Veratrum album · PhytoNexus

01 Identity and provenance

Accepted binomial: Veratrum album
Common names: White Hellebore
Family (APG IV): Melanthiaceae
Part used: Rhizome
Verification tier: Tier 2 · Verified Clinical columns reviewed and a source is on record.
Reviewer note (2026 audit): Ann Intern Med Clin Cases 2022. doi:10.7326/aimcc.2022.0715 | Veratrum album mistaken for Gentiana lutea case series | VERIFIED 2026 (batch 3) - synthetic analogue, application, interactions, side effects and references populated from retrieved primary/regulatory sources. Interactions labelled CLINICAL vs THEORETICAL. Marketed-formulation column intentionally blank. | IDENTITY

02 Constituent chemistry

Chemical class	Marker compound	Synthetic analogue in use
Steroidal alkaloids	Protoveratrine Rhizome	Historically marketed as an antihypertensive in the 1950s; withdrawn for narrow therapeutic index. No current equivalent.

The analogue column is what makes the interaction reasoning tractable: where a constituent has a marketed structural counterpart, the counterpart's interaction profile is the starting hypothesis for the plant.

Looking up structures and physicochemical properties from PubChem…

03 Stated application

Reported activity: No accepted therapeutic use. Toxicological reference only.
Reported adverse effects: MISIDENTIFICATION IS THE MAIN ROUTE OF HARM - regularly mistaken for Gentiana lutea (yellow gentian, used in beverages) and for Allium ursinum (wild garlic) because of similar elliptic leaves and overlapping season and habitat. Steroidal alkaloids (veratridine, cevadine) prolong Na+ channel opening, producing the BEZOLD-JARISCH REFLEX: hypotension, bradycardia and hypopnoea. Onset 30 min to 4 h: vomiting, abdominal pain, paraesthesia, visual disturbance including transient blindness, confusion, syncope, AV block. All parts toxic, root most. Some Veratrum alkaloids are teratogens acting on hedgehog signalling (cyclopia, holoprosencephaly). Recovery is usual with supportive care.

04 Interaction matrix

Source column, verbatim: CLINICAL: additive bradycardia and hypotension with beta-blockers, calcium-channel blockers and other negative chronotropes. Atropine and vasopressors are used to counter the reflex.
Normalised onto 2 canonical drug classes below.

Curated from the reviewed source

Drug class	Severity	Mechanism type	Provenance	Expected effect
Anticholinergics Autonomic	3Major	PD-additive	curated A	Anticholinergic toxidrome: dry mouth, urinary retention, blurred vision, …	why ▾
Class mechanism. Tropane alkaloids (atropine, hyoscine, hyoscyamine) are competitive muscarinic antagonists; added to prescribed anticholinergics, antihistamines or tricyclics the burden summates. Expected Anticholinergic toxidrome: dry mouth, urinary retention, blurred vision, tachycardia, delirium, hyperthermia. Management Calculate total anticholinergic burden. Avoid in older adults, prostatism and narrow-angle glaucoma. Onset rapid Evidence A - human data with a cited source Matched on “atropine” Find evidence for this pair Map this mechanism
Antihypertensives Cardiovascular	2Moderate	PD-additive	curated A	Orthostatic hypotension, dizziness, syncope and falls; or loss of blood-p…	why ▾
Class mechanism. Vasodilator, diuretic, ACE-inhibitory and calcium-antagonist activity in botanical extracts adds to prescribed blood-pressure lowering. A minority (ephedrine-, glycyrrhizin- and caffeine-bearing) act in the opposite direction and antagonise control. Expected Orthostatic hypotension, dizziness, syncope and falls; or loss of blood-pressure control with pressor botanicals. Management Home BP log for 2 weeks after any change. Warn about postural symptoms; review in the elderly and in those on multiple agents. Onset rapid Evidence A - human data with a cited source Matched on “calcium channel blockers” Find evidence for this pair Map this mechanism

Predicted from constituent chemistry

These edges are not clinical findings. Each one is a rule inference: a constituent class in this plant is known to act on a target that the drug class also acts on. They are shown because a blank cell reads as “safe”, and for a Tier 1 entry a blank cell only means “not yet looked at”. Treat them as a literature-search agenda, not as a warning.

Drug class	Severity	Mechanism type	Provenance	Expected effect
Narrow-therapeutic-index CYP3A4 substrates Pharmacokinetic	4Contraindicated	PK-CYP3A4	predicted D	Toxic accumulation or subtherapeutic failure of the co-prescribed drug, s…	why ▾
Chemistry of this pair. Alkaloidal bases have pH-dependent absorption and commonly interact with hepatic CYP isoenzymes and efflux transporters. Class mechanism. Furanocoumarins, bergamottin, piperine, glabridin and berberine inhibit CYP3A4; hyperforin, andrographolide and several diterpenes induce it through PXR. Because CYP3A4 handles roughly half of marketed drugs, the affected list is broad and the direction is product-specific. Expected Toxic accumulation or subtherapeutic failure of the co-prescribed drug, sometimes fatal for antiarrhythmics, immunosuppressants and oncology agents. Management Screen the full regimen for 3A4 substrates. Where the substrate has a narrow index, avoid rather than monitor. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Antacids, PPIs and H2 blockers Gastrointestinal	2Moderate	PK-absorption	predicted D	Reduced or erratic absorption of alkaloids; heartburn and reflux from pre…	why ▾
Chemistry of this pair. Alkaloidal bases have pH-dependent absorption and commonly interact with hepatic CYP isoenzymes and efflux transporters. Class mechanism. Gastric pH elevation alters the dissolution and ionisation of alkaloidal and enteric-coated botanical products; menthol- and peppermint-oil products lose their enteric protection at high pH and can be released prematurely. Expected Reduced or erratic absorption of alkaloids; heartburn and reflux from premature release of volatile-oil preparations. Management Separate administration by 2 hours. Avoid non-enteric peppermint oil in reflux disease. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism

05 Hazard register

misidentification - confused with Gentiana lutea and Allium ursi

06 Confusable material

These entries could be mistaken for this one in trade, in the herbarium, or in a prescription. Powdered material is often indistinguishable, so the check is macroscopic, microscopic and chromatographic rather than nominal.

Salix alba

White Willow

Salicaceae

Shares the common name "white"

07 Mechanism map

Chemistry sorts to the left, pharmacology to the right. Dashed edges are predicted. Drag nodes, scroll to zoom, export at 3× for a figure.

species

chemical class

marker compound

drug class

expected effect

hazard

08 Open literature

Abstract-scoped query built from this binomial, its common names and its marker compounds, run live against Europe PMC, PubMed and OpenAlex, then ranked locally against an evidence hierarchy.

Checking openFDA spontaneous reports…

09 Isomechanistic neighbours

Species whose interaction profile overlaps this one, ranked by shared severity weight rather than by count — a shared contraindication counts for more than a shared minor signal. Practical use: these are the plants you should not stack with this one, because the mechanisms summate.

Species	Family	Shared classes	Jaccard
Physostigma venenosum Calabar Bean	Fabaceae	4	0.50
Pilocarpus jaborandi Jaborandi	Rutaceae	4	1.00
Bacopa monnieri Brahmi	Plantaginaceae	3	0.50
Atropa belladonna Belladonna	Solanaceae	3	0.50
Hyoscyamus niger Henbane	Solanaceae	3	0.50
Areca catechu Areca Nut	Arecaceae	3	0.60

10 References and notes

Source column: Gruber H et al. Clin Toxicol 2010;48:949-52. doi:10.3109/15563650.2010.533675

Gruber H et al. Clin Toxicol 2010

Gruber H et al. Clin Toxicol 2010 manual

48:949-52. doi:10.3109/15563650.2010.533675

2010 doi:10.3109/15563650.2010.533675 manual

BibTeX for all 2 records

@article{GruberHet2010,
  title = {Gruber H et al. Clin Toxicol 2010},
  author = {Gruber H et al.},
  journal = {Clin Toxicol},
  year = {2010},
}

@article{anon2010,
  title = {48:949-52. doi:10.3109/15563650.2010.533675},
  year = {2010},
  doi = {10.3109/15563650.2010.533675},
}

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