia, seizures, convulsions, coma, pancreatitis, hepatic failure, renal failure, myocardial and muscle injury, and death due to multi-organ failure (27827,27828,99948). Fatal hepatic failure due to the Siberian cocklebur fruit has also been reported in a 20-month old child (27815).

Cardiovascular ...Orally, Siberian cocklebur seed can cause both tachycardia and bradycardia (27828,99948). Palpitations can occur in as little as 3 hours after ingestion, with arrhythmia occurring a few hours later (27828). Elevated heart enzymes can also occur soon after intake (27828). White blood cell infiltration in the myocardium has been reported in autopsy findings from patients who died after consuming Siberian cocklebur (27828).

Endocrine ...Orally, Siberian cocklebur seedlings and seeds can cause hypoglycemia. This occurs soon after consumption. Later, metabolic acidosis, hyperglycemia, and/or worsening hypoglycemia might occur. In some individuals, these changes can cause seizures (27828,99948).

Gastrointestinal ...Orally, Siberian cocklebur seedlings and seeds can cause abdominal pain, nausea, and vomiting. Gastrointestinal symptoms occur within a few hours after consumption (27827,27828,99948). In one case, pancreatitis occurred approximately 2 days after intake of the seeds in a 15-year-old girl (99948).

Hematologic ...Orally, Siberian cocklebur seedlings and seeds can increase the risk of bleeding, mainly due to hepatotoxic effects (27828).

Hepatic ...Orally, Siberian cocklebur seedlings and seeds can cause liver damage, including increased bilirubin levels and increases in liver enzyme levels by as much as 6 times the normal value. These symptoms can progress to include jaundice, hepatomegaly, and edema, resulting in liver failure and death in some patients (27827,27828,99948). In one case, grade 3 encephalopathy and liver failure necessitated a liver transplant in a 15-year-old girl who had consumed approximately 80 Siberian cocklebur seeds (27815,99948).
The Siberian cocklebur fruit has also been reported to cause fatal hepatic failure in a 20-month old child who consumed Siberian cocklebur fruit over a 2-month period (27815)

Musculoskeletal ...Orally, Siberian cocklebur seedlings and seeds can cause rhabdomyolysis (27828). White blood cell infiltration in the muscles has been reported in autopsy findings from patients who died after consuming Siberian cocklebur (27828).

Neurologic/CNS ...Orally, Siberian cocklebur seedlings and seeds can cause altered mental status, malaise, dizziness, sweating, fever, seizures, convulsions, unconsciousness, and coma (27827,27828,99948). Malaise, dizziness, and sweating onset are rapid (27828). Fever onset is usually after the onset of vomiting (27827). Unconsciousness can follow vomiting within minutes or hours, with coma occurring later in some individuals (27827,27828). Microvascular hemorrhage in the brain has been reported in autopsy findings for patients who died after consuming Siberian cocklebur (27828).

Pulmonary/Respiratory ...Orally, Siberian cocklebur seedlings and seeds can cause dyspnea and irregular breathing. White blood cell infiltration in the lungs has been reported in autopsy findings from patients who died after consuming Siberian cocklebur (27828).

Renal ...Orally, Siberian cocklebur seedlings and seeds have resulted in cases of renal injury with increased levels of creatinine and blood urea nitrogen. This can result in decreased urine output. In some individuals, renal symptoms return to normal. However, renal failure can occur and renal proximal tubular necrosis has been reported in autopsy findings for patients who died after consuming Siberian cocklebur (27828,99948).

Other ...Orally, Siberian cocklebur can cause death associated with multi-organ failure. In some cases, death occurred less than 12 hours following intake. In one outbreak of illness related to consumption of Siberian cocklebur seedlings, death occurred in 25% of those affected. In another group of individuals with Siberian cocklebur seed poisoning, death occurred in three of nine of those affected. Death is more likely to occur in young children, especially those less than 15 years of age (27827,27828).
The quantity of Siberian cocklebur associated with death is not clear. In one illness outbreak, deaths were mainly in children and the seedlings were consumed in large quantities due to a food shortage (27827). In another, children died after consuming an unknown quantity of seeds while working on a farm (27828).

(Read more about SIBERIAN COCKLEBUR)