Belladonna

Belladonna is an herb that has been used for centuries for a variety of indications, including headache, menstrual symptoms, peptic ulcer disease, inflammation, and motion sickness. Belladonna is known to contain active agents with anticholinergic properties, such as the tropane alkaloids atropine, hyoscine (scopolamine) and hyoscyamine.

There are few available studies of belladonna alone for any indication. Most research has evaluated belladonna in combination with other agents such as ergot alkaloids or barbiturates, or in homeopathic (diluted) preparations. Preliminary evidence suggests possible efficacy in combination with barbiturates for the management of symptoms associated with irritable bowel syndrome. However, there is currently insufficient scientific evidence regarding the use of belladonna for this or any other indication.

Common adverse effects include dry mouth, urinary retention, flushing, papillary dilation, constipation, confusion and delirium. Many of these effects may occur at therapeutic doses.

Synonyms

Atropa belladonna , atropa belladonna-AE, beladona, belladone, belladonnae herbae pulvis standardisatus, belladonna herbum, Belladonna Homaccord, Belladonna Injeel, Belladonna Injeel Forte, belladonna leaf, belladonna pulvis normatus, belladonnae folium, belladonna radix, belladonne, deadly nightshade, deadly nightshade leaf, devil's cherries, devil's herb, die belladonna, die tollkirsche, divale, dwale, dwayberry, galnebaer, great morel, herba belladonna, hoja de belladonna, naughty man's cherries, poison black cherries, powdered belladonna, Solanaceae (family), solanum mortale, solanum somniferum, stryshon, strygium, tollekirsche, tollkirschenblatter.

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^*
Airway obstruction Belladonna can cause relaxation of the airway and reduce the amount of mucus produced. However, due to lack of high-quality human research in this area, there is not enough evidence to form a clear conclusion.	C
Ear infection Little reliable research is available on the use of belladonna for ear infections. Other therapies have been shown effective and are recommended for this condition.	C
Headache The available studies of belladonna in the treatment of headache are not well designed and do not show a clear benefit. More studies are needed to test the ability of belladonna alone (not in multi-ingredient products) to treat or prevent headache.	C
Irritable bowel syndrome Belladonna has been used historically for the treatment of irritable bowel, and in theory its mechanism of action should be effective for some of the symptoms. However, of the few studies that are available, none clearly show that belladonna alone (not as part of a mixed product) provides this effect.	C
Nervous system disorders The autonomic nervous system, which helps control basic body functions like sweating and blood flow, is affected in several disorders. To date, human studies have shown no benefit from belladonna in treating these disorders.	C
Premenstrual syndrome (PMS) Bellergal® (a combination of phenobarbital, ergot, and belladonna) has been used to treat PMS symptoms. More studies are needed before a strong recommendation can be made.	C
Radiation therapy rash (radiation burn) There is a lack of reliable scientific evidence available for the effectiveness of belladonna for rash after radiation therapy. Further study is needed before a recommendation can be made.	C
Menopausal symptoms Bellergal® (a combination of phenobarbital, ergot, and belladonna) has been used historically to treat hot flashes. However, in human studies belladonna supplements have not shown effectiveness.	D

*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.

Abnormal menstrual periods, acute infections, anesthetic, anxiety, arthritis, asthma, bedwetting, chicken pox, colds, colitis, conjunctivitis (inflamed eyes), diuretic (use as a "water pill"), diverticulitis, earache, encephalitis (inflammation of the brain), excessive perspiration (sweating), eye disorders (dilation of the pupils), fever, flu, glaucoma, gout, hay fever, hemorrhoids, inflammation, kidney stones, measles, motion sickness, mumps, muscle and joint pain, muscle spasms (excessive unintentional muscle movements), nausea and vomiting during pregnancy, pain from nerve disorders, Parkinson's disease, pancreatitis, peritonitis, poisoning (especially by insecticides), rash, scarlet fever, sciatica (back and leg pain), sedative, short bowel syndrome, sore throat, stomach ulcers, teething, toothache, ulcerative colitis, urinary tract disorders (difficulty passing urine), warts, 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)

A traditional dose of belladonna leaf powder is 50 to 100 milligrams taken by mouth, with a maximum single dose of 200 milligrams (0.6 milligrams of total alkaloids, calculated as the ingredient hyoscyamine) and a maximum daily dose of 600 milligrams. A traditional dose of belladonna root is 50 milligrams, with a maximum single dose of 100 milligrams (0.5 milligrams of total alkaloids, calculated as hyoscyamine) and a maximum daily dose of 300 milligrams. A traditional dose of belladonna extract is 10 milligrams, with a maximum single dose of 100 milligrams (0.5 milligrams of total alkaloids, calculated as hyoscyamine) and a maximum daily dose of 150 milligrams. The expert German panel, the Commission E, suggests these doses mainly for the treatment of "gastrointestinal spasm." For tincture of belladonna (composed of 27 to 33 milligrams of belladonna leaf alkaloids in 100 milliliters of alcohol), informal reports suggest either a total dose of 1.5 milligrams daily (divided into 3 doses daily with a double dose at bedtime) or a dose of 0.6 to 1 milliliters (0.18 to 0.3 milligrams of belladonna leaf alkaloids) taken 3 to 4 times daily.

For headache, studies have used the combination product Bellergal® (40 milligrams phenobarbital, 0.6 milligrams ergotamine tartrate, 0.2 milligrams levorotatory alkaloids of belladonna), taken by mouth twice daily.

Homeopathic doses often depend on the symptom being treated and the style of the prescribing provider. Dosing practices may therefore vary widely. Usually, a homeopathic product is diluted several times. For example, belladonna may be diluted by 100 (one teaspoon belladonna added to 99 teaspoons water) in the first round, and this new, dilute mixture may be diluted 30-fold (1 teaspoon of the dilute mixture added to 29 teaspoons water).

A belladonna plaster produced by Cuxson Gerrard (England) containing 0.25% belladonna alkaloids (hyoscine 2%, atropine 1%) has been used topically (applied to the skin) for muscle and bone aches. Long-term use may cause a rash at the site of the plaster.

Children (younger than 18 years)

Informal reports describe a typical dose of 0.03 milliliter for each kilogram of weight, taken by mouth three times daily. Another dose that has been used is 0.8 milliliter for each square meter of body surface area, taken by mouth three times daily (27 to 33 milligrams of belladonna leaf alkaloids in 100 milliliters). The maximum dose is reported as 3.5 milliliters in a day. Safety and effectiveness have not been proven.

Death in children may occur at 0.2 milligram of atropine for each kilogram of a child's weight. Since 2 milligrams of atropine are often found in a fruit, just two fruits may be deadly for a small child.

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.

Belladonna should be avoided in people who have had significant reactions to belladonna or anticholinergic drugs, or who are allergic to belladonna or other members of the Solanaceae (nightshade) family such as bell peppers, potatoes, and eggplants. Long-term use of belladonna on the skin can lead to allergic rashes.

Side Effects and Warnings

In smaller doses, belladonna is traditionally thought to be safe, but may cause frequent side effects such as dilated pupils, blushing of the skin, dry mouth, rapid heartbeat, confusion, nervousness, and hallucinations. Based on animal study, belladonna alkaloids may inhibit cognitive function and gastrointestinal motility. High doses can cause death.

In children, death can be caused by a small amount of belladonna. Several reports of accidental belladonna overdose and death are reported. Belladonna overdose can also occur when it is applied to the skin. Belladonna overdose is highly dangerous and should be treated by qualified medical professionals. Because belladonna can slow the movement of food and drugs through the stomach and gut, the side effects may go on long after the belladonna is swallowed.

Belladonna may cause redness of the skin, flushing, dry skin, sun sensitivity, hives and allergic rashes, even at dilute concentrations. A very serious, potentially life threatening rash called Stevens-Johnson syndrome, has been reported. Other side effects reported are headache, hyperactivity, nervousness, dizziness, lightheadedness, drowsiness or sedation, unsteady walking, confusion, hallucinations, slurred speech, exaggerated reflexes, convulsions, or coma. The eyes may be dilated or sensitive to light, and vision may be blurry. If pieces of belladonna are put into the eye, the pupils may be dilated permanently. Belladonna may also cause photosensitivity.

Cases report hyperventilation, coma with the loss of breathing, rapid or abnormal heart rate, and severe high blood pressure. Others report dry mouth, abdominal fullness, difficult urination, decreased perspiration, slow release of breast milk while nursing, muscle cramps or spasms, and tremors. Belladonna should be avoided in those with difficulty passing urine, enlarged prostate, or kidney stones, dry mouth, Sjögren syndrome, dry eyes, or glaucoma. Belladonna should be used cautiously with a fever. People with myasthenia gravis (a disorder of nerves and muscles) or Down's syndrome may be especially sensitive to belladonna.

Older adults and children should avoid belladonna, as there are many reports of serious effects in these age groups. Belladonna should not be combined with prescribed anticholinergic agents. People with heart disease, who have had a heart attack, fluid in the lungs, high blood pressure, or abnormal heart rhythms should avoid belladonna. Because belladonna can affect the activity of the stomach and intestines, people who have had ulcers, reflux, hiatal hernia, obstruction of the bowel, poor movement of the intestines, constipation, colitis, or an ileostomy or colostomy after surgery should avoid belladonna.

Pregnancy and Breastfeeding

Belladonna is not recommended in pregnancy and breastfeeding because of the risks of side effects and poisoning. Belladonna is listed under category C according to the U.S. Food and Drug Administration (FDA category C includes drugs for which no thorough studies have been published). In nursing women who use belladonna, belladonna ingredients are found in breast milk, therefore endangering infants.

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

Belladonna may slow the movement of food and medication through the gut, and therefore some medications may be absorbed more slowly. Many prescribed medications can interact with anticholinergic drugs that have similar effects to belladonna. A qualified healthcare professional, including a pharmacist, should be consulted prior to taking belladonna.

Atropine is an ingredient in belladonna. Theoretically, drugs that interact with atropine may also interact with belladonna. Some antidepressant medications (tricyclic drugs) can interact with belladonna. The effects of the drug cisapride, used to increase the movement of food through the stomach, may be blocked. Medications that can increase heart rate, especially procainamide, can cause an exaggerated increase in heart rate if given with belladonna. The use of alcohol with belladonna can cause extreme slowing of brain function.

Interactions with Herbs and Dietary Supplements

Belladonna may slow the movement of food and medication through the gut, and therefore some supplements may be absorbed more slowly. The use of belladonna with supplements that have anticholinergic activity such ad Jimson weed ( Datura stramonium ) may increase its effects and worsen its side effects.

Belladonna (Atropa belladonna L. or its variety acuminata Royle ex Lindl)

Background

Synonyms

Evidence

Dosing

Safety

Interactions