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
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
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for prevention of gum disease and plaque; however, the sanguinarine-containing oral rinse product Viadent has been withdrawn from the market in North America, and use of these products has been largely discontinued due to increased risk of developing oral leukoplakia.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
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
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
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 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
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 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
In vitro data
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
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
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
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
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