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Oleander Leaf

Other common name(s): oleander, dogbane, laurier rose, rosebay, Anvirzel, Xenavex, SAOB-0401

Scientific/medical name(s): Nerium oleander, Oleandri polium, Thevetia peruviana

Description

Oleander is a poisonous evergreen shrub or small tree identified by its fragrant white, red, pink, or purple flowers and long slender, leathery leaves, which grow in pairs opposite each other or in whorls of 3. It grows in mild climates or as an indoor plant. The active ingredients are extracted from the leaves, but all parts of the plant are poisonous.

Overview

Oleander extracts -- in carefully controlled doses -- are in the early phases of testing to find out whether they are effective in treating cancer. There have been numerous reports of poisoning and death from ingestion of oleander, oleander leaf tea, and its extracts. It has killed adults, children, pets, and livestock. Even a small amount of oleander can cause death due to its effects on the heart. Inhaling the smoke from burning oleander or eating honey made from its nectar can produce poisonous effects. Since such tiny amounts can cause death, oleander supplements and extracts from any part of the oleander plant should not be used except under the careful observation and controlled conditions of a clinical trial.

How is it promoted for use?

Even though oleander is poisonous, heavily diluted oleander preparations have been promoted to treat a variety of conditions including muscle cramps, asthma, corns, menstrual pain, epilepsy, paralysis, skin diseases, heart problems, and cancer. It has also been used in folk remedies as an insecticide and to kill rats.

What does it involve?

There is no established therapeutic dose of oleander extract. The oleander leaf is on the Commission E (Germany's regulatory agency for herbs) list of unapproved herbs. This means that it is not recommended for use because it has not been proven to be safe or effective. The plant parts are toxic, whether cooked, raw, or made into tea.

An injectable oleander extract with the brand name of Anvirzel was available at one time, but it has not been approved for marketing by the US Food and Drug Administration (FDA). In March 2000, the FDA warned Anvirzel’s manufacturers to stop promoting the product as safe and effective after it found misleading information on their Web site. The FDA noted that claims were being made based on preliminary and inconclusive data. A company cannot claim a drug is safe and effective unless it has been fully tested and shown to be so.

What is the history behind it?

Although this plant is poisonous, products made from oleander have been used for centuries as herbal medicine. Historical records show that the Mesopotamians in the 15th century B.C. believed in the healing properties of oleander. The Babylonians used a mixture of oleander and licorice to treat hangovers. Pliny, the Elder of ancient Greece, wrote about the appearance and properties of oleander. Arab physicians first used oleander as a cancer treatment in the 8th century A.D.

During the 1960s, Huseyin Z. Ozel, MD, a Turkish physician, began his studies of oleander as an anti-cancer treatment. He developed an oleander extract that he patented and trademarked in the United States and Europe as Anvirzel. He began his study because of folk traditions that suggested that an extract of oleander was effective against leukemia.

What is the evidence?

The effectiveness of oleander has not been proven. In test tube studies, oleandrin, one of the substances found in oleander extracts, caused apoptosis (a specific type of cell death) of prostate cancer cells. In other test tube studies, Anvirzel appeared to slow the growth of human bladder cancer cells, but human studies are needed to determine whether it will work in people. Very early studies of carefully dosed Anvirzel in people with cancer have not yet shown that it helps. Side effects included nausea and vomiting, aches, and redness at the injection site, but the drug did not appear to affect the cancer in these patients. One very early study of 18 patients with advanced cancer was done primarily to determine the best dose of the drug. No measurable responses were noted in patients’ cancer during this small study. Although there are claims that Anvirzel improves quality of life, reduces pain, increases energy, and causes cancer regression and remission, available scientific evidence does not support these claims.

Another company had planned to offer an oleander extract that could be placed under the tongue, which they named Xenavex. Phase I and Phase II clinical trials on Xenavex were announced in 2005 on people with non–small-cell lung cancer. However, the clinical trials were not done, and the announcements were later removed from the federal clinical trials Web site. The company did not return calls or e-mails about the product.

Before any form of oleander can be recommended for human use, it must be thoroughly tested in people using the carefully controlled dosing and observation procedures used in clinical trials.

Are there any possible problems or complications?

This substance may not have been thoroughly tested to find out how it interacts with medicines, foods, herbs, or supplements. Even though some reports of interactions and harmful effects may be published, full studies of interactions and effects are not often available. Because of these limitations, any information on ill effects and interactions below should be considered incomplete.

The oleander plant is poisonous, and many people have died of heart failure or respiratory paralysis after eating parts of the plant or drinking tea made from it. Some of the symptoms and signs of oleander toxicity are nausea, vomiting, colic, appetite loss, dizziness, drowsiness, high potassium levels, dilated pupils, bloody diarrhea, seizures, loss of consciousness, slow or irregular pulse, and heart block -- a blockage of the electrical impulses that stimulate the heart to contract. There have been reports of death occurring after oral and/or rectal administration of the extract from the plant. The FDA has received reports of at least 2 deaths linked to Anvirzel.

Skin irritation from contact with oleander has occurred and allergies are possible. One report observed that, when oleander was taken by a pregnant woman 12 hours before delivery, her baby was affected with seizures and a slowed heart rate. No other cause for the seizures and low heart rate was found. This herb should be avoided, especially by children and by women who are pregnant or breast-feeding. Relying on this type of treatment alone and avoiding or delaying conventional medical care for cancer may have serious health consequences.

Additional resources

More information from your American Cancer Society

The following information on complementary and alternative therapies may also be helpful to you. These materials may be found on our Web site (www.cancer.org) or ordered from our toll-free number (1-800-ACS-2345).

Dietary Supplements: What Is Safe?

The ACS Operational Statement on Complementary and Alternative Methods of Cancer Management

Complementary and Alternative Methods and Cancer

Placebo Effect

Learning About New Ways to Treat Cancer

Learning About New Ways to Prevent Cancer

References

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin, TX: American Botanical Council; 1998.

Clark RF, Selden BS, Curry SC. Digoxin-specific Fab fragments in the treatment of oleander toxicity in a canine model. Ann Emerg Med. 1991;20:1073-1077.

Davies MK, Mayne AJ. Oleander poisoning. Arch Dis Child. 2001;84:9.

Fetrow CW, Avila JR. Professional's Handbook of Complementary & Alternative Medicines. Philadelphia, PA: Lippincott Williams & Wilkins; 2004.

Gruenwald J. PDR for Herbal Medicines. 3rd ed. Montvale, NJ: Thomson PDR; 2004.

Lamm D, Ashish K, DeHaven J. Cytotoxic effect of nerium oleander extract (Anvirzel) on bladder cancer cells. In: Program and abstracts of the American Society of Clinical Oncology (ASCO) annual meeting; May 15-19, 1999; Atlanta, Georgia. Abstract 1328.

Langford SD, Boor PJ. Oleander toxicity: examination of human and animal toxic exposures. Toxicology. 1996;109:1-13.

McConkey DJ, Lin Y, Nutt LK, Ozel HZ, Newman RA. Cardiac glycosides stimulate Ca2+ increases and apoptosis in androgen-independent, metastatic human prostate adenocarcinoma cells. Cancer Res. 2000;60:3807-3812.

Mekhail T, Kaur H, Ganapathi R, et al. Phase 1 trial of Anvirzel in patients with refractory solid tumors. Inves New Drugs. 2006;24:423-427.

Oleander (nerium oleander, thevetia peruviana). Aetna InteliHealth Web site. Accessed at www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402/351437.html on June 6, 2008.

Thilagar S, Thirumalaikolundusubramanian P, Gopalakrishnan S, et al. Possible yellow oleander toxicity in a neonate. Indian Pediatr. 1986;23:393.

Turan N, Akgün-Dar K, Kuruca SE, et al. Cytotoxic effects of leaf, stem and root extracts of Nerium oleander on leukemia cell lines and role of the p-glycoprotein in this effect. J Exp Ther Oncol. 2006;6:31-38.

US National Institutes of Health. Clinical trial announcement: a phase I/II multicenter, off-label, dose escalation study of Xenavex in patients with advanced (stage IIIB or IV) non-small cell lung cancer; for whom previous therapy has failed. Clinical Trials Web site. Accessed at www.clinicaltrials.gov on October 18, 2005. Content no longer available.

Note: This information may not cover all possible claims, uses, actions, precautions, side effects or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for consultation with your doctor, who is familiar with your medical situation.


Last Medical Review: 11/28/2008
Last Revised: 11/28/2008