Anamirta cocculus · PhytoNexus

01 Identity and provenance

Accepted binomial: Anamirta cocculus
Common names: Fish Berry
Family (APG IV): Menispermaceae
Part used: Fruit
Verification tier: Tier 2 · Verified Clinical columns reviewed and a source is on record.
Reviewer note (2026 audit): Lee MR et al. J R Coll Physicians Edinb 2020;50:335-40 (GABA-antagonist plants) | Hong Kong Hospital Authority toxic plant database | VERIFIED 2026 (batch 4) - synthetic analogue, application, interactions, side effects and references populated from retrieved primary/regulatory sources. Interactions labelled CLINICAL vs THEORETICAL. Marketed-formulation column intentionally blank. | DOSE

02 Constituent chemistry

Chemical class	Marker compound	Synthetic analogue in use
Sesquiterpene lactones	Picrotoxin Fruit	No therapeutic analogue. Picrotoxin is a non-competitive GABA-A antagonist; flumazenil and bicuculline act at different sites.

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. Picrotoxin is a laboratory research tool for GABA-A pharmacology and was historically a respiratory stimulant and barbiturate antidote in animals. Seeds are used by fishermen in southern India to stun fish (hence "fish berry", kaka-mari).
Reported adverse effects: POTENT CONVULSANT. Picrotoxin (an equimolar mixture of active picrotoxinin and largely inactive picrotin) is roughly 1-1.5% of seed weight and blocks the GABA-A chloride channel. Approximately 20 mg picrotoxin is toxic; TWO OR THREE BERRIES CAN BE LETHAL. Muscular twitching, incoordination, delirium, epileptiform convulsions, gastroenteritis, then respiratory stimulation followed by paralysis and death. Do not apply to broken or abraded skin. HISTORICAL ADULTERANT: cocculus berries were used to adulterate beer to increase bitterness and apparent intoxicant strength.

04 Interaction matrix

Source column, verbatim: CLINICAL: antagonises benzodiazepines, barbiturates and other GABAergic sedatives; lowers seizure threshold - additive risk with any proconvulsant. Benzodiazepines are the logical treatment for picrotoxin seizures.
Normalised onto 1 canonical drug class below.

Curated from the reviewed source

Drug class	Severity	Mechanism type	Provenance	Expected effect
Sedatives, hypnotics and benzodiazepines CNS	4Contraindicated	PD-additive	curated A	Excess sedation, psychomotor and driving impairment, falls, respiratory d…	why ▾
Class mechanism. Valepotriate, kavalactone, apigenin, sesquiterpene and alkaloid constituents act at GABA-A, adenosine and histamine sites, summating with prescribed CNS depression. Some also inhibit CYP3A4 and raise benzodiazepine exposure. Expected Excess sedation, psychomotor and driving impairment, falls, respiratory depression when combined with opioids. Management Warn against driving and machine operation. Avoid triple combinations with opioids. Reduce hypnotic dose in older adults. Onset rapid Evidence A - human data with a cited source Matched on “benzodiazepines” 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
Anticoagulants (vitamin-K antagonists, DOACs) Haemostasis	4Contraindicated	PD-additive + PK-CYP2C9	predicted D	INR destabilisation in either direction; ecchymosis, epistaxis, gum bleed…	why ▾
Chemistry of this pair. Alpha-methylene-gamma-lactone groups alkylate cysteine residues on NF-kB and are the principal Compositae contact allergens. Class mechanism. Coumarin-, salicylate- and coumestan-bearing botanicals add to vitamin-K-antagonist effect; several also compete for CYP2C9 and CYP3A4, raising S-warfarin exposure. Botanicals rich in vitamin K1 act in the opposite direction and blunt anticoagulation. Expected INR destabilisation in either direction; ecchymosis, epistaxis, gum bleeding, GI or intracranial haemorrhage. Management Do not start or stop the botanical without INR cover. Check INR at 3-5 days and again at 2 weeks. Document the product, batch and dose in the anticoagulation record. Onset rapid Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Antiplatelet agents Haemostasis	4Contraindicated	PD-additive	predicted D	Prolonged bleeding time, surgical and post-procedural bleeding, bruising,…	why ▾
Chemistry of this pair. Alpha-methylene-gamma-lactone groups alkylate cysteine residues on NF-kB and are the principal Compositae contact allergens. Class mechanism. Organosulfur compounds, gingerols, salicylates, ginkgolides and eugenol inhibit thromboxane A2 synthesis, platelet aggregation and PAF-mediated activation, duplicating the pharmacology of aspirin and P2Y12 blockers. Expected Prolonged bleeding time, surgical and post-procedural bleeding, bruising, haematuria. Management Stop the botanical 7-14 days before elective surgery or neuraxial anaesthesia. Record it on the pre-operative medicines list. Onset rapid Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
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. Volatile terpenes are lipophilic, cross membranes readily and induce or inhibit CYP2B6 and CYP3A4 depending on the constituent. 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
Hypersensitivity and allergy risk Immunology	3Major	Immunological	predicted D	Urticaria, angio-oedema, allergic contact dermatitis, anaphylaxis; cross-…	why ▾
Chemistry of this pair. Alpha-methylene-gamma-lactone groups alkylate cysteine residues on NF-kB and are the principal Compositae contact allergens. Class mechanism. Sesquiterpene lactones, urushiol-type catechols and protein allergens cause type I and type IV reactions with well-documented cross-reactivity across the Asteraceae and Apiaceae. Expected Urticaria, angio-oedema, allergic contact dermatitis, anaphylaxis; cross-reaction with related species. Management Take an allergy history by plant family, not by product name. Withhold in known Compositae sensitivity. Onset unspecified Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism
Topical antiseptics, keratolytics and irritants Dermatology	3Major	PD-additive local	predicted D	Contact dermatitis, chemical burn, photoirritation, unexpected systemic a…	why ▾
Chemistry of this pair. Volatile terpenes are lipophilic, cross membranes readily and induce or inhibit CYP2B6 and CYP3A4 depending on the constituent. Class mechanism. Essential-oil terpenes, capsaicinoids and phorbol-type diterpenes add to the barrier disruption caused by topical antiseptics, retinoids and keratolytics, and increase percutaneous absorption of anything applied with them. Expected Contact dermatitis, chemical burn, photoirritation, unexpected systemic absorption from broken skin. Management Patch test first. Never apply undiluted essential oils to broken or freshly shaved skin, or with occlusion. Onset rapid Evidence D - in silico rule prediction only Find evidence for this pair Map this mechanism

05 Hazard register

threshold - two or three berries can kill. Historical beverage a

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.

Vaccinium macrocarpon Cranberry	Ericaceae	Shares the common name "berry"
Vaccinium myrtillus Bilberry	Ericaceae	Shares the common name "berry"
Morus alba Mulberry	Moraceae	Shares the common name "berry"
Berberis vulgaris Barberry	Berberidaceae	Shares the common name "berry"
Sambucus nigra Elderberry	Adoxaceae	Shares the common name "berry"
Lycium barbarum Goji Berry	Solanaceae	Shares the common name "berry"

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
Achillea millefolium Yarrow	Asteraceae	6	0.50
Artemisia absinthium Wormwood	Asteraceae	5	0.63
Myristica fragrans Nutmeg	Myristicaceae	4	0.44
Artemisia annua Sweet Wormwood	Asteraceae	5	0.83
Cichorium intybus Chicory	Asteraceae	5	0.83
Taraxacum officinale Dandelion	Asteraceae	5	0.83

10 References and notes

Source column: Olsen RW. Proc Natl Acad Sci USA 2006;103:6081-2

Olsen RW. Proc Natl Acad Sci USA 2006

Olsen RW 2006 manual

103:6081-2

manual

BibTeX for all 2 records

@article{OlsenRW2006,
  title = {Olsen RW. Proc Natl Acad Sci USA 2006},
  author = {Olsen RW},
  year = {2006},
}

@article{anon,
  title = {103:6081-2},
}

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