Health Care Professional Information

Scientific Name
Sanguinaria canadensis
Common Name

Bloodroot, red root, Indian paint, snakebite, sweet slumber, coonroot, puccoon, tetterwort

Clinical Summary

Bloodroot is a perennial flowering plant native to eastern North America. It is thought to have antiseptic, cathartic, diuretic, emetic, and escharotic (scab forming) properties and has been used for inflammation, cough, infections, as an anti-plaque agent, and for cancer treatment. The major constituent of blood root is sanguinarine, an alkaloid that exhibits antimicrobial (8), tumoricidal (22) (23), anticancer (25) (27), antiangiogenic (4) (5) (9) and antimicrotubule (21) properties. However, its efficacy has not been tested in humans.

Topical use of bloodroot for skin cancer can lead to severe adverse effects including disfigurement (15) (24).
The use of sanguinarine as an oral antiplaque agent has been linked to leukoplakia (10) (14).
Bloodroot is an ingredient in black salve, which is promoted as an alternative cancer treatment.

Purported Uses
  • Bone resorption
  • Cancer
  • Infection
  • Inflammation
  • Oral Plaque
  • Sclerosing agent
  • Chronic cough
  • Warts
  • Migraines
Constituents
  • Sanguinarine
  • Chelerythrine
  • Chelirubine
  • Chelilutine
  • Sanguilutine
  • Sanguirubine
  • Homochelidonine
  • Sanguidimerine
  • Protopine
  • Dihydrosangilutine
  • Berberine
  • Red resin
    (20)
Mechanism of Action

Bloodroot was shown to have anticarcinogenic and anti-inflammatory properties in animals (7). It intercalates with DNA at guanine-cytosine-rich sequences (17). Sanguinarine inhibits the transcription factor NF kB (6) and tubulin protein formation (21). It also activates pro-apoptotic Bcl-2 family proteins in immortalized human HaCaT keratinocytes (2) and induces apoptosis in human prostate carcinoma cells (3). It was shown to induce apoptosis in HT-29 human colon cancer cells by increasing activation of caspases 3 and 9 (27).
Sanguinarine exhibits antiplatelet effects and reduces platelet thromboxane production. It also suppresses cyclooxygenase-1 (13). The antiplaque effect of blood root is thought to be caused by the conversion of sanguinarine to an iminium ion that then binds to plaque. When used in oral preparation, bloodroot has been linked with leukoplakia (10) (16). Bloodroot can inhibit the action of sodium-potassium ATPase and also prolong ventricular refractory period (18) (19).

Warnings

Avoid use in patients with glaucoma.
(12)

Contraindications
Adverse Reactions

Common: Dizziness, vertigo, nausea, vomiting, skin irritation, esophageal burning, burning of the gums, systemic burning, oral leukoplakia.
Rare: hypersensitivity reaction, angioedema.
(11) (10) (14)
Case Reports
An 87-year-old Caucasian man with a history of basal cell carcinomas self-treated a new basal cell carcinoma over his left nasal ala with a “black salve” (a combination of zinc chloride and bloodroot). This resulted in complete loss of the nasal ala (24).
Two men, one with unremarkable medical history and the other with metastatic colon cancer used bloodroot salves for treating their skin lesions. The lesions in both men grew worse after application of the salve requiring hospitalization (26).
A 63-year-old man diagnosed with basal cell carcinoma preferred to self-treat the lesion with the black salve product containing 300 mg of bloodroot, galangal, red clover, and sheep sorrel. After a 4-month delay with no improvement, the patient consented to Mohs micrographic surgery. But a few months later, he was diagnosed with colon cancer and elected to self-treat with an oral black salve product and subsequently died (28).

Herb-Drug Interactions
  • Bloodroot may increase the risk of bleeding when used with anticoagulant, antiplatelet, or antiangiogenic drugs.
  • Bloodroot may interfere with the actions of antiarrhythmic drugs.
Literature Summary and Critique

Clinical studies have yet to be conducted with bloodroot.

Dosage (Inside MSKCC Only)
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References
  1. Doctor Accused of Aiding Man Who Disfigured Cancer Patients. The Washinton Post. http://www.washingtonpost.com/wp-dyn/content/article/2005/08/13/AR2005081301016.html. Accessed February 25, 2013.
  2. Adhami VM, Aziz MH, Mukhtar H, et al. Activation of prodeath Bcl-2 family proteins and mitochondrial apoptosis pathway by sanguinarine in immortalized human HaCaT keratinocytes. Clin Cancer Res 2003;9(8):3176-82.
  3. Adhami VM, Aziz MH, Reagan-Shaw SR, et al. Sanguinarine causes cell cycle blockade and apoptosis of human prostate carcinoma cells via modulation of cyclin kinase inhibitor-cyclin-cyclin-dependent kinase machinery. Mol Cancer Ther 2004;3(8):933-40.
  4. Basini G, Santini SE, Bussolati S, et al. The plant alkaloid sanguinarine is a potential inhibitor of follicular angiogenesis. J Reprod Dev 2007;53(3):573-9.
  5. Basini G, Santini SE, Bussolati S, et al. Sanguinarine inhibits VEGF-induced Akt phosphorylation. Ann N Y Acad Sci 2007;1095:371-6.
  6. Chaturvedi MM, Kumar A, Darnay BG, et al. Sanguinarine (pseudochelerythrine) is a potent inhibitor of NF-kappaB activation, IkappaBalpha phosphorylation, and degradation. J Biol Chem 1997;272(48):30129-34.
  7. Ding Z, Tang SC, Weerasinghe P, et al. The alkaloid sanguinarine is effective against multidrug resistance in human cervical cells via bimodal cell death. Biochem Pharmacol 2002;63(8):1415-21.
  8. Dzink JL, Socransky SS. Comparative in vitro activity of sanguinarine against oral microbial isolates. Antimicrob Agents Chemother 1985;27(4):663-5.
  9. Eun JP, Koh GY. Suppression of angiogenesis by the plant alkaloid, sanguinarine. Biochem Biophys Res Commun 2004;317(2):618-24.
  10. Eversole LR, Eversole GM, Kopcik J. Sanguinaria-associated oral leukoplakia: comparison with other benign and dysplastic leukoplakic lesions. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000;89(4):455-64.
  11. Fetrow C. Professional's handbook of complementary and alternative medicines 2nd ed. 2001, Springhouse, PA: Springhouse Corp.
  12. Hakim SA, Sanguinarine and hypothalamic glaucoma. J All India Ophthalmol Soc. 1962 Dec;10:83-102.
  13. Jeng JH, Wu HL, Lin BR, et al. Antiplatelet effect of sanguinarine is correlated to calcium mobilization, thromboxane and cAMP production. Atherosclerosis 2007;191(2):250-8.
  14. Mascarenhas AK, Allen CM, Loudon J. The association between Viadent use and oral leukoplakia. Epidemiology. 2001;12(6):741-3.
  15. McDaniel S, Goldman GD. Consequences of using escharotic agents as primary treatment for nonmelanoma skin cancer. Arch Dermatol 2002;138(12):1593-6.
  16. Munro IC, Delzell ES, Nestmann ER, et al. Viadent usage and oral leukoplakia: a spurious association. Regul Toxicol Pharmacol 1999;30(3):182-96.
  17. Nandi R, Maiti M. Binding of sanguinarine to deoxyribonucleic acids of differing base composition. Biochem Pharmacol 1985;34(3):321-4.
  18. Scheiner-Bobis G. Sanguinarine induces K+ outflow from yeast cells expressing mammalian sodium pumps. Naunyn Schmiedebergs Arch Pharmacol 2001;363(2):203-8.
  19. Seifen E, Adams RJ, Riemer RK. Sanguinarine: a positive inotropic alkaloid which inhibits cardiac Na+,K+-ATPase. Eur J Pharmacol 1979;60(4):373-7.
  20. Suchomelova J, Bochorakova H, Paulova H, et al. HPLC quantification of seven quaternary benzo[c]phenanthridine alkaloids in six species of the family Papaveraceae. J Pharm Biomed Anal 2007;44(1):283-7.
  21. Wolff J, Knipling L. Antimicrotubule properties of benzophenanthridine alkaloids. Biochemistry 1993;32(48):13334-9.
  22. Mazzio EA, Soliman KF. In vitro screening for the tumoricidal properties of international medicinal herbs. Phytother Res. 2009 Mar;23(3):385-98.
  23. Han MH, Yoo YH, Choi YH. Sanguinarine-induced apoptosis in human leukemia U937 cells via Bcl-2 downregulation and caspase-3 activation. Chemotherapy. 2008;54(3):157-65.
  24. Saltzberg F, Barron G, Fenske N. Deforming self-treatment with herbal “black salve”. Dermatol Surg. 2009 Jul;35(7):1152-4.
  25. Sun M, Liu C, Nadiminty N, et al. Inhibition of Stat3 activation by sanguinarine suppresses prostate cancer cell growth and invasion. Prostate. 2011 May 2. doi: 10.1002/pros.21409.
  26. Cienki JJ, Zaret L. An Internet misadventure: bloodroot salve toxicity. J Altern Complement Med. 2010 Oct;16(10):1125-7.
  27. Lee JS, Jung WK, Jeong MH, Yoon TR, Kim HK. Sanguinarine induces apoptosis of HT-29 human colon cancer cells via the regulation of Bax/Bcl-2 ratio and caspase-9-dependent pathway. Int J Toxicol. 2012 Jan-Feb;31(1):70-7.
  28. Eastman KL, McFarland LV, Raugi GJ. Buyer beware: a black salve caution. J Am Acad Dermatol. 2011 Nov;65(5):e154-5.

Consumer Information

How It Works

Bottom Line: Bloodroot has not been shown to treat cancer in humans.

Bloodroot is a perennial flowering herb native to eastern North America. It has been used for inflammation, cough, infections, as an antiplaque agent, and for cancer treatment. Sanguinarine, a compound present in bloodroot, was shown to have antimicrobial activity and to inhibit growth of new blood vessels. Use of bloodroot for skin lesions may result in serious harm. Other side effects of bloodroot include dizziness, vertigo, nausea, and vomiting.

Purported Uses
  • Cancer
    Extracts of bloodroot have been studied in the laboratory and in animals for their anticancer effects. Traditional use of bloodroot for cancer is associated with serious adverse effects.
  • Oral plaque
    Sanguinarine, a compound present in bloodroot, has been shown to reduce plaque and is added to tooth pastes and oral rinses.
  • Cough
    There is not enough scientific evidence to support this use.
  • Inflammation
    This use is not backed by any studies.
Research Evidence

Bloodroot has not been studied in clinical trials.

Patient Warnings
  • Inappropriate use of bloodroot for cancer treatment can have severe adverse effects.
  • Bloodroot should not be used in individuals with glaucoma.
Do Not Take If
  • If you are pregnant or breast feeding.
  • If you are taking medication that decreases blood clotting or affects growth of new blood vessels (because blood root may aggravate the symptoms.)
Side Effects

Rare: hypersensitivity reaction, accumulation of fluid in blood vessels
Common:
Systemic: Dizziness, vertigo, nausea, vomiting
Topical: skin irritation, burning and lesions of oral and esophageal tissues.
Case Reports
An 87-year-old Caucasian man with a history of basal cell carcinomas self-treated a new basal cell carcinoma over his left nasal ala (nasal cartilage) with a “black salve” (a combination of zinc chloride and bloodroot). This resulted in complete loss of the nasal ala.
Two men, one with unremarkable medical history and the other with metastatic colon cancer used bloodroot salves for treating their skin lesions. The lesions in both men grew worse after application of the salve requiring hospitalization.
A 63-year-old man diagnosed with basal cell carcinoma preferred to self-treat the lesion with the black salve product containing 300 mg of bloodroot, galangal, red clover, and sheep sorrel. After a 4-month delay with no improvement, the patient consented to Mohs micrographic surgery. But a few months later, he was diagnosed with colon cancer and elected to self-treat with an oral black salve product and subsequently died (28).
 

Special Point

Unapproved use of bloodroot paste externally as cancer treatment has been linked to disfigurement.

E-mail your questions and comments to aboutherbs@mskcc.org.