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Bloodroot

Scientific Name(s): Sanguinaria canadensis L.
Common Name(s): Black paste, Bloodroot, Bloodwort, Coon root, Indian paint, Moh's paste, Paucon, Red puccoon, Redroot, Snakebite, Sweet slumber, Tetterwort

Medically reviewed by Drugs.com. Last updated on Apr 1, 2018.

Clinical Overview

Use

In vitro studies suggest potential applications in cancer therapy; however, animal experiments and clinical studies are lacking, and use is not recommended. Topical application and/or use in toothpaste and mouthwash products is not recommended due to adverse effects and potential toxicity.

Dosing

Clinical studies are lacking to provide dosage guidelines.

Contraindications

Contraindications have not been identified.

Pregnancy/Lactation

Avoid use due to documented adverse effects.

Interactions

None well documented.

Adverse Reactions

Use of bloodroot as an escharotic agent in the form of a salve or paste has led to localized tissue damage and disfiguring scarring in case reports.

Toxicology

Based on epidemiological studies, there is a correlation between the use of toothpastes containing sanguinarine, an alkaloid derived from bloodroot, and development of oral leukoplakia (a possible precursor to oral cancer).

Scientific Family

  • Papaveraceae (poppy)

Botany

Bloodroot is an early spring wildflower that grows in the woodlands of the eastern United States and Canada. Its single white flower emerges from the ground folded within a grey-green leaf, and the delicate petals rapidly detach as the seed pod matures. The stout rhizome yields a bright red latex when cut, giving the plant its common name. The root and rhizome are collected in the fall for medicinal use.Salmore 2001, USDA 2017

History

Bloodroot was used by eastern American Indian tribes as a red dye, and medicinally as a blood purifier and for treatment of ulcers and skin conditions (eg, warts, polyps, moles). These medicinal uses derived from the blood-red latex exuded from the fresh root. The juice has also been used for treatment of cough and sore throat, with the bitter taste masked by placing the juice on a lump of maple sugar that is then sucked. Higher oral doses have been observed to have expectorant and emetic properties. Use of the root as a caustic topical treatment for skin cancer was first reported in medical literature in the 19th century. In 1983, an extract of bloodroot was marketed in toothpastes and mouthwashes for prevention of gum disease and plaque; however, the sanguinarine-containing oral rinse product Viadent has been withdrawn from the market in North America, and use of these products has been largely discontinued due to increased risk of developing oral leukoplakia. Bloodroot is also added to livestock feed for its antibiotic properties.Croaker 2016, Eversole 2000, Laub 2008, Wang 2012

Chemistry

Sanguinaria root is an abundant source of isoquinoline alkaloids, with the 2 major quaternary alkaloids sanguinarine and chelerythrine isolated in the 19th century. While most alkaloids are colorless, sanguinarine is a bright red benzophenanthridine alkaloid and is considered to be the most active constituent in the plant. The highest levels of sanguinarine are found in the rhizomes, followed by the roots, with lesser amounts found in the flowers and leaves. Other related compounds include berberine, sanguidimerine, protopine, and other minor alkaloids.Croaker 2016

The alkaloids have been characterized and quantified by a variety of methods, such as thin-layer chromatography, ion-pair high-pressure liquid chromatography (HPLC), fast atom bombardment mass spectroscopy, reversed-phase HPLC, and capillary electrophoretic methods.Bambagiotti-Alberti 1991, Campbell 2007, Husain 1999, Salmore 2001, Senchina 2009, Sevcík 2000

Uses and Pharmacology

Animal food supplement

Animal data

The use of bloodroot as a food supplement in animals has been explored due to its purported appetite-stimulating and antioxidant effects.Croaker 2016 In pigs fed a sanguinarine and chelerythrine mix over 90 days, elevations in liver enzymes were observed, but no other adverse effects occurred.Kosina 2004

Antimicrobial activity

In vitro data

Bloodroot extracts exhibited antimicrobial properties, primarily in the oral cavity but also in the GI tract, against Helicobacter pylori and cholera bacterium.Giuliana 1997, Godowski 1989, Mahady 2003, Nandi 1983

Clinical data

Clinical applications beyond the use of sanguinarine in mouthwashes have not been investigated, and toxicity with use of these products has been reported (see Toxicology).Croaker 2016

Cancer

Animal and in vitro data

In vitro studies in human cancer cells and studies in animal models suggest that bloodroot extracts and sanguinarine may have potential clinical applications in the treatment of various cancers. Studies have shown antiangiogenic, cytotoxic, and apoptosis-inducing properties, and reviews of the literature have been published.Achkar 2017, Basu 2016, Croaker 2016 In an in vitro study comparing the potential anticancer activities of the plant alkaloids sanguinarine and chelerythrine in human breast adenocarcinoma cells, sanguinarine demonstrated more chemotherapeutic activity than chelerythrine, indicating it may be a promising candidate for development of new therapies for breast cancer.Almeida 2017

Clinical data

Clinical trials are lacking. There is inconsistent evidence to support the use of bloodroot in nonmelanoma skin cancer; use for this condition is not recommended.Croaker 2016, Eastman 2014, Saltzberg 2009

Immune system

In vitro data

Increases in cytokine production and suppression of cyclooxygenase-1 have been demonstrated in human mononuclear cells.Jeng 2007, Senchina 2009, Senchina 2009

Dosing

Clinical studies are lacking to provide dosage guidelines. Bloodroot may be emetic at dosages as low as 30 mg in humans.Duke 2002 Formerly, sanguinarine-containing toothpastes and mouthwashes were offered as alternatives to chemical-based oral antiseptics, but use has largely been discontinued because of toxicity concerns.Croaker 2016, Eversole 2000

Pregnancy / Lactation

Avoid use due to documented adverse reactions, including emmenagogue effects and uterine-stimulant action.Ernst 2002 Studies in pigs have shown antiangiogenic effects on ovarian follicle development.Basini 2007

Interactions

None well documented. Inhibition of platelet aggregation has been shown in vitro, but no case reports of clinical interactions with antiplatelet drugs have been published.Jeng 2007

Adverse Reactions

Use of bloodroot as an escharotic agent in the form of a salve or paste has led to localized tissue damage and disfiguring scarring in several case reports. Tissue damage cannot be limited, and evidence is lacking to support use in nonmelanoma skin cancer; bloodroot is not recommended for this condition.Affleck 2007, Eastman 2014, Laub 2008, McDaniel 2002, Saltzberg 2009, Wang 2012

Epidemic edema has been reported in India due to edible cooking oils contaminated with sanguinarine-containing Argemone mexicana seeds.Das 1997, Shenolikar 1974,

Toxicology

In rats, short-term toxicity studies of sanguinarine and Sanguinaria extracts found minimal oral toxicity (median lethal dose [LD50] of 1,200 to 1,700 mg/kg), likely due to its very limited gastric absorption. Sanguinarine was considerably more toxic via acute intravenous administration (LD50 of 29 mg/kg). A dermal LD50 of more than 200 mg/kg in rabbits was estimated,Becci 1987 and no reproductive or developmental effects in rats and rabbits were reported.Keller 1989

Despite its DNA intercalating ability, sanguinarine was not mutagenic in the Ames test. Phototoxic effects against mosquito larvae have been reported.Arnason 1992, Kevekordes 1999 In pigs fed a sanguinarine and chelerythrine mix over 90 days, mild elevations in liver enzymes were observed, but there were no histological changes or apparent adverse effects.Kosina 2004

A correlation between use of sanguinarine-containing toothpastes and preneoplastic oral leukoplakia has been reported in epidemiological studies and is supported by in vitro studies.Croaker 2016, Vlachojannis 2012

Sanguinarine dental products remain available and are promoted, especially via the Internet, but caution is warranted. The mouth rinse product Viadent has been withdrawn from the market in North America due to concerns regarding its carcinogenic potential.Croaker 2016

In one study, a correlation between elevated blood levels of sanguinarine and the incidence of gall bladder cancer was observed, although some analytical methods used may be problematic.Croaker 2017

References

Achkar IW, Mraiche F, Mohammad RM, Uddin S. Anticancer potential of sanguinarine for various human malignancies. Future Med Chem. 2017;9(9):933-950.28636454
Affleck AG, Varma S. A case of do-it-yourself Mohs' surgery using bloodroot obtained from the internet. Br J Dermatol. 2007;157(5):1078-1079.17854372
Almeida IV, Fernandes LM, Biazi BI, Vicentini VEP. Evaluation of the anticancer activities of the plant alkaloids sanguinarine and chelerythrine in human breast adenocarcinoma cells. Anticancer Agents Med Chem. 2017;17(11):1586-1592.28270066
Arnason JT, Guèrin B, Kraml MM, Mehta B, Redmond RW, Scaiano JC. Phototoxic and photochemical properties of sanguinarine. Photochem Photobiol. 1992;55(1):35-38.1603849
Bambagiotti-Alberti M, Pinzauti S, Moneti G, Gratteri P, Coran SA, Vincieri FF. Characterization of Sanguinaria canadensis L. fluid extract by FAB mass spectrometry. J Pharm Biomed Anal. 1991;9(10-12):1083-1087.1822177
Basini G, Santini SE, Bussolati S, Grasselli F. The plant alkaloid sanguinarine is a potential inhibitor of follicular angiogenesis. J Reprod Dev. 2007;53(3):573-579.17310078
Basu P, Kumar GS. Sanguinarine and its role in chronic diseases. Adv Exp Med Biol. 2016;928:155-172.27671816
Becci PJ, Schwartz H, Barnes HH, Southard GL. Short-term toxicity studies of sanguinarine and of two alkaloid extracts of Sanguinaria canadensis L. J Toxicol Environ Health. 1987;20(1-2):199-208.3806703
Campbell S, Affolter J, Randle W. Spatial and temporal distribution of the alkaloid sanguinarine in Sanguinaria canadensis L. (bloodroot). Econ Bot. 2007;61(3):223-234.
Croaker A, King GJ, Pyne JH, Anoopkumar-Dukie S, Liu L. Sanguinaria canadensis: traditional medicine, phytochemical composition, biological activities and current uses. Int J Mol Sci. 2016;17(9). pii: E1414.27618894
Croaker A, King GJ, Pyne JH, Anoopkumar-Dukie S, Simanek V, Liu L. Carcinogenic potential of sanguinarine, a phytochemical used in 'therapeutic' black salve and mouthwash. Mut Res. 2017;774:46-56.29173498
Das M, Khanna SK. Clinicoepidemiological, toxicological, and safety evaluation studies on argemone oil. Crit Rev Toxicol. 1997;27(3):273-297.9189656
Duke J, Bogenschutz-Godwin M, duCellier J, Duke P. Handbook of medicinal herbs. 2nd ed. Boca Raton, FL: CRC Press; 2002.
Eastman KL, McFarland LV, Raugi GJ. A review of topical corrosive black salve. J Altern Complement Med. 2014;20(4):284-289.24175872
Ernst E. Herbal medicinal products during pregnancy: are they safe? BJOG. 2002;109(3):227-235.11950176
Eversole LR, Eversole GM, Kopcik J. Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(4):455-464.10760727
Giuliana G, Pizzo G, Milici ME, Musotto GC, Giangreco R. In vitro antifungal properties of mouthrinses containing antimicrobial agents. J Periodontol. 1997;68(8):729-733.9287062
Godowski KC. Antimicrobial action of sanguinarine. J Clin Dent. 1989;1(4):96-101.2700895
Husain S, Narsimha R, Rao RN. Separation, identification and determination of sanguinarine in argemone and other adulterated edible oils by reversed-phase high-performance liquid chromatography. J Chromatogr A. 1999;863(1):123-126.10591470
Jeng JH, Wu HL, Lin BR, et al. Antiplatelet effect of sanguinarine is correlated to calcium mobilization, thromboxane and cAMP production. Atherosclerosis. 2007;191(2):250-258.16797553
Keller KA, Meyer DL. Reproductive and developmental toxicological evaluation of sanguinaria extract. J Clin Dent. 1989;1(3):59-66.2597330
Kevekordes S, Mersch-Sundermann V, Burghaus CM, et al. SOS induction of selected naturally occurring substances in Escherichia coli (SOS chromotest). Mutat Res. 1999;445(1):81-91.10521693
Kosina P, Walterová D, Ulrichová J, et al. Sanguinarine and chelerythrine: assessment of safety on pigs in ninety days feeding experiment. Food Chem Toxicol. 2004;42(1):85-91.14630132
Laub DR Jr. Death from metastatic basal cell carcinoma: herbal remedy or just unlucky? J Plast Reconstr Aesthet Surg. 2008;61(7):846-848.18472318
Mahady GB, Pendland SL, Stoia A, Chadwick LR. In vitro susceptibility of Helicobacter pylori to isoquinoline alkaloids from Sanguinaria canadensis and Hydrastis canadensis. Phytother Res. 2003;17(3):217-221.12672149
McDaniel S, Goldman GD. Consequences of using escharotic agents as primary treatment for nonmelanoma skin cancer. Arch Dermatol. 2002;138(12):1593-1596.12472348
Nandi R, Maiti M, Chaudhuri K, Mahato SB, Bairagi AK. Sensitivity of vibrios to sanguinarine. Experientia. 1983;39(5):524-525.26.6852180
Salmore AK, Hunter MD. Environmental and genotypic influences on isoquinoline alkaloid content in Sanguinaria canadensis. J Chem Ecol. 2001;27(9):1729-1747.11545367
Saltzberg F, Barron G, Fenske N. Deforming self-treatment with herbal "black salve." Dermatol Surg. 2009;35(7):1152-1154.19438678
Senchina DS, Hallam JE, Dias AS, Perera MA. Human blood mononuclear cell in vitro cytokine response before and after two different strenuous exercise bouts in the presence of bloodroot and Echinacea extracts. Blood Cells Mol Dis. 2009;43(3)298-303.19766513
Senchina DS, Flinn GN, McCann DA, Kohut ML, Shearn CT. Bloodroot (Sanguinaria canadensis L., Papaveraceae) enhances proliferation and cytokine production by human peripheral blood mononuclear cells in an in vitro model. J Herbs Spices Med Plants. 2009;15(1):45.20111671
Sevcík J, Vicar J, Ulrichová J, Válka I, Lemr K, Simánek V. Capillary electrophoretic determination of sanguinarine and chelerythrine in plant extracts and pharmaceutical preparations. J Chromatogr A. 2000;866(2):293-298.10670819
Shenolikar IS, Rukmini C, Krishnamachari KA, Satyanarayana K. Sanguinarine in the blood and urine of cases of epidemic dropsy. Food Cosmet Toxicol. 1974;12(5-6):699-702.4452541
Sanguinaria canadensis L. USDA, NRCS. 2017. The PLANTS Database (http://plants.usda.gov, November 2017). National Plant Data Team, Greensboro, NC 27401-4901 USA.
Vlachojannis C, Magora F, Chrubasik S. Rise and fall of oral health products with Canadian bloodroot extract. Phytother Res. 2012;26(10):1423-1426.22318955
Wang MZ, Warshaw EM. Bloodroot. Dermatitis. 2012;23(6):281-283.23169210

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This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.

This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.

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