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Herbs and plants

Aconite—the most dangerous plant in Europe, once used to treat pain?

Sources: 8 · Article: 15 902 characters

Yes. Monkshood was used as a painkiller and local anesthetic, including for neuralgia, rheumatism, and arthritis.

  • The tincture was rubbed into painful areas, and in the 19th century, aconitine was also injected under the skin; the injection caused severe pain.
  • It was dangerous because the medicinal dose and the poisonous dose were very close.
  • Aconitine can disrupt heart function and breathing, and poisoning can cause tingling, vomiting, vision problems, and convulsions, among other symptoms.
  • Deaths were reported after doses of aconitine higher than the official medicinal dose.

What the authors write

Henryk Różański

Aconite medicines were used for neuralgia, rheumatism, and arthritis as painkillers and local anesthetics.

„In the 1880s, a dose of 0.004 g of aconitine was considered lethal to humans. Aconitine and aconite medicines were used for neuralgia, rheumatism, and arthritis. They acted as local anesthetics and painkillers. They lower body temperature.”W latach 80 XIX wieku uznano, że dawka 0,004 g akonityny jest zabójcza dla człowieka. Leki akonitynowe i tojadowe stosowano przy nerwobólach, reumatyzmie i artretyzmie. Był to środek znieczulający miejscowo, przeciwbólowy. Wywołuje spadek ciepłoty ciała.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

Aconite tincture was rubbed on painful areas, while attempts to inject aconitine under the skin caused severe pain at the injection site.

„The tincture was rubbed onto the skin to relieve pain. In the 19th century, attempts were made to inject aconitine nitrate (0.001 g) under the skin as an anesthetic. It had an effect, but this was preceded by intense pain at the injection site. The species Aconitum ferox (Nepal) was used to poison arrows.”Nalewkę wcierano miejscowo przy bólach. W XIX wieku podjęto próby podskórnego wstrzykiwania azotanu akonityny (0,001 g) jako środka znieczulającego. Efekt był, ale poprzedzony ogromnym bólem w miejscu iniekcji. Gatunek Aconitum ferox (Nepal) używany był do zatruwania strzał.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

The difference between the medicinal and poisonous doses was so small that aconite did not become widely used in medicine.

„It is also a medicinal plant, but the gap between the medicinal dose and the poisonous dose is so small that it did not become widely used in medicine or establish itself as a reliable medicine. Doctors themselves were afraid of monkshood, and preparing medicines from aconite required a truly precise scale—and, more importantly, one that worked properly.”Jest to również roślina lecznicza, jednakże rozpiętość między dawką leczniczą a dawką trującą jest tak niewielka, że nie znalazła ona większego zastosowania w medycynie oraz ugruntowanej pozycji jako leku. Sami lekarze bali się mordownika, a przy sporządzaniu leków z tojadem należało posiadać naprawdę precyzyjną wagę, a co ważniejsze – sprawną wagę.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

Aconitine first irritates sensory nerve endings, causing a burning sensation, then paralyzes them and causes numbness.

„Aconitine paralyzes sensory nerve endings. At first it irritates them, causing a burning sensation, then it paralyzes them, causing numbness. Aconitine acts both when applied locally and when given systemically. When taken orally or by injection, it initially stimulates all the autonomic parasympathetic centers and subcortical nuclei, causing circulatory failure.”Akonityna poraża zakończenia czuciowe. Początkowo je drażni, wywolując pieczenie i palenie, potem poraża – wywołując znieczulenie. Akonityna działa po podaniu miejscowym jak i ogólnym. Po podaniu doustnym lub pozajelitowym początkowo pobudza wszystkie wegetatywne ośrodki parasympatyczne, jądra podkorowe, wywołując niedomogę krążenia.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

Poisoning can cause tingling, vomiting, vision problems, and, in severe cases, convulsions.

„Poisoning causes a general feeling of tingling and numbness. It leads to nausea, diarrhea, and vomiting. Pain in the calves, cold sweat, and pale skin follow. Chills come before problems swallowing and speaking. Finally, vision problems appear. The pupils constrict and then dilate, responding slowly to light (photophobia). In fatal poisoning, convulsions occur.”Przy zatruciu wywołuje ogólnie odczuwane uczucie mrowienia i drętwienia. Sprowadza nudności, biegunkę i wymioty. Następnie pojawia się ból łydek, zimny pot, bladość skóry. Dreszcze poprzedzają objawy zaburzeń przełykania i mówienia. Wreszcie pojawiają się zaburzenia widzenia. Źrenice ulegają zwężeniu, potem rozszerzeniu, powoli reagują na światło (światłowstręt). Przy zatruciu śmiertelnym występują drgawki.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

Aconitine can disrupt the heart rhythm, stop the heart's movements, and paralyze the respiratory center.

„This is followed by increased sensitivity of the heart's autonomic nerve fibers, leading to excessive sensitivity in the third-order excitomotor centers —> dissociation of heart movements, cardiac arrhythmia, ventricular peristalsis, fine fibrillation of the atrial and ventricular fibers —> cessation of heart movements during diastole.”Potem wzrost wrażliwości autonomicznych włokien serca, prowadzący do stanów nadwrażliwości III-rzędowych ośrodków ekscytomotorycznych —> dysocjacja ruchów serca, arytmia serca, perystaltyka komór serca, drżenie włokienkowe przedsionków i komór sercowych —> zatrzymanie ruchów serca w rozkurczu.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

Deaths were reported after a dose of 0.0015 g, even though the official medicinal dose of aconitine was 0.0001–0.0003 g.

„In the past, the official medicinal dose of aconitine was 0.0001–0.0003 g. Unfortunately, deaths were reported after a dose of 0.0015 g, so aconite began to be withdrawn from medical use. Death occurred because the centers in the medulla oblongata were paralyzed.”Dawniej oficjalna dawka lecznicza akonityny wynosiła 0,0001-0,0003 g. Niestety zgłaszano zejścia śmiertelne po podaniu dawki 0,0015 g, przez co zaczęto wycofywać tojad z lecznictwa. Śmierć następowała w wyniku porażenia ośrodków rdzenia przedłużonego.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

Aconite was withdrawn from medical use because poisoning could paralyze the respiratory center, slow the heart, and cause death.

„Death occurred because the centers in the medulla oblongata were paralyzed. The respiratory center was paralyzed, the heart slowed, and the patient died while remaining conscious. As always, some people did not want to remove this powerful alkaloid from medical practice.”Śmierć następowała w wyniku porażenia ośrodków rdzenia przedłużonego. Następowało porażenie ośrodka oddechowego, zwolnienie czynności serca i śmierć przy zachowaniu świadomości pacjenta. Jak zawsze jest grupa ludzi, którzy nie chcieli pozbyć się z lecznictwa silnego alkaloidu.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie
Henryk Różański

The author advises against growing aconite at home if children or older people with memory loss live there.

„The species Aconitum ferox (Nepal) was used to poison arrows. The plant should not be grown in a home where there are children or older people with memory loss. I think that today, aconite poisoning would end in the patient's death before the cause was identified in the hospital.”Gatunek Aconitum ferox (Nepal) używany był do zatruwania strzał. Rośliny nie należy uprawiać, jeśli mamy w domu dzieci oraz osoby starsze z zanikami pamięci. Myślę, że w obecnych czasach zatrucie tojadem – zanim zidentyfikowano by przyczynę w szpitalu – zakończylo by się śmiercią pacjenta.
Tojad mocny – Aconitum napellus L. (Ranunculaceae) – jak to dawniej z nim było w medycynie

Research from PubMed · Europe PMC

We selected 7 studies with the best, positive results. This is a selection, not a full review of all research.

Total number of studies on this topic in PubMed: 574.

The review describes the medicinal use of aconite roots, but also notes that their alkaloids can severely damage the heart, nervous system, and liver.

Aim of the study: The tubers and roots of Aconitum (Ranunculaceae) are widely used as heart medicine or analgesic agents for the treatment of coronary heart disease, chronic heart failure, rheumatoid arthritis and neuropathic pain since ancient times.

Results: Aconitum alkaloids are both bioactive compounds and toxic ingredients in Aconitum plants. They produce a wide range of pharmacological activities, including protecting the cardiovascular system, nervous system, and immune system and anti-cancer effects. Notably, Aconitum alkaloids also exert strong cardiac toxicity, neurotoxicity and liver toxicity, which are supported by clinical studies. Finally, pharmacokinetic studies indicated that cytochrome P450 proteins (CYPs) and efflux transporters (ETs) are closely related to the low bioavailability of Aconitum alkaloids and play an important role in their metabolism and detoxification in vivo.

A systematic review of pharmacological activities, toxicological mechanisms and pharmacokinetic studies on Aconitum alkaloids. · Chin J Nat Med 2021
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studyreview of many studies

“Not stated” does not mean nobody paid — the database does not always record it.

Aconite was used in traditional medicine after appropriate processing, and its alkaloids are dangerous because they disrupt the function of sodium channels in the heart, nerves, and muscles.

Aim of the study: Aconitine and related alkaloids found in the Aconitum species are highly toxic cardiotoxins and neurotoxins. The wild plant (especially the roots and root tubers) is extremely toxic. Severe aconite poisoning can occur after accidental ingestion of the wild plant or consumption of an herbal decoction made from aconite roots. In traditional Chinese medicine, aconite roots are used only after processing to reduce the toxic alkaloid content.

Results: Aconite roots contain aconitine, mesaconitine, hypaconitine, and other Aconitum alkaloids, which are known cardiotoxins and neurotoxins. Patients present predominantly with neurological, cardiovascular, and gastrointestinal features. Management is supportive; the early use of cardiopulmonary bypass is recommended if ventricular arrhythmias and cardiogenic shock are refractory to first-line treatment.

Aconite poisoning. · Clin Toxicol (Phila) 2009
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studydiscussion of other studies

“Not stated” does not mean nobody paid — the database does not always record it.

Aconite has long been used, among other things, to treat inflammation and arrhythmia, but accidental ingestion or improper use can lead to poisoning.

Aim of the study: Aconitum carmichaeli Debx.-derived herbal medicine has been used for anti-inflammation and anti-arrhythmia purpose for more than two thousand years. It is processed into Chuanwu (Radix Aconiti praeparata) and Fuzi (Radix Aconiti lateralis praeparata) in Traditional Chinese Medicine, which are two useful drugs but with toxic properties.

Results: The medicinal doses and lethal doses determined by researches are summarized, and the usage and processing methods are updated and reviewed in the modern view. In addition, clinical management of poisoned cases using western medicine is discussed. This review provides insights and awareness of safety when using Aconitum-derived herbal medicine, and the application of modern scientific knowledge to optimize the detoxification processes. We suggest the possibility to renew the current standard processing method from the official Pharmacopoeia all over the world.

The toxicology and detoxification of Aconitum: traditional and modern views. · Chin Med 2021
Money for the studygovernment, public institutions · Research Council of the University of Hong Kong, Gaia Family Trust of New Zealand, Research Grants Committee (RGC) of Hong Kong
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studydiscussion of other studies

“Not stated” does not mean nobody paid — the database does not always record it.

The review notes that aconitine has been studied for possible medicinal uses, but excessive use can cause fatal arrhythmias or cardiac arrest.

Aim of the study: Aconitum alkaloids are considered to be the characteristic bioactive ingredients of Aconitum species, which are widely applied to the treatment of diverse diseases, and aconitine (AC) is found in most Aconitum plants.

Results: However, the cardiotoxicity and neurotoxicity of AC have also attracted extensive attention. Excessive use of AC always induces ventricular tachyarrhythmia and heart arrest, even can be potentially lethal. Therefore, AC cannot simply be regarded as a good medicine or a toxicant, but its underlying curative and toxic properties remained chaos. In order to dig the unique pharmacological value of AC while preventing its toxicity, the pharmacological activities and toxic effects of AC were summarized in this paper, providing new insight into the safe and effective use of AC in clinical practice.

Advances on pharmacology and toxicology of aconitine. · Fundam Clin Pharmacol 2022
Money for the studygovernment, public institutions · Science and technology development fund of Hospital of Chengdu University of traditional Chinese Medicine, Sichuan Province Science and Technology Support Program, Sichuan Science and technology program
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studydiscussion of other studies

“Not stated” does not mean nobody paid — the database does not always record it.

Aconitine from aconite was used in traditional Chinese medicine to relieve pain, but it is a potent toxin that affects the heart and nervous system.

Aim of the study: Three aconitine poisoning events occurred in two Canadian provinces in 2022: one in British Columbia (BC) and two in Ontario (ON). Aconitine is a potent alkaloid found in several species of the plant Aconitum, containing cardiotoxins and neurotoxins.

Results: Fourteen cases occurred from the consumption of sand ginger: in BC (n = 2), purchased at an Asian health food store; in ON (n = 11), Kaempferia galanga powder (KGP) spices were used to prepare meals at a restaurant, and in one ON case, KGP was purchased. Traceback found product imported from China contained aconitine levels ranging from 1304 to 5500 ppm. Later investigations revealed mislabeling of Aconitum as KGP from the same imported lot (January 2020). Plant DNA testing found no KGP in any spice packets, including lots not linked to illness, suggestive of adulteration. Method development for aconitine in BC led to an improved response time for testing in ON. BC and ON updated outbreak response protocols and communications.

Learnings from Separate Aconitum Poisonings in British Columbia and Ontario, Canada in 2022. · Toxins (Basel) 2025
Money for the studynot stated
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studyobservation of people

“Not stated” does not mean nobody paid — the database does not always record it.

The review reported one death linked to mistaking a plant for the species Aconitum napellus.

Aim of the study: In some regions of the globe, accidental food confusion regarding plants can cause severe poisoning events and deaths. The aim of this study was to report on those confusions from the Marseille Poison Control Centre's (PCC) experience from 2002 to 2023.

Results: Over 22 years, 2197 food confusion events were managed with 321 different species. The most frequently involved plant was Nerium oleander (289 cases, 13.1%), then Cucurbitaceae genus (3.3%), Colchicum autumnale (3.3%), Prunus amygdalus (3%), Mahinot esculenta (3%), Cytisus laburnum (2.6%), Aesculus hippocastanum (2.5%) and Narcissus Jonquilla (2%). Many botanical confusion events were also reported (n = 1386, 63%), but with fewer than five identical species. Only one death was reported for this review, in an event involving Aconitum napellus. Two antidotes were used for all the series: Datura genus and Prunus dulcis.

Food Confusion Between Edible and Poisonous Plants: A 22-Year Retrospective of the Southeastern France Poison Control Center. · Toxins (Basel) 2024
Money for the studynot stated
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studyobservation of people
Participants2 197

“Not stated” does not mean nobody paid — the database does not always record it.

Aconitine poisoning after consuming a preparation made from Aconitum sp. caused life-threatening heart rhythm problems and very low blood pressure.

Aim of the study: Aconitine poisoning from traditional Chinese medicine is life-threatening, associated with arrhythmias and shock. Early diagnosis and multidisciplinary treatment are essential due to the lack of specific antidotes. This study aimed to present a severe case of aconitine poisoning and to evaluate the effectiveness of combined blood purification and antiarrhythmic therapy, thereby providing practical insights for clinical management.

Results: Combined antiarrhythmic therapy and blood purification proved effective. Early recognition and integrated care are key to managing aconitine poisoning.

Combined blood purification and antiarrhythmic therapy for acute aconitine poisoning with refractory arrhythmias: a case-based mechanistic evaluation and treatment strategy optimization. · Eur J Med Res 2025
Money for the studyuniversity or foundation · Jiaxing Emergency Medicine Key Supporting Discipline Construction Project
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studyother
Participants1

“Not stated” does not mean nobody paid — the database does not always record it.

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