American pennyroyal

The essential oil of pennyroyal is considered toxic. Death has been reported after consumption of small amounts. A characteristic noted in most cases of pennyroyal overdose is a strong minty smell on the patient's breath.

A possible role for N-acetylcysteine (NAC) in the management of pennyroyal overdose has been suggested. However, this application has not been confirmed by animal or human studies.

The essential oil of pennyroyal may act as an emmenagogue (menstrual flow stimulant) and induce abortion. However, it may do so at lethal or near-lethal doses, making this action unpredictable and dangerous. Future research to determine the safety and efficacy of the less toxic parts of the pennyroyal plant on the menstrual cycle is needed before a recommendation can be made.

Synonyms

Aloe herbal horse spray, brotherwort, chasse-puces, churchwort, Cunila pulegioides , dictamne de Virginie, European pennyroyal, fleabane, flea mint, fretillet, Hedeoma phlebitides , herbal horsespray, herbe aux puces, herbe de Saint-Laurent, Labiatae (family), la menthe pouliot (French), Lamiacea (family), Lurk-in-the-Ditch , Melissa pulegioides , mentha pouillot, Miracle Coat spray-on dog shampoo, mock pennyroyal, mosquito plant, Old World pennyroyal, pennyroyal essential oil, petit baume, piliolerial, poley, pouliot royal, pudding herb, pudding grass, pulegium, pulegium oil, Pulegium vulgare , pulioll-royall, Pulegium regium , run-by-the-ground, squaw balm, squawmint, stinking balm, tickweed.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence	Grade^*
Abortifacient (uterus contraction stimulant/abortion inducer) Folkloric use and several human case reports describe use of the essential oil of pennyroyal to cause abortion. However, it may do so at deadly or toxic doses, making this an unpredictable and dangerous use.	C
Menstrual flow stimulant (emmenagogue) Folkloric use and several human case reports describe use of the essential oil of pennyroyal as an emmenagogue (menstrual flow stimulant). However, it may do so at lethal or near-lethal doses, making this action unpredictable and dangerous.	C

*Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use;
F: Strong scientific evidence against this use.

Grading rationale

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acaricidal (lethal to mites), acne, antiseptic, anti-spasm, anxiety, asthma, bruises and burns, cancer, chest congestion, colds, colic, cough, cramps, diarrhea, digestion, diuretic (increasing urine flow), dizziness, dysentery, fever, flavoring agent, flea control, flu, fragrance (detergents, perfumes, soaps), fumigant, gallbladder disorders, gas, gout, hallucinations, headache, hysteria, immortality, indigestion, insect repellant, intestinal disorders, itchy eyes, joint problems, kidney disease, leprosy, liver disease, mouth sores, muscle pain, nosebleeds, pneumonia, potpourri, pregnancy, premenstrual syndrome, preparing the uterus for labor, purifier (water, blood), refrigerant, respiratory ailments, sedative, skin ailments (itching, burning, bruising), snake bites (venomous), stimulant, stomach pain, sunstroke, sweating, syncope, toothache, uterine fibroids, whooping cough.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (18 years and older)

No safe dose of pennyroyal has been established. Extracts, oils, teas and infusions have been taken by mouth, but may be toxic. Topical preparations have also been applied to the skin. Pennyroyal has been used as an herbal flea collar for animals by hanging a bag of pennyroyal from a regular collar or using a pennyroyal garland. Safety and effectiveness of these preparations have not been proven.

Children (under 18 years old)

Pennyroyal is not recommended in children due to lack of scientific study and potential toxicity.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergic reactions including rash caused by pennyroyal or to its components, including pulegone, may occur.

Side Effects and Warnings

Pennyroyal herb and volatile oils have been associated with multiple reports of toxicity and adverse effects, including seizures, loss of consciousness, and death. In animals, pennyroyal (taken by mouth or placed on the skin) has been associated with liver, lung, and brain toxicity. Even small amounts of pennyroyal may be associated with death. Cases of human overdose and death have been reported in infants, children, and adults.

Pennyroyal oil toxicity may cause nausea, vomiting, abdominal pain, burning in the throat, difficulty swallowing, diarrhea, excessive sweating, chills, fever, headache, ringing in the ears, dizziness, extreme thirst, muscle spasms, restlessness, tremor, excessive talkativeness, hallucinations, agitation, drowsiness, fatigue, confusion, mania, seizures, organ failure (brain, liver, lung, kidney, heart), altered (low or high) heart rate, altered (low or high) blood pressure, slow breathing, coma, loss of consciousness, and death. Symptoms in pennyroyal overdose may mimic that of acetaminophen (Tylenol®) overdose, and the use of N-acetylcysteine (an antidote used for acetaminophen toxicity) treatment may prove beneficial although this is not well proven.

Other side effects may include contact dermatitis, rash (when placed on the skin), malaise, lethargy, agitation, abnormal sensations, or change (increase or decrease) in pupil size. There are reports that pennyroyal may cause abortion. Pennyroyal has been used historically as an emmenagogue (menstrual stimulant) and may cause menstrual bleeding. There are reports that large amounts of pennyroyal may be irritating to the urinary tract. Pennyroyal may cause hypoglycemia (low blood sugar), hemolytic anemia (low red blood cell count due to destruction of cells), disseminated intravascular coagulation (widespread abnormal clotting and/or bleeding), and metabolic acidosis.

Pregnancy and Breastfeeding

Pennyroyal is not recommended during pregnancy or breastfeeding, due to the risk of uterine contractions, stimulation of menstruation, and abortion.

Many tinctures contain high levels of alcohol, and should be avoided during pregnancy.

Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Interactions with Drugs

In theory, the toxicity of pennyroyal may be increased when combined with acetaminophen (Tylenol®). Pennyroyal may lower a liver substance (glutathione), which may increase the risk of acetaminophen toxicity. Pennyroyal may cause increased risk of liver damage caused by other drugs.

Pennyroyal may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be increased in the blood, and may cause increased effects or potentially serious adverse reactions. Patients using any medications should check the package insert and speak with a healthcare provider including a pharmacist about possible interactions.

Pennyroyal may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. Patients taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare provider. Medication adjustments may be necessary.

Pennyroyal may have antihistamine effects, and may cause increased effects if combined with drugs that have antihistamine action such as diphenhydramine (Benadryl®), fexofenadine (Allegra®), or loratidine (Claritin®).

Many tinctures contain high levels of alcohol, and may cause nausea or vomiting when taken with metronidazole (Flagyl®) or disulfiram (Antabuse®).

Interactions with Herbs and Dietary Supplements

Pennyroyal may increase the risk of liver damage when combined with some herbs or supplements such as kava.

Based on animal research, pennyroyal may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of these herbs or supplements may be increased in the blood, and may cause increased effects or potentially serious adverse reactions. It may also alter the effects that other herbs or supplements possibly have on the P450 system such as St. John's wort..

Pennyroyal may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar such as American ginseng.

Pennyroyal and black cohosh have been taken together to induce abortion, and this combination has been associated with toxicity and death. Pennyroyal and blue cohosh have traditionally been taken together to normalize the menstrual cycle in women. In theory, the combination of the two herbs may act together to increase menstrual flow. Notably, blue cohosh has been associated with multiple dangerous effects including stroke.

Pennyroyal may reduce the body's ability to absorb iron in meals.

Severe psychotic episode and seizures have been reported in a young pregnant woman after ingesting an unknown dose of pennyroyal and "Widow Welch's Female Pills," a combination of ferrous sulfate, sulfur, licorice ( Glycyrrhiza glabra ), and turmeric ( Curcuma longa ). The exact cause is unknown.