Pennyroyal Toxicity: Measurement of Toxic Metabolite Levels in Two Cases and Review of the Literature

  title={Pennyroyal Toxicity: Measurement of Toxic Metabolite Levels in Two Cases and Review of the Literature},
  author={Ilene B. Anderson and Walter Mullen and James E. Meeker and Siamak Cyrus Khojasteh-Bakht and Shimako Oishi and Sidney D. Nelson and Pauline Blanc},
  journal={Annals of Internal Medicine},
An increasing segment of the U.S. population is seeking alternatives to traditional Western allopathic medicine. In 1990, Americans made an estimated 425 million visits to providers of unconventional therapies [1]. One particularly popular alternative is herbal medication. Herbal medicines are promoted as more natural and therefore safer than conventional over-the-counter and prescription medicines, but many may be more dangerous than conventional pharmaceutical agents [2]. Both over-the… 
Nephrotoxicity of Herbal Products in Europe—A Review of an Underestimated Problem
Critically review significant data of the nephrotoxicity of several plants used in European phytotherapy, including Artemisia herba-alba, Glycyrrhiza glabra, Euphorbia paralias, and Aloe (Causative mechanisms and factors predisposing to intoxications from the use of herbs are discussed).
A decades-long investigation of acute metabolism-based hepatotoxicity by herbal constituents: a case study of pennyroyal oil
This review presents the investigational tools used in the study of pennyroyal oil, allowing the reader to not only appreciate these methods but also utilize them to tackle and better understand metabolism-based toxicity in their own projects.
Herbal Medicine of the 21st Century: A Focus on the Chemistry, Pharmacokinetics and Toxicity of Five Widely Advocated Phytotherapies.
Herbal medicine can directly affect hepatocytes leading to hepatoxicity based on both intrinsic and extrinsic factors, and the potentiation of the activity of concurrently administered conventional agents is potentially lethal especially if the drug bear dangerous side effects and low therapeutic windows.
Hepatotoxicity of botanicals†
Severe liver injury, including acute and chronic abnormalities and even cirrhotic transformation and liver failure, has been described after the ingestion of a wide range of herbal products and other botanical ingredients, such as mushrooms.
The toxicology of African herbal remedies.
It is important that toxicologists in the West be alert to the possibility of encountering poisoning in patients due to traditional African remedies because of a lack of pharmaceutic quality control in harvesting and preparation.
Hepatotoxicity of monoterpenes and sesquiterpenes
The present review is focused on the hepatotoxic properties of monoterpenes and sesquiterpenes, plant secondary metabolites that represent the major components of essential oils wildly used in folk medicines, pharmaceutical industry and cosmetics.
Herbal hepatotoxicity: An expanding but poorly defined problem
An updated tabulation of the adverse effects of major herbal hepatotoxins is provided and key issues of diagnosis and prevention of this growing problem are addressed.
The objective of study is to aware the researchers about most commonly used medicinal herbs, which are known to induce various types of toxicities, and to improve herbal medicine safety.
Hepatotoxicity of herbal and dietary supplements: an update
Herbal and dietary supplements have been used for health-related purposes since more than 5000 years, and their application is firmly anchored in all societies worldwide, but their use is predominantly based on belief and hope.
Herbal hepatotoxicity in traditional and modern medicine: actual key issues and new encouraging steps
Encouraging steps in the field of herbal hepatotoxicity focus on introducing analytical methods that identify cases of intrinsic liver injury caused by pyrrolizidine alkaloids, and on omics technologies, including genomics, proteomics, metabolomics, and assessing circulating micro-RNA in the serum of some patients with intrinsic hepatot toxicity.


Pennyroyal oil poisoning and hepatotoxicity.
Two recent cases of pennyroyal oil ingestion for the purpose of abortion are reported, one of which resulted in shock, disseminated intravascular coagulation (DIC), massive hepatic nercrosis, and death.
Plant known for centuries still causes problems today.
An abortifacient used in ancient Rome is causing present-day problems and has been used for at least 2,000 years, but there is no documentation that it can induce abortion at other than near-lethal dosage.
Efficacy of oral N-acetylcysteine in the treatment of acetaminophen overdose. Analysis of the national multicenter study (1976 to 1985)
It is concluded that N-acetylcysteine treatment should be started within eight hours of an acetaminophen overdose, but that treatment is still indicated at least as late as 24 hours after ingestion, and it may be superior when treatment is delayed.
The Metabolism of ( R )-(+)-Pulegone, a Toxic Monoterpene
(R)-(+)-Pulegone is a major monoterpene constituent of pennyroyal oil, a mint oil obtained from the leaves of plants Mentha pulegiwn or Hedeoma pulegoides (1). Pennyroyal oil is widely used as a
Menthofuran-dependent and independent aspects of pulegone hepatotoxicity: roles of glutathione.
indirect evidence is provided for cytochrome P-450-catalyzed bioactivation of pulegone via at least two independent pathways: 1) the formation and subsequent activation of menthofuran from puLegone; and 2) the Formation of reactive intermediate(s) from puleg one, but not menthofian, which can be detoxified through a mechanism requiring reduced glutathione.
Acetaminophen overdose in young children. Treatment and effects of alcohol and other additional ingestants in 417 cases.
  • B. Rumack
  • Medicine
    American journal of diseases of children
  • 1984
Four hundred seventeen young children who had ingested a potentially serious amount of acetaminophen were examined and treated in a national multicenter open study and were significantly more likely to be lethargic than those who had not consumed other ingestants.
Unconventional medicine in the United States. Prevalence, costs, and patterns of use.
The frequency of use of unconventional therapy in the United States is far higher than previously reported and expenditure associated with use in 1990 amounted to approximately $13.7 billion, comparable to the $12.8 billion spent out of pocket annually for all hospitalizations in theUnited States.