Celandine Herb Description - Drug Interactions, Dosage and Some of its Useful Properties

Taxonomic Class

Papaveraceae

Common Trade Names

Multi-ingredient preparations: Bloodroot/Celandine Supreme, Cacau, Celandine Extract, Celandine Tops and Roots, Cytopure, Fennel/Wild Yam Supreme, No. 2040 Headache Remedy, No. 2090 Indigestion Remedy, Venancapsan.

Ukrain, a semisynthetic derivative of celandine alkaloids conjugated with thiophosphoric acid, is available only in Europe.

Common Forms

Available as extracts, tinctures, and teas and as a prescribed injection in Eastern Europe.

Source

Celandine alkaloids are extracted from the roots and flowering tops of Chelidonium majus, a member of the poppy family commonly found in North America, Europe, and Asia. The milky, orange juice from the stems and other parts of the plant has been used for medicinal purposes. Greater celandine is not related to the plant known as lesser celandine, Ranunculus ficaria.

Chemical Components

The main alkaloids from the celandine root are chelidonine and coptisine; more than 30 isoquinoline alkaloids have been detected as secondary metabolites. Other compounds include caffeic acid esters, chelidocystatin, chelidonic acid, chelidoniol, choline, cinnamic acids, flavonoids, histamine, methylamine, other alkaloids, quercetin, rutin, and tyramine.

Actions

Caffeic acid is claimed to have antispasmodic and choleretic activity. Coptisine and caffeoylmalic acid have shown similar spasmolytic activity. Chelidonine has mild central analgesic and strong spasmolytic properties that primarily affect the biliary system .

Extracts of celandine inhibit keratinocyte proliferation, suggesting their possible use in treating such skin diseases as warts and psoriasis. Other researchers found cytotoxic (but not antitumorigenic) activity associated with coptisine chloride and an unidentified alkaloid. Chelidocystatin exhibits proteolytic enzyme (cathepsin, papain) inhibition properties.

Reported Uses

Celandine is reported to be useful in treating digestive disorders, eye irritation, and hepatic disease. The plant sap has been used to remove warts, soften calluses and corns, and loosen bad teeth. Chelidonium alkaloids have been used from the late 1800s in cancer treatment. In Europe, they have also been used to treat colonic polyposis and to remove warts, papillomas, condylomas, and nodules. Celandine was found to stimulate the flow of bile and pancreatic enzymes in treating biliary inflammation and obstruction, gallstones, hepatitis, and jaundice. It is also a component of an antiretroviral preparation that may act against the Epstein-Barr and herpes viruses.

One Russian abstract suggests the efficacy of C. majus tincture in reducing the recurrence of chronic tonsillitis in children. This information should be viewed as preliminary findings .

Ukrain (NSC-631570), a novel, investigational semisynthetic drug obtained from C. majus alkaloids, has been demonstrated to possess antineoplastic and immunomodulatory properties. It is thought that the drug may interfere with the metabolism of cancer cells while improving the function of the host immune system . A monograph included with Ukrain referred to a claim that a National Cancer Institute study showed drug action against human cancers. However, Ukrain has not been approved by the FDA for use in the United States . Ukrain claims to kill cancer cells by inducing apoptosis and inhibiting DNA, RNA, and protein synthesis. It was found to be toxic to malignant cells at levels that are nonlethal to normal cells. This theory has been questioned because the purported host-cellular protection phenomenon is thought to be related to subtherapeutic dosing of Ukrain. In a study on women with breast cancer, the drug acted on malignant cells, making them more recognizable to the immune system, and resulting in their rejection . Case reports and studies obtained through MEDLINE document Ukrain's apparent success in treating several types and sites of cancer, including breast, cervical, colorectal, esophageal, ovarian, testicular, and urethral cancers; malignant melanoma; optic nerve astrocytoma; and Kaposi's sarcoma in patients with AIDS.

Dosage

Dosage of celandine extract depends on the product and use. Because the alkaloid content varies, it is not always standardized in available products.

Dosage of Ukrain is determined by the patient's immune status. A single dose is 5 to 20 mg per I.V. injection, depending on tumor mass, speed of growth, extent of the disease, and the patient's immune status. In several published studies, Ukrain injections were given every other day.

Adverse Reactions

• CNS: dizziness, drowsiness, fatigue, insomnia, restlessness.

• CV: hypotension.

• GI: acute cholestatic hepatitis, elevated liver function test results, nausea, thirst.

• GU: polyuria.

• Skin: contact dermatitis.

• Other: may be embryotoxic (animal studies); tingling, itching, stabbing pains in tumor area.

Interactions

Cardiac glycosides (and Ukrain): May elicit ECG changes. Avoid administration with celandine.

Morphine derivatives and sulfonamides (and Ukrain); May reduce efficacy. Avoid administration with celandine.

Sulfonylureas (and Ukrain); May cause hypoglycemia. Avoid administration with celandine.

Contraindications And Precautions

Celandine is contraindicated in children and pregnant or breast-feeding women and for prolonged periods (longer than 2 weeks). Also, herbal supplements and fresh herbs are contraindicated to self-treat serious hepatic and digestive disorders and other organ systems if disease is suspected.

Avoid direct contact with the fresh plant juices (including the milky sap). Also avoid using herb extracts not approved by the FDA for ophthalmic or topical use because blindness, infection, or tissue ulceration can occur.

Special Considerations

• Some European patients may receive celandine as a prescription drug.

• Inform the patient that few data exist for using this plant for any indication.

• Caution the patient that celandine may interact with such drugs as analgesics, antibiotics, antidiabetic drugs, and cardiac drugs .

• Alert Caution the patient that the C. majus plant must be considered highly toxic. Contact with the sap causes dermatitis, and oral ingestion has been reported to cause abdominal pain, coma, diarrhea, fainting, gastroenteritis, hemorrhagic gastritis, severe stomatitis, vomiting, and even death.

• Alert Mild to severe acute cholestatic hepatitis has been reported in a case series of 10 patients known to have ingested herbal preparations that contained greater celandine. Elevated liver enzyme levels returned to normal in all patients 2 to 6 months after discontinuation of the product.

Points of Interest

Ukrain is available by prescription in Europe, but it is not approved for use in the United States. Products available in the United States are manufactured as herbal nutritional supplements or topical herbal treatments and have not undergone FDA testing. The herb should not be used instead of prescribed drugs for diagnosed ailments or considered equivalent to Ukrain for preventing or treating disease.

Commentary

Although substantial evidence exists that celandine extracts can produce several pharmacologic effects, there are many reports of harm, particularly hepatitis, resulting from its ingestion. Because of the serious risk of complications of self-treating GI, hepatic, and ocular diseases and the possibility of dermatologic reactions in areas surrounding hyperkeratotic skin lesions, the use of celandine supplements and topical agents is not recommended. Alternative, more reliable treatment should be sought from a primary health care provider. Ukrain may have an important role in the treatment of cancer and other diseases, but further research is needed before its use in the United States is approved. Patients interested in Ukrain should try to enroll in compassionate-use protocols or experimental clinical trials after discussing alternatives with their primary care provider or oncologist.

Herbal Medicines