Bloodroot

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Bloodroot

Common Names

  • Bloodroot; Red root
  • Indian paint
  • Snakebite
  • Coonroot; Puccoon

For Patients & Caregivers

How It Works

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.
  • Cough There is not enough scientific evidence to support this use.
  • Inflammation This use is not backed by any studies.
  • Infection This use is not backed by any studies.
Patient Warnings
  • Inappropriate use of bloodroot for cancer treatment can have severe adverse effects.
  • Bloodroot should not be used in individuals with glaucoma.
Side Effects

Topical: Skin irritation, burning and lesions in the mouth and throat.

Case Reports
Disfigurement, worsening lesions:
With topical use of bloodroot salves to treat skin lesions, with some cases requiring hospitalization.

 

Special Point

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

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For Healthcare Professionals

Scientific Name
Sanguinaria canadensis
Clinical Summary

Bloodroot is a perennial flowering plant native to eastern North America. It is thought to have antiseptic, diuretic, and emetic properties and has been used for inflammation, cough, infections, as an anti-plaque agent, and for cancer treatment. Bloodroot is also an ingredient in black salve, which is promoted as an alternative cancer treatment.

The major constituent of bloodroot 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) (26) (28) (29) (30). The use of sanguinarine as an oral antiplaque agent has been linked to leukoplakia (10) (14).

Purported Uses
  • Cancer
  • Infection
  • Inflammation
  • Cough
Mechanism of Action

Laboratory studies suggest sanguinarine, a benzophenanthrine alkaloid, has potential antineoplastic properties, as it intercalates with DNA at guanine-cytosine-rich sequences (17). Sanguinarine also inhibits transcription factor NFkB (6) and tubulin protein formation (21), activates pro-apoptotic Bcl-2 family proteins (2), and induces apoptosis (3) perhaps via increased activation of caspases 3 and 9 (27).

Sanguinarine exhibits antiplatelet effects, reduces platelet thromboxane production, and suppresses cyclooxygenase-1 (13). Bloodroot can inhibit the action of sodium-potassium ATPase and also prolong ventricular refractory period (18) (19).

Antiplaque effects may be caused by conversion of sanguinarine to an iminium ion that binds to plaque. However when used in oral preparations, bloodroot has been linked with leukoplakia (10) (14).

Warnings

Avoid use in patients with glaucoma (12).

Adverse Reactions

Mouth rinse: Skin irritation, esophageal burning, burning of the gums, oral leukoplakia (10) (14)

Case reports
Disfigurement, worsening lesions: With topical use of bloodroot salves to treat skin lesions, with some cases requiring hospitalization (15) (24) (26) (28) (29) (30).

Dosage (OneMSK Only)
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 April 15, 2020.
  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.
  29. Schlichte MJ, Downing CP, Ramirez-Fort M, Gordon R, Tyring S. Bloodroot associated eschar. Dermatol Online J. 2014 Jul 15;20(7).
  30. Robbins AB, Bui MR, Morley KW. The Dangers of Black Salve: An Unregulated, Commercially Available Caustic Agent. JAMA Dermatol. May 1 2018;154(5):618-619.
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