- Squaw mint
- Mosquito plant
- Squaw balm
For Patients & Caregivers
Pennyroyal is an extremely toxic herb that has caused multi-organ failure and death in several people.
Pennyroyal is a flowering plant that was used in folk medicine to treat various minor ailments, including colic and bronchitis, but is better known for its abortion-inducing effects. Scientists are unsure exactly how pennyroyal exerts these effects (which, it should be noted, have not been consistently shown to occur), but it is thought that the herb causes irritation of the uterus, leading to contractions. However, lethal doses are necessary for this to occur, injuring or killing the mother as well as the fetus. The extensive toxicity of pennyroyal is due to a substance called pugelone, which is metabolized in the liver to highly toxic molecules that cause tissue damage in the internal organs. Studies in both animals and humans show that pulegone is directly toxic to the nervous system.
Pennyroyal has not been studied in clinical trials. None of the claims below are backed by scientific evidence.
- To induce menstruation
- To treat lung conditions such as asthma and bronchitis
- To treat cancer
- To relieve stomach and intestinal gas (colic)
- To treat the common cold and the flu
- To treat headaches
- To induce abortion
- To reduce inflammation
- As an insect repellant
- To relieve the symptoms of premenstrual syndrome (PMS)
- To treat toothaches
- Abdominal cramps
- Nausea and stomach upset
- Liver toxicity
- Kidney toxicity
- Toxicity: At least 24 cases of pennyroyal toxicity are have been reported, including total liver failure, acute kidney failure, hypoglycemia (low blood sugar), blood clotting problems, metabolic acidosis (acidic pH of the blood), GI hemorrhage, lung congestion, mental status changes, cerebral edema, seizures, disseminated intravascular coagulation (blood clots forming in the blood vessels), and death. There are several reports of young women who took pennyroyal oil for its abortion-inducing effects and died of multi-organ failure. One infant given pennyroyal tea for respiratory infections died from organ failure.
For Healthcare Professionals
An essential oil or tea derived from the leaves and flowering tops of the plant, pennyroyal is used in folklore medicine to induce abortion, alleviate menstrual symptoms, to treat inflammatory conditions, chronic bronchitis, minor ailments and colic in infants. Small amounts of the oil are approved by the Food and Drug Administration for use as a flavoring agent.
Pennyroyal oil contains several monoterpenes, principally pulegone, which has known toxic effects on the liver and lungs. Oxidative metabolites of pugelone, such as menthofuran, are oxidized further by cytochrome P450 to reactive intermediates that form adducts with cellular proteins and cause organ damage (4).
Ingestion of pennyroyal oil in adults or tea in children causes severe toxicity (4)(5), including hepatic failure, acute renal failure, coagulopathies, metabolic acidosis, GI hemorrhage, pulmonary congestion with consolidation, cerebral edema, seizures, disseminated intravascular coagulation, and death.
Pennyroyal’s abortifacient properties are thought to be due to irritation of the uterus, causing contractions, but lethal doses are necessary for this to occur and the effect is inconsistent. Pennyroyal’s mint properties, attributable to the menthol component, theoretically may act in dilating respiratory passages in bronchitis or asthma when consumed as a tea (5). European and American pennyroyal oil consist of 80-90% and 16-30% (R)-(+)-pulegone, respectively, which is oxidized by cytochrome P450 to menthofuran (about 50%) and other toxic metabolites (4). The menthofuran is further oxidized to an epoxide which is likely the ultimate toxic biological reactive intermediate (15) that causes liver damage. Animal and human studies also show that pulegone is neurotoxic. Menthofuran is known to decrease glucose-6-phosphatase activity in rat models, causing hypoglycemia (1).
Reported: Dizziness, weakness, syncope, hallucinations, abdominal cramps, nausea, GI upset, pupillary changes, hepatotoxicity, renal injury.
Toxicity: At least 24 cases of pennyroyal toxicity are in the literature, reporting fulminant hepatic failure, acute renal failure, hypoglycemia, coagulopathy, metabolic acidosis, GI hemorrhage, pulmonary congestion with consolidation, mental status changes, cerebral edema, seizures, disseminated intravascular coagulation, and death. Pennyroyal oil ingestion is treated with gastric lavage, activated charcoal, and N-acetylcysteine in patients evaluated soon after ingestion.
Case Report (Oil): A 24-year-old woman ingested pennyroyal extract for over 2 weeks and, after acute ingestion, developed abdominal cramps, chills, vomiting, syncope, cardiopulmonary arrest and multiorgan failure leading to coma and death. Exploratory laparotomy showed a hemorrhagic ectopic pregnancy (13). An 18-year old ingested 30 ml of pennyroyal oil and developed abdominal pain, vomiting, coagulopathy, and died one week later from cardiopulmonary arrest and multiple organ failure (5).
Case Report (Tea): An 8-week old boy, after ingesting 120 ml of homegrown pennyroyal mint tea to treat a suspected infection, experienced multiple organ failure, including confluent hepatocellular necrosis, kidney hemorrhage and necrosis, bilateral lung consolidation with diffuse alveolar damage and hemorrhage, and diffuse cerebral edema with acute ischemic necrosis and isolated vacuolation of the midbrain. The infant died 4 days after admission. A 6-month old boy developed acute hepatic injury, seizures, and sinus hemorrhage after regular consumption of pennyroyal tea, and recovered after 2 months of hospitalization (4).