Peganum harmalaL. Intoxication in a Pregnant Woman

Abstract

Peganum harmala L. is a plant widely distributed in the Mediterranean region. It is commonly used in traditional medicine in Morocco as sedative and abortifacient but exposes users to the risk of overdose and poisoning. The pharmacologically active compounds of this plant include a number of β-carboline and quinazoline alkaloids responsible of its pharmacological and toxicological effects. We report the case of a 24-year-old woman, 22 weeks pregnant, intoxicated with the seeds of Peganum harmala L. On admission, she had disturbance of consciousness, uterine contraction, and oliguria. Laboratory tests revealed renal failure and liver injury, and she benefited then from hemodialysis. During hospitalization, she was intubated after deterioration of consciousness and presented a spontaneous expulsion of the fetus. After extubation, she kept unusual sequelae: cerebellar ataxia and peripheral polyneuropathy. Physicians in regions using Peganum harmala L. as traditional medicine must be able to detect symptoms of its toxicity, in order to establish early gastrointestinal decontamination. The prognosis of this intoxication is variable; most cases can be managed successfully; but in high doses of intoxication, evolution can be fatal.

Abortion Induced by Peganum Harmala Ingestion in a Pregnant Woman: A Case Report and Literature Review

“…The flowering period is March to April and seeds are gathered in the summer [1,6]. The medicinally-active parts of the plant are seeds and roots [1,3,4,7,8]. P. harmala, also known as "Espand" or "Esfand" in Persian [3,4], has been used to ward off the evil eye as an old belief in Iran [9].…”

“…Similarly, the dried capsules of the plant are hung in some houses to protect against "the evil eye" in some regions of Iran and Turkey [2]. P. harmala is recognized as "Üzerlik" or "Yüzerlik" in Turkey, "Harmel" or "Harmal" in North Africa and Arab countries, and "African Rue", "Syrian rue", "Turkish Rue", and "Mexican Rue" in the United States [1][2][3][4][5][6][7]. For centuries, it has been used to produce a red dye for Persian carpets, and in the 1920s, it was imported into the United States for this purpose [5].…”

“…Traditional Iranian Medicine (TIM) have described many medicinal effects for the seeds of P. harmala, also known as "Espand-daneh". The seeds are insect repellant, disinfectant (antibacterial and antifungal), sedative, analgesic (for the management of sciatic pain, joints pain, coxalgia, chronic headache, and toothache), anti-inflammatory, antispasmodic, antithrombotic, antihypertensive, antidiabetic, emetic, purgative, carminative, diuretic, galactagogue, emmenagogue, abortifacient, anthelmintic, aphrodisiac, and visionstrengthening [1,2,4,[7][8][9][10][11]. Ingestion is the main way of both administration and intoxication, but inhalation and fumigation are also frequent [1].…”

Interspecies metabolic diversity of harmaline and harmine in in vitro 11 mammalian liver microsomes

“…According to previous studies, harmaline is almost twice as toxic as harmine and in moderate doses causes tremors and clonic convulsions, and sever intoxication occur in cattle, donkeys, sheep and horses . The toxic doses of harmine (rats: 200 mg/kg and mice: 38 mg/kg) are quite different, and the intoxication symptoms are varieties in human and animals . Moreover, studies have showed that all domesticated animals are susceptible to poisoning from Peganum harmala , camels especially cubs that are affected mostly in dry seasons…”

“…[14] The toxic doses of harmine (rats: 200 mg/kg and mice: 38 mg/kg) are quite different, and the intoxication symptoms are varieties in human and animals. [15][16][17] Moreover, studies have showed that all domesticated animals are susceptible to poisoning from Peganum harmala, camels especially cubs that are affected mostly in dry seasons. [18] During the past few decades, the in vitro metabolism of harmaline and harmine has already been extensively investigated in some species, for instance, rat, mouse, and human.…”