Scientific Name(s): Anamirta cocculus Wight & Arn.
Common Name(s): Cocculus fructus, Cocculus indicus, Fish killer, Fishberry, Hockle elderberry, Indian berry, Kockel-lian, Levant berry, Levantnut, Louseberry, Poisonberry, Tuba biji
A. cocculus, known as levant berry, is a climbing woody shrub native to India, Burma, and other parts of Malaysia. It has wide thick leaves and rootlets that ooze a white milky latex. The fragrant flowers produce U-shaped seeds. The fruit dries to a bitter, nearly black wrinkled shape.1, 2, 3
The fruit of levant berry is gathered from the wild and sun dried for export. In India, the leaves have been inhaled as a snuff to relieve malaria, and the leaf juice used in combination with other natural products as a vermifuge.1 Extracts of the plant have been applied topically for lice, but the toxic nature of the components (in particular picrotoxin) makes this application dangerous, especially in cases of abraded or irritated skin. For centuries, fishermen in Asia used the seeds to produce a poison to stun fish,4 and in some societies, ground whole dried fruit has been used to kill birds or dogs, and to stupefy game as well as fish.5 Picrotoxin has been used as a stimulant for the management of morphine and barbiturate poisoning and was considered an official remedy for epilepsy at the turn of the 19th century into the 20th in the United States; however, it is no longer used for this condition because of severe toxicity.1, 3 Use as a biological weapon has been suggested for picrotoxin because of the ease of chemical isolation and purification.5
The fruit flesh and seed shells contain the nontoxic alkaloids menispermine and paramenispermine.1, 6 The seed, however, contains the bitter, toxic principle picrotoxin (1.5% to 5%); this compound can be separated into picrotoxinin and picrotin, which are oxygenated sesquiterpene derivatives.7 The tasteless compounds anamirtin and cocculin are also present, along with a fixed oil (11% to 24% of the seed).1 The seed is also rich in fatty acids. The stem and roots of the plant contain quaternary alkaloids (eg, berberine, palmatine).6
Uses and Pharmacology
Picrotoxin acts as gamma-aminobutyric acid (GABA) receptors, blocking conductance enhancement of agonists such as propofol and barbiturates, hence its historical application as an antidote to barbiturate poisoning.4, 8 Studies conducted in rodents have shown improved sexual behavior in adult rats and their offspring due to possible action of picrotoxin on GABA receptors.9, 10, 11
Clinical studies of picrotoxin use in Meniere disease, as well as in combination with other natural remedies for vertigo, have been limited because of toxicity concerns.12, 13 In a small clinical study, picrotoxin suppositories (1 mg 3 times per week) were more effective than betahistine in reducing the frequency and intensity of vertigo attacks.12
No clinical evidence supports any clinical applications of levant berry. In a small clinical study, picrotoxin suppositories (1 mg 3 times per week) were more effective than betahistine in reducing the frequency and intensity of vertigo attacks.12
Pregnancy / Lactation
Avoid use. Adverse effects have been documented. Exposure to picrotoxin has been shown to induce demasculinization of male offspring.11
None well documented.
Picrotoxin stimulates the CNS and is a GI irritant.1
High doses can cause salivation, vomiting, purging, rapid shallow respiration, palpitations or heart slowing, stupor, loss of consciousness, and death.3, 8 Death from doses of 2 to 3 g of the fruit have been reported.3
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