Sanguinaria canadensis

01 Identity and provenance

Accepted binomial: Sanguinaria canadensis
Common names: Bloodroot
Family (APG IV): Papaveraceae
Part used: Rhizome
Verification tier: Tier 2 · Verified Clinical columns reviewed and a source is on record.
Reviewer note (2026 audit): Croaker A et al. Mutat Res 2017;774:46-56 (carcinogenic potential of sanguinarine) | McDaniel S & Goldman GD. Arch Dermatol 2002;138:1593-6 | 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. | CARE PATHWAY

02 Constituent chemistry

Chemical class	Marker compound	Synthetic analogue in use
Benzophenanthridine alkaloids	Sanguinarine Rhizome	No legitimate analogue. Escharotic action is non-selective chemical cauterisation, not targeted therapy.

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 USE. Historically an escharotic in "black salve". FDA lists black salve as a fake cancer cure; such products are no longer legally marketable in the US. Sanguinarine-containing mouthwash was withdrawn.
Reported adverse effects: PERMANENT DISFIGUREMENT AND DEATH. Sanguinarine plus zinc chloride causes coagulative necrosis indiscriminately in malignant AND healthy tissue; the in-vitro selectivity does not hold at the variable doses in unregulated products. FDA has identified 24 adverse-event cases (15 in the preceding five years), mostly permanent damage and cancer progression, with at least one death in someone who used salve instead of proven therapy. Reported: complete destruction of the nasal ala, metastatic recurrence 11 years later. Tumour may appear to resolve while continuing to grow beneath the eschar. Sanguinarine is a DNA intercalator structurally similar to polyaromatic hydrocarbon carcinogens; bloodroot mouthwash was epidemiologically linked to dysplastic leukoplakia. SOLD UNDER MANY NAMES: Cansema, Skinprov, drawing salve, red salve, Indian Herb, Black Drawing Ointment.

04 Interaction matrix

Source column, verbatim: Not applicable - the harm is direct tissue destruction and, critically, DELAY OF EFFECTIVE TREATMENT.
Normalised onto 0 canonical drug classes below.

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

delay of effective treatment - harm is as much from forgone effe

06 Confusable material

No same-genus or shared-common-name entry in the corpus.

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
Holarrhena pubescens Kurchi	Apocynaceae	2	1.00
Sida cordifolia Bala	Malvaceae	2	1.00
Solanum virginianum Kantakari	Solanaceae	2	1.00
Tylophora indica Antamul	Apocynaceae	2	1.00
Carica papaya Papaya	Caricaceae	2	1.00
Morus alba Mulberry	Moraceae	2	1.00

10 References and notes

Source column: FDA consumer update: black salve is dangerous and has many names

FDA consumer update: black salve is dangerous and has many names

manual

BibTeX for all 1 records

@article{anon,
  title = {FDA consumer update: black salve is dangerous and has many names},
}

Curator notes

No notes yet.

Sign in to add notes and save monographs.

PhytoNexus