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Medically reviewed on Sep 20, 2018

Scientific Name(s): Sanguinaria canadensis L. Family: Papaveraceae (poppies)

Common Name(s): Bloodroot ( blood root ), bloodwort , red puccoon , redroot , coon root , paucon , sweet slumber , tetterwort , snakebite , Indian paint , black paste


In vitro studies demonstrate potential for use in cancer therapy; however, animal experiments and clinical studies are lacking. Bloodroot has been marketed in toothpastes and mouthwashes for the prevention of gum disease and plaque, but studies have found it inferior to drugs such as doxycycline and chlorhexidine, with concerns of toxicity.


Clinical studies are lacking to provide dosage guidelines.


Contraindications have not been identified.


Avoid use due to documented adverse effects.


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 a number of case reports.


Based on epidemiological studies, there is a correlation between the use of sanguinarine-containing toothpastes and oral leukoplakia (a possible precursor to oral cancer).


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. 1 , 2


Bloodroot was used by eastern American Indian tribes as a red dye and medicinally as a blood purifier, as well as for treating ulcers and skin conditions. These medicinal uses derived from the appearance of the blood-red latex exuded from the fresh root. The juice was also taken for coughs and sore throats, with the bitter taste masked by placing the juice on a lump of maple sugar that was then sucked. Higher oral doses were observed to have expectorant and emetic properties. The root was used in 19th century medicine as a caustic topical treatment for skin cancers, polyps, and warts. In 1983, an extract of bloodroot was marketed in toothpastes and mouthwashes for prevention of gum disease and plaque. 3


Sanguinaria root is an abundant source of isoquinoline alkaloids, with the two major quaternary alkaloids sanguinarine and chelerythrine having been isolated in the 19th century. While most alkaloids are colorless, sanguinarine is a bright red benzophenanthradine alkaloid and is considered to be the most active constituent in the plant. Highest levels of sanguinarine are found in the rhizomes, then the roots, with lesser amounts found in the flowers and leaves. Other related compounds include berberine, sanguidimerine, protopine, and other minor alkaloids.

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. 2 , 4 , 5 , 6 , 7 , 8

Uses and Pharmacology


In vitro studies in human cancer cells and 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. 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19

Clinical trials are lacking. 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 a number of case reports. Because there is inconsistent evidence to support the use of bloodroot in nonmelanoma skin cancer, it should not be used in this disease. 20

Other effects
Antimicrobial activity

Bloodroot extracts exhibited antimicrobial properties, primarily of the oral cavity, but also versus Helicobacter pylori and cholera bacterium. 21 , 22 , 23 , 24 Clinical applications beyond the use of sanguinarine in mouthwashes have not been investigated.

Antiplaque and gingivitis

Sanguinarine use for the prevention and treatment of dental plaque and gingivitis is considered modestly effective, but inferior to chlorhexidine, doxycycline, and other agents. 25 , 26 , 27


Inhibition of platelet aggregation has been shown in vitro. 16 , 28

Immune system

Increases in cytokine production and suppression of cyclooxygenase 1 have been demonstrated in human mononuclear cells. 7 , 28 , 29

Animal food supplement

The use of bloodroot as a food supplement in animals has been explored due to its purported appetizing and antioxidant effects. In pigs fed a sanguinarine and chelerythrine mix over 90 days, elevations in liver enzymes were observed but there were no other apparent ill effects. 30


Clinical studies are lacking to provide dosage guidelines. Bloodroot is emetic at dosages of 30 to 125 mg in humans. It was formerly an ingredient in toothpastes and mouthwashes, but its use has largely been discontinued because of toxicity concerns. 31


Avoid use due to documented adverse reactions, including emmenogogue effect and uterine stimulant action. 32 Studies in pigs have shown antiangiogenic effects on ovarian follicle development. 33


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. 28

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 a number of cases reports. Because tissue damage cannot be limited, and because inconsistent evidence exists to support its use in nonmelanoma skin cancer, bloodroot should not be used in this disease. 3 , 20 , 34 , 35

Epidemic edema has been reported in India, where edible cooking oils contaminated with sanguinarine-containing Argemone mexicana seeds were found. 36 , 37


In rats, short-term toxicity studies of sanguinarine and Sanguinaria extracts found minimal oral toxicity (median lethal dose [LD 50 ] 1,200 to 1,700 mg/kg), probably due to its very limited gastric absorption. Sanguinarine was considerably more toxic via acute intravenous administration (LD 50 29 mg/kg). A dermal LD 50 of more than 200 mg/kg in rabbits was estimated, 38 and no reproductive or developmental effects in rats and rabbits were reported. 39

Despite its DNA intercalating ability, sanguinarine was not mutagenic in the Ames test. Phototoxic effects against mosquito larvae have been reported. 40 , 41 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 ill effects. 30

A correlation between use of sanguinarine-containing toothpastes and oral leukoplakia has been reported in epidemiological studies and supported by in vitro studies. 31 , 42 , 43 , 44 , 45 , 46 However, the relevance of this association has been disputed, and the products included in the research ( Viadent toothpaste and mouthwash) no longer contain sanguinarine. 44 , 47 Other sanguinarine dental products are available and promoted especially via the Internet, and caution is warranted.


1. Sanguinaria canadensis L. USDA, NRCS. 2007. The PLANTS Database ( , February, 2010). National Plant Data Center, Baton Rouge, LA 70874-4490 USA.
2. Salmore AK, Hunter MD. Environmental and genotypic influences on isoquinoline alkaloid content in Sanguinaria canadensis . J Chem Ecol . 2001;27(9):1729-1747.
3. Laub DR Jr. Death from metastatic basal cell carcinoma: herbal remedy or just unlucky? J Plast Reconstr Aesthet Surg . 2008;61(7):846-848.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. Ahmad N, Gupta S, Husain MM, Heiskanen KM, Mukhtar H. Differential antiproliferative and apoptotic response of sanguinarine for cancer cells versus normal cells. Clin Cancer Res . 2000;6(4):1524-1528.
10. Hu CM, Cheng HW, Cheng YW, Kang JJ. Induction of skeletal muscle contracture and calcium release from isolated sarcoplasmic reticulum vesicles by sanguinarine. Br J Pharmacol . 2000;130(2):299-306.
11. Hussain AR, Al-Jomah NA, Siraj AK, et al. Sanguinarine-dependent induction of apoptosis in primary effusion lymphoma cells. Cancer Res . 2007;67(8):3888-3897.
12. Adhami VM, Aziz MH, Reagan-Shaw SR, Nihal M, Mukhtar H, Ahmad N. Sanguinarine causes cell cycle blockade and apoptosis of human prostate carcinoma cells via modulation of cyclin kinase inhibitor-cyclin-cyclin-dependent kinase machinery. Mol Cancer Ther . 2004;3(8):933-940.
13. Adhami VM, Aziz MH, Mukhtar H, Ahmad N. Activation of prodeath Bcl-2 family proteins and mitochondrial apoptosis pathway by sanguinarine in immortalized human HaCaT keratinocytes. Clin Cancer Res . 2003;9(8):3176-3182.
14. Basini G, Bussolati S, Santini SE, Grasselli F. Sanguinarine inhibits VEGF-induced angiogenesis in a fibrin gel matrix. Biofactors . 2007;29(1):11-18.
15. Basini G, Santini SE, Bussolati S, Grasselli F. Sanguinarine inhibits VEGF-induced Akt phosphorylation. Ann N Y Acad Sci . 2007;1095:371-376.
16. Chang MC, Chan CP, Wang YJ, et al. Induction of necrosis and apoptosis to KB cancer cells by sanguinarine is associated with reactive oxygen species production and mitochondrial membrane depolarization. Toxicol Appl Pharmacol . 2007;218(2):143-151.
17. Eun JP, Koh GY. Suppression of angiogenesis by the plant alkaloid, sanguinarine. Biochem Biophys Res Commun . 2004;317(2):618-624.
18. Han MH, Yoo YH, Choi YH. Sanguinarine-induced apoptosis in human leukemia U937 cells via Bcl-2 downregulation and caspase-3 activation. Chemotherapy . 2008;54(3):157-165.
19. Kim S, Lee TJ, Leem J, Choi KS, Park JW, Kwon TK. Sanguinarine-induced apoptosis: generation of ROS, down-regulation of Bcl-2, c-FLIP, and synergy with TRAIL. J Cell Biochem . 2008;104(3):895-907.
20. Saltzberg F, Barron G, Fenske N. Deforming self-treatment with herbal “black salve.” Dermatol Surg . 2009;35(7):1152-1154.
21. Godowski KC. Antimicrobial action of sanguinarine. J Clin Dent . 1989;1(4):96-101.
22. 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.
23. 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.
24. Nandi R, Maiti M, Chaudhuri K, Mahato SB, Bairagi AK. Sensitivity of vibrios to sanguinarine. Experientia . 1983;39(5):524-525.
25. Grenby TH. The use of sanguinarine in mouthwashes and toothpaste compared with some other antimicrobial agents. Br Dent J . 1995;178(7):254-258.
26. Polson AM, Garrett S, Stoller NH, et al. Multi-center comparative evaluation of subgingivally delivered sanguinarine and doxycycline in the treatment of periodontitis. II. Clinical results. J Periodontol . 1997;68(2):119-126.
27. Tenenbaum H, Dahan M, Soell M. Effectiveness of a sanguinarine regimen after scaling and root planing. J Periodontol . 1999;70(3):307-311.
28. 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.
29. 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):45-65.
30. 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.
31. 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.
32. Ernst E. Herbal medicinal products during pregnancy: are they safe? BJOG . 2002;109(3):227-235.
33. 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.
34. McDaniel S, Goldman GD. Consequences of using escharotic agents as primary treatment for nonmelanoma skin cancer. Arch Dermatol . 2002;138(12):1593-1596.
35. 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.
36. 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.
37. Das M, Khanna SK. Clinicoepidemiological, toxicological, and safety evaluation studies on argemone oil. Crit Rev Toxicol . 1997;27(3):273-297.
38. 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.
39. Keller KA, Meyer DL. Reproductive and developmental toxicological evaluation of sanguinaria extract. J Clin Dent . 1989;1(3):59-66.
40. 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.
41. 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.
42. Mascarenhas AK, Allen CM, Loudon J. The association between Viadent use and oral leukoplakia. Epidemiology . 2001;12(6):741-743.
43. Damm DD, Curran A, White DK, Drummond JF. Leukoplakia of the maxillary vestibule—an association with Viadent ? Oral Surg Oral Med Oral Pathol Oral Radiol Endod . 1999;87(1):61-66.
44. Frankos VH, Brusick DJ, Johnson EM, et al. Safety of Sanguinaria extract as used in commercial toothpaste and oral rinse products. J Can Dent Assoc . 1990;56 (7 suppl):41-47.
45. Babich H, Zuckerbraun HL, Barber IB, Babich SB, Borenfreund E. Cytotoxicity of sanguinarine chloride to cultured human cells from oral tissue. Pharmacol Toxicol . 1996;78(6):397-403.
46. Agarwal S, Piesco NP, Peterson DE, et al. Effects of sanguinarium, chlorhexidine and tetracycline on neutrophil viability and functions in vitro. J Periodontal Res . 1997;32(3):335-344.
47. Munro IC, Delzell ES, Nestmann ER, Lynch BS. Viadent usage and oral leukoplakia: a spurious association. Regul Toxicol Pharmacol . 1999;30(3):182-196.

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