Chelidonium majus

Chelidonium majus (celandine, common celandine, greater celandine) contains a number of alkaloids, including chelidonine, chelerythrine, chelidocystatin, coptisine, sanguinarine, berberine, and sparteine.

Greater celandine was traditionally used to improve eyesight and in modern times has been used as a mild sedative, and antispasmodic in the treatment of bronchitis, whooping cough, asthma, jaundice, gallstones, and gallbladder pain. The latex is used topically to treat warts, ringworm, and corns. A semisynthetic thiophosphate derivative of alkaloids from C. majus, called Ukrain, has cyto-toxic and cytostatic effects on tumor cells (1).

Adverse effects

Hematologic

Hemolytic anemia has been reported after the oral use of a celandine extract; there was intravascular hemolysis, renal insufficiency, liver cytolysis, and thrombocytopenia; a direct antiglobulin test was positive (2).

Liver

Hepatitis has been attributed to celandine (3).

• A 42-year-old woman had been admitted twice to hospital with hepatitis (4). No toxic agent could be identified during the first episode, but detailed questioning during the second showed that in both cases she had self-prescribed a commercially available medication of common celandine. Withdrawal of this herbal remedy was followed by an unremarkable recovery.

Table 1 The genera of Papaveraceae

Arctomecon (bear poppy) Argemone (prickly poppy) Bocconia (bocconia) Canbya (pygmy poppy) Chelidonium (celandine) Dendromecon (tree poppy) Eschscholzia (California poppy) Glaucium (horn poppy) Hunnemannia (hunnemannia) Macleaya (macleaya) Meconella (fairy poppy) Papaver (poppy) Platystemon (cream cups) Platystigma (queen poppy) Roemeria (roemeria) Romneya (Matilija poppy) Sanguinaria (bloodroot) Stylophorum (stylophorum) Stylomecon (wind poppy)

• A 42-year-old woman developed acute hepatitis several weeks after taking a herbal formulation containing greater celandine and curcuma root for a skin complaint (5). After withdrawal recovery was rapid and hepatic function returned to normal within 2 months.

Ten cases of acute hepatitis induced by formulations of greater celandine were observed over 2 years in a German University hospital (6). Perhaps ironically, this product is popular in Germany for gastric and gall-bladder problems. In five cases there was marked cholestasis but no liver failure. After withdrawal of the product, the symptoms subsided and the liver enzymes normalized within 2-6 months. Unintentional rechallenge led to a further episode of acute hepatitis in one patient.

In addition to about 15 published cases, some 40 cases of liver damage from C. majus have been reported to the German regulatory authorities (7). The course of the hepatitis can be severe and can include cholestasis and fibrosis, but acute liver failure has not been observed. Based on these data, celandine has been banned for oral use in several countries.

Skin

Contact sensitivity has been attributed to C. majus (8). Susceptibility factors

Some authors caution that the use of celandine in children should be discouraged because of an early fatal colitis in a 3-year-old boy (9); however, this report does not provide convincing evidence that the victim had indeed taken C. majus.

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