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Drugs and Lactation Database (LactMed®) [Internet]. Bethesda (MD): National Institute of Child Health and Human Development; 2006-.
Drug Levels and Effects
Summary of Use during Lactation
Appalachian bunchflower (Veratrum parviflorum) found in the Southeastern United States that contains several cardiotoxic alkaloids, such as cyclopamine, jervine, veratramine. It has no known use in lactation. A woman who mistakenly ate Appalachian bunchflower had veratramine and cyclopamine in her milk, although the toxicological significance of their presence in milk for the breastfed infant is unknown.
Drug Levels
Maternal Levels. A nursing mother developed nausea and vomiting approximately 2 hours after ingestion of approximately one tablespoon of cooked Veratrum parviflorum. She had sinus bradycardia with heart rate of 56, with incomplete right bundle branch block. After discharge from the emergency department, she provided 4 milk samples. The initial sample contained 405 mcg/L of veratramine. About 5 hours later, the milk concentration was 136 mcg/L and about 15.5 hours later on the next morning, the milk sample contained 303 mcg/L of veratramine. In a final milk sample 9 hours later, veratramine was undetectable (<44 mcg/L). The cyclopamine concentration of cyclopamine was above the limit of detection (11 mcg/L), but below but below the limit of quantification (32 mcg/L) in all samples.[1]
Infant Levels. Relevant published information was not found as of the revision date.
Effects in Breastfed Infants
A nursing mother ingested one tablespoon of cooked Veratrum parviflorum. She had detectable levels of veratramine and cyclopamine in her milk, but no adverse effects were reported in her infant. The extent of nursing after the ingestion was not reported.[1]
Effects on Lactation and Breastmilk
Relevant published information was not found as of the revision date.
References
- 1.
- Seale JT, Carpenter JE, Eisenstat MD, et al. Veratrum parviflorum poisoning: Identification of steroidal alkaloids in patient blood and breast milk. Clin Toxicol (Phila). 2022;60:1309–17. [PMC free article: PMC9822863] [PubMed: 36301078]
Substance Identification
Substance Name
Appalachian bunchflower
Scientific Name
Veratrum parviflorum
Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.
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- Veratrum parviflorum poisoning: identification of steroidal alkaloids in patient blood and breast milk.[Clin Toxicol (Phila). 2022]Veratrum parviflorum poisoning: identification of steroidal alkaloids in patient blood and breast milk.Seale JT, Carpenter JE, Eisenstat MD, Kiernan EA, Morgan BW, Nogee DP, Pu X, Therriault CA, Yeh M, McDougal OM. Clin Toxicol (Phila). 2022 Dec; 60(12):1309-1317. Epub 2022 Oct 27.
- Pharmacokinetics of Veratramine and Jervine from Alcohol Extracts of Radix Veratri.[Comput Math Methods Med. 2022]Pharmacokinetics of Veratramine and Jervine from Alcohol Extracts of Radix Veratri.Wang S, Cui J, Zhao G, Liu H, Wang J. Comput Math Methods Med. 2022; 2022:8289548. Epub 2022 Jun 23.
- Review Veratrum parviflorum: An Underexplored Source for Bioactive Steroidal Alkaloids.[Molecules. 2022]Review Veratrum parviflorum: An Underexplored Source for Bioactive Steroidal Alkaloids.Seale JT, McDougal OM. Molecules. 2022 Aug 22; 27(16). Epub 2022 Aug 22.
- De Novo Synthesis of the DEF-Ring Stereotriad Core of the Veratrum Alkaloids.[J Org Chem. 2020]De Novo Synthesis of the DEF-Ring Stereotriad Core of the Veratrum Alkaloids.Horwitz MA, Robins JG, Johnson JS. J Org Chem. 2020 May 15; 85(10):6808-6814. Epub 2020 Apr 30.
- Review Cyclopamine: from cyclops lambs to cancer treatment.[J Agric Food Chem. 2014]Review Cyclopamine: from cyclops lambs to cancer treatment.Lee ST, Welch KD, Panter KE, Gardner DR, Garrossian M, Chang CW. J Agric Food Chem. 2014 Jul 30; 62(30):7355-62. Epub 2014 Apr 22.
- Appalachian bunchflower - Drugs and Lactation Database (LactMed®)Appalachian bunchflower - Drugs and Lactation Database (LactMed®)
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