| Revision as of 14:35, 24 November 2011 editBeetstra (talk | contribs)Edit filter managers, Administrators172,077 edits Saving copy of the {{chembox}} taken from revid 454735245 of page Oleandrin for the Chem/Drugbox validation project (updated: 'ChEMBL', 'CASNo'). |
Latest revision as of 12:55, 11 October 2024 edit Citation bot (talk | contribs)Bots5,458,034 edits Added bibcode. | Use this bot. Report bugs. | Suggested by Abductive | Category:Articles requiring reliable medical sources | #UCB_Category 183/938 |
| Line 1: |
Line 1: |
|
{{ambox | text = This page contains a copy of the infobox ({{tl|chembox}}) taken from revid of page ] with values updated to verified values.}} |
|
|
{{chembox |
|
{{chembox |
|
|
| Verifiedfields = changed |
|
|ImageFile=Oleandrin.png |
|
|
|
| Watchedfields = changed |
|
|ImageSize=200px |
|
|
|
| verifiedrevid = 462264921 |
|
|IUPACName= <small>acetic acid [(3''S'',5''R'',10''S'',13''R'',14''S'',16''S'',17'''R'')-14-hydroxy-3-<nowiki>[[</nowiki>(2''R'',4''S'',5''S'',6''S'')-5-hydroxy-4-methoxy-6-methyl- |
|
|
|
| ImageFile=Oleandrin.svg |
|
2-tetrahydropyranyl]oxy]-10,13-dimethyl-17-(5-oxo-2H-furan-3-yl)-1,2,3,4,5,6,7,8,9,11,12,15,16,17- |
|
|
|
| ImageSize=200px |
|
tetradecahydrocyclopentaphenanthren-16-yl] ester</small> |
|
|
|
| ImageFile2=Oleandrin 3D BS.png |
|
|OtherNames= |
|
|
|
| ImageSize2=200px |
|
|
| IUPACName=16β-(Acetyloxy)-3β-(2,6-dideoxy-3-''O''-methyl-α-<small>L</small>-''arabino''-hexopyranosyloxy)-14-hydroxy-5β-card-20(22)-enolide |
|
|
| SystematicName=(1''R'',2''S'',3a''S'',3b''R'',5a''R'',7''S'',9a''S'',9b''S'',11a''R'')-3a-Hydroxy-7-{oxy}-9a,11a-dimethyl-1-(5-oxo-2,5-dihydrofuran-3-yl)hexadecahydro-1''H''-cyclopentaphenanthren-2-yl acetate |
|
|
| OtherNames= |
|
|Section1={{Chembox Identifiers |
|
|Section1={{Chembox Identifiers |
|
|
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} |
|
| ChemSpiderID = 9716290 |
|
|
|
| ChemSpiderID = 9716290 |
|
| ChEMBL = <!-- blanked - oldvalue: 109718 --> |
|
|
|
| ChEMBL_Ref = {{ebicite|changed|EBI}} |
|
|
| ChEMBL = 109718 |
|
| InChI1 = 1/C32H48O9/c1-17-29(35)24(37-5)14-27(39-17)41-21-8-10-30(3)20(13-21)6-7-23-22(30)9-11-31(4)28(19-12-26(34)38-16-19)25(40-18(2)33)15-32(23,31)36/h12,17,20-25,27-29,35-36H,6-11,13-16H2,1-5H3/t17-,20+,21-,22-,23+,24-,25-,27-,28-,29-,30-,31+,32-/m0/s1 |
|
| InChI1 = 1/C32H48O9/c1-17-29(35)24(37-5)14-27(39-17)41-21-8-10-30(3)20(13-21)6-7-23-22(30)9-11-31(4)28(19-12-26(34)38-16-19)25(40-18(2)33)15-32(23,31)36/h12,17,20-25,27-29,35-36H,6-11,13-16H2,1-5H3/t17-,20+,21-,22-,23+,24-,25-,27-,28-,29-,30-,31+,32-/m0/s1 |
|
| InChIKey1 = JLPDBLFIVFSOCC-XYXFTTADBR |
|
| InChIKey1 = JLPDBLFIVFSOCC-XYXFTTADBR |
|
|
| StdInChI_Ref = {{stdinchicite|correct|chemspider}} |
|
| StdInChI = 1S/C32H48O9/c1-17-29(35)24(37-5)14-27(39-17)41-21-8-10-30(3)20(13-21)6-7-23-22(30)9-11-31(4)28(19-12-26(34)38-16-19)25(40-18(2)33)15-32(23,31)36/h12,17,20-25,27-29,35-36H,6-11,13-16H2,1-5H3/t17-,20+,21-,22-,23+,24-,25-,27-,28-,29-,30-,31+,32-/m0/s1 |
|
| StdInChI = 1S/C32H48O9/c1-17-29(35)24(37-5)14-27(39-17)41-21-8-10-30(3)20(13-21)6-7-23-22(30)9-11-31(4)28(19-12-26(34)38-16-19)25(40-18(2)33)15-32(23,31)36/h12,17,20-25,27-29,35-36H,6-11,13-16H2,1-5H3/t17-,20+,21-,22-,23+,24-,25-,27-,28-,29-,30-,31+,32-/m0/s1 |
|
|
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} |
|
| StdInChIKey = JLPDBLFIVFSOCC-XYXFTTADSA-N |
|
| StdInChIKey = JLPDBLFIVFSOCC-XYXFTTADSA-N |
|
|
| CASNo_Ref = {{cascite|correct|CAS}} |
|
| CASNo = <!-- blanked - oldvalue: 465-16-7 --> |
|
|
|
| CASNo=465-16-7 |
|
| PubChem = 11541511 |
|
|
|
| UNII_Ref = {{fdacite|correct|FDA}} |
|
| SMILES = O=C\1OC/C(=C/1)2(OC(=O)C)C6(O)2(C)CC46CC5C(O3O((O)(OC)C3)C)CC45C |
|
|
|
| UNII = II95UDU7I4 |
|
|
| PubChem = 11541511 |
|
|
| SMILES = O=C\1OC/C(=C/1)2(OC(=O)C)C6(O)2(C)CC46CC5C(O3O((O)(OC)C3)C)CC45C |
|
}} |
|
}} |
|
|Section2={{Chembox Properties |
|
|Section2={{Chembox Properties |
|
| Formula=C<sub>32</sub>H<sub>48</sub>O<sub>9</sub> |
|
| Formula=C<sub>32</sub>H<sub>48</sub>O<sub>9</sub> |
|
| MolarMass=576.72 g/mol |
|
| MolarMass=576.72 g/mol |
|
| Appearance= Oleandrin forms colourless, odourless, acicular crystals that are very bitter |
|
| Appearance= Oleandrin forms colourless, odourless, acicular crystals that are very bitter |
|
| Density= |
|
| Density=1.261 g/ml |
|
| MeltingPtC = 250.0 |
|
| MeltingPtC = 250.0 |
|
| BoilingPtc= |
|
| BoilingPtC= |
|
| Solubility= |
|
| Solubility= |
|
}} |
|
}} |
|
|Section3={{Chembox Hazards |
|
| Section3 = {{Chembox Hazards |
|
|
| AutoignitionPt = |
|
| MainHazards= |
|
|
|
| ExploLimits = |
|
| FlashPt= |
|
|
|
| FlashPt = |
|
| Autoignition= |
|
|
|
| LD50 = 0.248 mg/kg (], Intravenous) |
|
|
| LC50 = |
|
|
| MainHazards = Acute Toxicity (Oral, inhalation) |
|
|
| NFPA-F = 0 |
|
|
| NFPA-H = 4 |
|
|
| NFPA-R = 0 |
|
|
| NFPA-S = - |
|
|
| PEL = |
|
|
| REL = |
|
|
| ExternalSDS = |
|
|
| GHSPictograms = {{GHS skull and crossbones}}{{GHS health hazard}} |
|
|
| GHSSignalWord = Danger |
|
|
| HPhrases = {{H-phrases|300|330|373}} |
|
|
| PPhrases = {{P-phrases|260|264|270|271|284|301+310|304+340|310|320|330|403+233|405|501}} |
|
}} |
|
}} |
|
}} |
|
}} |
|
|
|
|
|
'''Oleandrin''' is a ] found in the ] ] (''Nerium oleander'' L.).<ref name="drugs">{{cite web |title=Oleander |url=https://www.drugs.com/npp/oleander.html |publisher=Drugs.com |access-date=17 August 2020 |date=1 December 2018}}</ref> As a main ] of oleander, oleandrin is associated with the toxicity of oleander sap, and has similar properties to ].<ref name=drugs /> |
|
|
|
|
|
Oleander has been used in ] for its presumed therapeutic purposes, such as for treating ]. There is no ] that oleander or its constituents, including oleandrin, are safe or effective. Oleandrin is not ] as a ] or ].<ref name=drugs /> |
|
|
|
|
|
== Structure and reactivity == |
|
|
The structure of oleandrin contains a central ] nucleus with an unsaturated ] ring structure on C17 and a dideoxy arabinose group on C3. In addition, the steroid ring has a substitute of an acetyloxy group on C16.<ref name="Ref S">{{cite journal |last1=Jortani |first1=Saeed A. |last2=Helm |first2=R. Allen |last3=Valdes |first3=Roland |title=Inhibition of Na,K-ATPase by oleandrin and oleandrigenin, and their detection by digoxin immunoassays |journal=Clinical Chemistry |volume=42 |issue=10 |pages=1654–8 |year=1996 |doi=10.1093/clinchem/42.10.1654 |pmid=8855150 |doi-access=free }}</ref> The sugar forming the glycoside is ]. |
|
|
|
|
|
Oleandrin resembles very much other glycosides like ] and ] but has less effect than digoxin. It is however, just like its ] oleandrigenin, a more potent glycoside than ouabain.<ref name="Ref S" /> |
|
|
|
|
|
== Synthesis == |
|
|
Oleandrin and its derivate oleandrigenin are formed in the ''N. oleander'' plant. The oleandrin itself can be won out of the leaves and other parts of the plant but can also be produced in the lab by using cell cultures. Here, the oleandrin synthesis (along with other metabolites) can be stimulated in untransformed plant cell cultures with supplementation of ]. However, this is not enough to produce large quantities because of early cell death. ] cultures of ] are able to synthesize great quantities of oleandrin and other metabolites of the oleander plants, fit for pharmaceutical purposes.<ref name="Ref LK">{{cite journal |last1=Ibrahim |first1=Amany K. |last2=Khalifa |first2=Sherief |last3=Youssef |first3=Diaa |last4=Khan | first4=Ikhlas |last5=Mesbah |title=Stimulation of oleandrin production by combined Agrobacterium tumefaciens mediated transformation and fungal elecitation in Nerium oleander cell cultures |journal=Enzyme and Microbial Technology |volume=41 |issue=3 |pages=331–66 |year=2007 |doi=10.1016/j.enzmictec.2007.02.015 |first5=I |last6=Mesbah |first6=M }}</ref> |
|
|
|
|
|
=== Related substances === |
|
|
Oleandrin is, apart from its pure form, also closely related to structural similar glycosides and alkaloids, which all have more or less the same characteristics as oleandrin:<ref name=drugs /> |
|
|
* Oleandrigenin is a deglycosylated metabolite of oleandrin. It has however a more mild effect.<ref name="Ref S" /> |
|
|
* ] |
|
|
* Neritaloside |
|
|
* Odorside |
|
|
|
|
|
== Metabolism == |
|
|
Although oleandrigenin is not formed in human plasma, it was found in the volunteers injected with oleandrin, suggesting that it is formed in other human tissues.<ref name="oleandrigenin">{{cite journal |last1=Wang |first1=Xiaomin |last2=Plomley |first2=Jeffry B. |last3=Newman |first3=Robert A. |last4=Cisneros |first4=Angela |author-link3=Robert A. Newman |title=LC/MS/MS Analyses of an Oleander Extract for Cancer Treatment |journal=Analytical Chemistry |volume=72 |issue=15 |pages=3547–52 |year=2000 |pmid=10952541 |doi=10.1021/ac991425a}}</ref> Because of its lipophilic properties, oleandrin can be easily absorbed in the gastrointestinal tract after oral dosing.<ref name=drugs /> The clearance is slow. The plasma concentration obtains its maximum at twenty minutes after oral intake (half-life of about 2 hours, but half-life after ] is half an hour).<ref name="Murine">{{cite journal |last1=Ni |first1=Dan |last2=Madden |first2=Timothy L. |last3=Johansen |first3=Mary |last4=Felix |first4=Edward |last5=Ho |first5=Dah H. |last6=Newman |first6=Robert A. |title=Murine pharmacokinetics and metabolism of oleandrin, a cytotoxic component of ''Nerium oleander'' |journal=Journal of Experimental Therapeutics and Oncology |volume=2 |issue=5 |pages=278–85 |year=2002 |pmid=12416031 |doi=10.1046/j.1359-4117.2002.01052.x}}</ref> |
|
|
|
|
|
It is excreted mostly in feces, but also in urine.<ref name="Murine" /> Because the main route of excretion is through biliary excretion into the feces, it is mainly the liver that is exposed to oleandrin.<ref name="Murine" /> As excretion in urine is only a smaller route, the kidneys are less exposed. There is also accumulation in the heart, which explains its potential for cardiac toxicity.<ref name="Murine" /> |
|
|
|
|
|
== Mechanism of action == |
|
|
Because of its properties as a ], oleandrin interferes in some essential processes within the cell, the most important of these being the inhibition of the ].<ref name=drugs /> This protein enables the cell to exchange the cations Na+ and K+ between the intercellular and extracellular spaces by which, for instance, electric signaling is made possible in nerve cells. Oleandrin binds to specific amino acids in the protein, causing it to lose its function.<ref name="Ref T">{{cite book |last=Timbrell |first=J. A. |year=2009 |title=Principles of Biochemical Toxicology |url=https://archive.org/details/principlesbioche00timb_973 |url-access=limited |pages=–51 |publisher=Informa Healthcare |location=New York |isbn=978-0-8493-7302-2}}</ref><ref name="Ref Y">{{cite journal |doi=10.1158/1535-7163.MCT-08-1085 |title=Oleandrin-mediated inhibition of human tumor cell proliferation: Importance of Na,K-ATPase subunits as drug targets |year=2009 |last1=Yang |first1=P. |last2=Menter |first2=D. G. |last3=Cartwright |first3=C. |last4=Chan |first4=D. |last5=Dixon |first5=S. |last6=Suraokar |first6=M. |last7=Mendoza |first7=G. |last8=Llansa |first8=N. |last9=Newman |first9=R. A. |journal=Molecular Cancer Therapeutics |volume=8 |issue=8 |pages=2319–2328 |pmid=19671733 |doi-access=free }}</ref> |
|
|
|
|
|
Apart from being a potent toxic compound, there are no results on oleandrin from human ] that support its use as a treatment for cancer or any disease.<ref name=drugs/> |
|
|
|
|
|
== Toxicity == |
|
|
Due to its considerable ], use of oleander or its constituents, such as oleandrin, is regarded as unsafe and potentially ].<ref name=drugs /> Use of oleander may cause ], headache, ], ], and ], with symptoms appearing within a few hours of ingestion.<ref name=drugs /> In one fatality, the blood concentration of oleandrin and a related ] from the oleander plant was estimated at 20 ng/ml.<ref name="Ref AFC">{{cite journal |pages=e31–6 |doi=10.1016/j.forsciint.2008.05.002 |title=A fatal case of oleandrin poisoning |year=2008 |last1=Wasfi |first1=I |last2=Zorob |first2=O |last3=Alkatheeri |first3=N |last4=Alawadhi |first4=A |journal=Forensic Science International |volume=179 |issue=2–3 |pmid=18602779}}</ref> In practice, there have been adult cases wherein 14–20 oleander leaves (of unknown oleandrin concentration) proved not to be fatal, but also a lethal case of a child that consumed only one leaf.<ref name="inchem" /> |
|
|
|
|
|
=== Symptoms === |
|
|
Symptoms of oleandrin poisoning can cause both gastrointestinal and cardiac effects.<ref name=drugs /> The gastrointestinal effects can consist of nausea, abdominal pain, and vomiting, as well as higher salivation and diarrhea (which may contain blood).<ref name=drugs /> After these first symptoms, the heart may be affected by ], ], ], or ]age. Also, ] (yellow vision), a burning sensation of the ] of the eyes, and gastrointestinal tract and respiratory paralysis can occur.<ref name=drugs /><ref name="Ref S" /> Reactions to poisonings from this plant can also affect the central nervous system. These symptoms can include drowsiness, ]s, or shaking of the muscles, seizures, collapse, and even coma that can lead to death.<ref name=drugs /> Oleander sap can cause skin irritations, severe eye inflammation and irritation, and allergy reactions characterized by ] when administered topically.<ref name=drugs /><ref name="Goetz">{{cite web |
|
|
|author=Goetz, Rebecca. J. |author2=Jordan Thomas N. |author3=McCain, John W. |author4=Su, Nancy Y. |
|
|
|work=Indiana Plants Poisonous to Livestock and Pets |url=http://www.vet.purdue.edu/depts/addl/toxic/plant52.htm |
|
|
|title=Oleander |
|
|
|publisher=Cooperative Extension Service, ] |
|
|
|year=1998 |
|
|
|access-date=2005-10-23 |
|
|
|archive-url = https://web.archive.org/web/20051021002639/http://www.vet.purdue.edu/depts/addl/toxic/plant52.htm |archive-date = 2005-10-21}}</ref> |
|
|
|
|
|
=== Diagnosis === |
|
|
Diagnosis of oleandrin poisoning is mainly based on description of the plant, how much of it was ingested, time since ingestion, and symptoms.<ref name=drugs /> |
|
|
|
|
|
Three methods are used for detecting oleandrin in the blood. ] immunoassay is widely used. This test is slower and has a lower sensitivity than digoxin immunoassay (Digoxin III).<ref name="pp14">{{cite journal |doi=10.1309/CC6791DFF20QPCX3 |title=Rapid Detection of Oleander Poisoning by Digoxin III, a New Digoxin Assay: Impact on Serum Digoxin Measurement |year=2008 |last1=Actor |first1=Jeffrey K. |last2=Reyes |first2=Meredith |last3=Risin |first3=Semyon A. |last4=Dasgupta |first4=Amitava |journal=American Journal of Clinical Pathology |volume=129 |issue=4 |pages=548–553 |pmid=18343781|doi-access=free }}</ref> A direct analytic technique like ] is used when there are medical or legal issues.<ref name="pp15">{{cite journal |pages=4322–5 |doi=10.1021/jf050201s |title=Determination of Oleandrin in Tissues and Biological Fluids by Liquid Chromatography−Electrospray Tandem Mass Spectrometry |year=2005 |last1=Tor |first1=Elizabeth R. |last2=Filigenzi |first2=Michael S. |last3=Puschner |first3=Birgit |journal=Journal of Agricultural and Food Chemistry |volume=53 |issue=11 |pmid=15913289}}</ref> |
|
|
|
|
|
== Treatment == |
|
|
{{more medical citations needed|section|date=August 2020}} |
|
|
|
|
|
Oleander toxicity should be treated aggressively, including as needed ] or induced ].<ref name=drugs/> Onset of symptoms may vary with the way of intake. Teas made of leaves or root of ''N. oleander'' give rise to a more acute onset, while eating raw leaves causes a slower onset of symptoms.<ref name="Hayn s">{{cite journal |last1=Haynes |first1=B |last2=Bessen |first2=H |last3=Wightman |first3=W |title=Oleander tea: Herbal draught of death |journal=Annals of Emergency Medicine |volume=14 |issue=4 |pages=350–3 |year=1985 |pmid=4039113 |doi=10.1016/S0196-0644(85)80103-7}}</ref> Management of oleandrin poisoning is done in the following steps:<ref name="Bandara">{{cite journal |pmid=20438743 |year=2010 |last1=Bandara |first1=V |last2=Weinstein |first2=SA |last3=White |first3=J |last4=Eddleston |first4=M |title=A review of the natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning |volume=56 |issue=3 |pages=273–81 |doi=10.1016/j.toxicon.2010.03.026 |journal=Toxicon|bibcode=2010Txcn...56..273B }}</ref> |
|
|
|
|
|
There is a lack of evidence that weighs efficacy versus harm.<ref name="pp2">{{cite journal |pages=136–43 |doi=10.1080/15563650601006009 |title=The hazards of gastric lavage for intentional self-poisoning in a resource poor location |year=2007 |last1=Eddleston |first1=Michael |last2=Haggalla |first2=Sapumal |last3=Reginald |first3=K. |last4=Sudarshan |first4=K. |last5=Senthilkumaran |first5=M. |last6=Karalliedde |first6=Lakshman |last7=Ariaratnam |first7=Ariaranee |last8=Sheriff |first8=M.H.Rezvi |last9=Warrell |first9=David A. |last10=Buckley |first10=Nick A. |journal=Clinical Toxicology |volume=45 |issue=2 |pmid=17364630 |pmc=1941903|display-authors=8 }}</ref> |
|
|
Activated charcoal is still used, since it binds toxins in the gastrointestinal tract to reduce absorption. It is uncertain whether repeated administration of activated charcoal is effective, in theory interrupting ]. This treatment is used for digoxin poisoning, another cardiac glycoside.<ref name="pp3">{{cite journal |pmid=6963097 |year=1982 |last1=Reissell |first1=P |last2=Manninen |first2=V |title=Effect of administration of activated charcoal and fibre on absorption, excretion and steady state blood levels of digoxin and digitoxin. Evidence for intestinal secretion of the glycosides |volume=668 |pages=88–90 |journal=Acta Medica Scandinavica. Supplementum|doi=10.1111/j.0954-6820.1982.tb08527.x }}</ref> |
|
|
Supportive care like monitoring vitals and electrolyte and fluid balance is important. Patients may present hypovolemic due to vomiting and diarrhea, but severely elevated potassium can also occur.<ref name="pp4">{{cite journal |pages=206–12 |doi=10.1080/15563650902824001 |title=Management of yellow oleander poisoning |year=2009 |last1=Rajapakse |first1=Senaka |s2cid=37334350 |journal=Clinical Toxicology |volume=47 |issue=3 |pmid=19306191}}</ref> |
|
|
Electrolyte balance is vital, since patients with low cardiac glycoside levels can still die after adequate digoxin Fab antibody treatment if they have disturbed electrolyte levels.<ref name="pp5">{{cite journal |pages=483–5 |doi=10.1093/qjmed/92.9.483 |title=Management of acute yellow oleander poisoning |year=1999 |last1=Eddleston |first1=M. |journal=QJM |volume=92 |issue=9 |pmid=10627866 |last2=Warrell |first2=DA|doi-access=free }}</ref> |
|
|
|
|
|
Treatment of slow heart rate and heart rhythm irregularities may require intravenous ] or ].<ref name="pp6">{{cite journal |pmid=18678118 |year=2008 |last1=Peiris-John |first1=RJ |last2=Wickremasinghe |first2=AR |title=Efficacy of activated charcoal in yellow oleander poisoning |volume=53 |issue=2 |pages=33–5 |journal=The Ceylon Medical Journal |doi=10.4038/cmj.v53i2.228|doi-access=free |hdl=2292/41963 |hdl-access=free }}</ref> In moderate cases, prolonging of the PR interval and progression to AV dissociation, cardiac pacing is used.<ref name="pp7">{{cite journal |pages=266–73 |doi=10.1046/j.1365-3156.1999.00397.x |title=Epidemic of self-poisoning with seeds of the yellow oleander tree (Thevetia peruviana) in northern Sri Lanka |year=1999 |last1=Eddleston |first1=M. |last2=Ariaratnam |first2=C. A. |last3=Meyer |first3=W. P. |last4=Perera |first4=G. |last5=Kularatne |first5=A. M. |last6=Attapattu |first6=S. |last7=Sheriff |first7=M. H. R. |last8=Warrell |first8=D. A. |journal=Tropical Medicine and International Health |volume=4 |issue=4 |pmid=10357862|doi-access=free }}</ref> |
|
|
|
|
|
The effectiveness of all these interventions is unknown and are associated with side-effects. Therefore, consultation with a cardiologist is recommended when managing significant N. Oleander induced arrhythmias.<ref name="pp4" /> The use of anti-digoxin Fab IV has proven successful in cases of oleandrin poisoning<ref name="pp8">{{cite journal |pages=817–23 |doi=10.1007/s00392-005-0293-3 |pmid=16382383 |title=Successful treatment of oleander intoxication (cardiac glycosides) with digoxin-specific Fab antibody fragments in a 7-year-old child |year=2005 |last1=Camphausen |first1=C. |last2=Haas |first2=N. A. |last3=Mattke |first3=A. C. |s2cid=25517175 |journal=Zeitschrift für Kardiologie |volume=94 |issue=12}}</ref> |
|
|
|
|
|
A dose of 400 mg is used in digoxin poisoning, but a dose of 800 mg is recommended for oleandrin poisoning due to the lower binding affinity of the antibody to oleandrin.<ref name="pp10">{{cite journal |pages=273–81 |doi=10.1016/j.toxicon.2010.03.026 |title=A review of the natural history, toxinology, diagnosis and clinical management of Nerium oleander (common oleander) and Thevetia peruviana (yellow oleander) poisoning |year=2010 |last1=Bandara |first1=Veronika |last2=Weinstein |first2=Scott A. |last3=White |first3=Julian |last4=Eddleston |first4=Michael |journal=Toxicon |volume=56 |issue=3 |pmid=20438743|bibcode=2010Txcn...56..273B }}</ref><ref name="pp11">{{cite journal |pages=967–72 |doi=10.1016/S0140-6736(00)90014-X |pmid=10768435 |title=Anti-digoxin Fab fragments in cardiotoxicity induced by ingestion of yellow oleander: a randomised controlled trial |year=2000 |last1=Eddleston |first1=M |last2=Rajapakse |first2=S |last3=Rajakanthan |last4=Jayalath |first4=S |last5=Sjöström |first5=L |last6=Santharaj |first6=W |last7=Thenabadu |first7=PN |last8=Sheriff |first8=MHR |last9=Warrell |first9=DA |s2cid=2095538 |journal=The Lancet |volume=355 |issue=9208 }}</ref> Patients receiving an adequate dose of anti-digoxin Fab show a good response, resolving serious arrhythmias in two hours in fifty percent of the cases. Treated patients showed a rapid increase in heart rate and a significant decline in serum potassium levels.<ref name="pp11" /> The reason anti-digoxin Fab is sparingly used in developing countries is its high cost, even though it is such an effective treatment.<ref name="pp12">{{cite journal |pages=1041–4 |doi=10.1016/S0140-6736(03)14415-7 |pmid=14522536 |title=Deaths due to absence of an affordable antitoxin for plant poisoning |year=2003 |last1=Eddleston |first1=Michael |last2=Senarathna |first2=Lalith |last3=Mohamed |first3=Fahim |last4=Buckley |first4=Nick |last5=Juszczak |first5=Edmund |last6=Sheriff |first6=MH Rezvi |last7=Ariaratnam |first7=Ariaranee |last8=Rajapakse |first8=Senaka |last9=Warrell |first9=David |last10=Rajakanthan |first10=K |s2cid=20194201 |journal=The Lancet |volume=362 |issue=9389|display-authors=8 }}</ref> |
|
|
|
|
|
== Traditional medicine == |
|
|
Although oleander has been used in ] for treating various disorders, there is no evidence that it is safe or effective for any medicinal purpose.<ref name=drugs /> |
|
|
|
|
|
== Political controversy == |
|
|
During the ], ]'s ] ], and ] CEO ], a major Trump booster and an investor in a company that develops oleandrin, promoted oleandrin as a potential treatment of the disease in a July 2020 ] meeting with Trump, who expressed enthusiasm for the substance.<ref name="swan">{{cite news|url=https://www.axios.com/trump-covid-oleandrin-9896f570-6cd8-4919-af3a-65ebad113d41.html|author=Jonathan Swan|title=Trump eyes new unproven coronavirus "cure"|work=Axios|date=2020-08-17|access-date=2020-08-17}}</ref><ref name="frias">{{cite news|url=https://www.businessinsider.com/trump-new-unproven-coronavirus-cure-oleandrin-hud-ben-carson-2020-8|title=Trump reportedly pushing new unproven coronavirus treatment that is also embraced by HUD Sec. Ben Carson and MyPillow's Mike Lindell|work=Business Insider|author=Lauren Frias|date=2020-08-17|access-date=2020-08-17}}</ref><ref>{{cite news|url=https://www.washingtonpost.com/politics/trump-struggled-summer-coronavirus/2020/08/08/e12ceace-d80a-11ea-aff6-220dd3a14741_story.html|newspaper=Washington Post|date=August 8, 2020|title=The lost days of summer: How Trump fell short in containing the virus|author=Philip Rucker, Yasmeen Abutaleb, Josh Dawsey and Robert Costa|quote=The president recently hosted Andrew Whitney, a biopharmaceuticals executive on the board of a company called Phoenix, who met in the Oval Office with Trump. Whitney, who has a limited health background, pitched Trump on a botanical extract called oleandrin as a treatment for the coronavirus, according to two senior administration officials with knowledge of the discussion. One official said Mike Lindell, a Trump booster and the chief executive of MyPillow — who stars as pitchman for his product in advertising on some of the Fox News shows Trump watches — helped arrange the meeting. Since then, Whitney has personally made overtures to senior leaders at the Food and Drug Administration, including its commissioner, Stephen Hahn, in an effort to get the agency to approve oleandrin as a treatment for the coronavirus.}}</ref><ref name="facher">{{cite web|author=Lev Facher|url=https://www.statnews.com/2020/08/27/trump-has-launched-an-all-out-attack-on-the-fda-will-its-scientific-integrity-survive/|title=Trump has launched an all-out attack on the FDA. Will its scientific integrity survive?|publisher=STAT|date=27 August 2020|access-date=29 August 2020}}</ref> These claims were widely regarded by scientists as dubious, misleading, and alarming, as well as having no clinical proof of safety or effectiveness.<ref name=swan/><ref name=facher/><ref name="novella">{{cite web | author-link= Steven Novella |last1=Novella |first1=Steven |title=Oleandra – The New COVID Snake Oil |date=19 August 2020 |url=https://sciencebasedmedicine.org/oleandra-the-new-covid-snake-oil/ |publisher=Science Based Medicine |access-date=28 August 2020}}</ref> |
|
|
|
|
|
The unproven claims of benefit further caused concern among scientists that the Trump administration might force unwarranted FDA approval of oleandrin as a safe and effective treatment for COVID-19 infection.<ref name=frias/><ref name=facher/><ref name=novella/> However, on 14 August 2020, the FDA rejected the application for marketing an oleandrin dietary supplement by Phoenix Biotechnology, Inc. – the manufacturer of the product – due to concerns that oleandrin would not be safe to consume.<ref name="cnn">{{cite news |author1=Jen Christensen |author2=Jamie Gumbrecht |title=FDA rejects oleandrin, an unproven coronavirus therapeutic pushed by MyPillow CEO, as a dietary supplement ingredient |url=https://www.cnn.com/2020/09/04/health/oleandrin-coronavirus-fda-mypillow/index.html |access-date=4 September 2020 |work=CNN |date=4 September 2020}}</ref> |
|
|
|
|
|
== Effects on animals == |
|
|
Oleandrin poisoning by eating oleander leaves can be lethal at low dosages.<ref>{{ cite journal |author1=Soto-Blanco, B. |author2=Fontenele-Neto, J. D. |author3=Silva, D. M. |author4=Reis, P. F. |author5=Nóbrega, J. E. |s2cid=7361800 | title = Acute cattle intoxication from ''Nerium oleander pods'' | journal = Tropical Animal Health and Production | year = 2006 | volume = 38 | issue = 6 | pages = 451–454 | doi = 10.1007/s11250-006-4400-x | pmid = 17243471 }}</ref> Cases of sheep lethality have been reported to only one leaf of oleander.<ref name="inchem">{{ cite web | url = http://www.inchem.org/documents/pims/plant/pim366.htm | title = Nerium oleander L.(PIM 366) | publisher = IPCS Inchem | year = 2005 | access-date = 2005-10-23 }}</ref> Symptoms present in poisoned animals include bloody diarrhea and ], the latter especially in ]. Because the leaf itself is quite bitter, only starving animals will be likely to eat the plant. The ] for animals is estimated to be about 0.5 mg/kg.<ref name="inchem" /> |
|
|
|
|
|
== References == |
|
|
{{reflist}} |
|
|
|
|
|
] |
|
|
] |
|
|
] |
|
|
] |
|
|
] |