Mayapple

Scientific Name(s): Podophyllum hexandrum Royle., Podophyllum peltatum L.
Common Name(s): American podophyllum (P. peltatum), Bajiaolian, Devil's apple, Duck's foot, Gwai-kou, Hog apple, Indian podophyllum (P. hexandrum), Mandrake, Mayapple, Racoonberry, Vegetable mercury, Wild or American mandrake

Medically reviewed by Drugs.com. Last updated on Dec 27, 2021.

Clinical Overview

Use

Podophyllum has been used topically in the treatment of genital warts and hairy leukoplakia. Semisynthetic derivatives of podophyllotoxin are used to treat RA and various cancers, including refractory testicular tumors and small-cell lung cancer; however, limited information is available. Use as a cathartic is considered unsafe.

Dosing

The risk of toxicity is too high to recommend home use. Classical use of mayapple resin as a purgative used 10 mg doses. As a caustic for papillomas, a 20% suspension in petrolatum has been used. Pure podophyllotoxin was formulated at 0.5% to 2% in a recent clinical trial for treatment of penile warts.

Contraindications

The use of mayapple in pregnancy is contraindicated.

Pregnancy/Lactation

Birth defects, fetal death, and stillbirth have been associated with the use of podophyllum in pregnant patients. Pregnant patients or patients planning to become pregnant should avoid use of this product. Excretion into breast milk is unknown. Avoid use in nursing patients.

Interactions

None well documented.

Adverse Reactions

Chronic use of mayapple as a cathartic has been associated with hypokalemia and metabolic acidosis. Topical application may cause skin irritation and chemical burns. Application to the inside of the mouth may cause transient burning, unpleasant taste, and pain.

Toxicology

Fatalities have occurred following ingestion or topical application of podophyllum. Clinical signs appear within 12 hours and include altered mental states, tachypnea, peripheral neuropathy, nausea, hypotension, vomiting, and fever. Muscle paralysis with respiratory failure, renal failure, hallucinations, and seizures has been reported.

Scientific Family

• Berberidaceae

Botany

P. peltatum is an herbaceous perennial found in damp, open woodlands and wet meadows in Canada and the eastern United States.2 The plant grows to 0.3 to 0.6 m in height with a single stalk and 1 or 2 broad, deeply divided, shiny leaves about the size of a hand. Plants with 2 leaves bear a single, pendulous, small white flower in May (hence, the name Mayapple); the odor has been described as "nauseous".2 The fruit, which ripens in midsummer, is about 2.5 to 5 cm in length and is pulpy, lemon-yellow, and berry-like. It is the only edible part of the plant; all other parts are considered poisonous. The root is composed of many thick tubers and is the main source of podophyllotoxin, the active principle.2P. hexandrum is found in Tibet, Afghanistan5 and northern India. The roots are stouter and knottier than P. peltatum and contain about twice as much podophyllotoxin.2 The Latin name is derived from podos (a foot) and phyllon (a leaf), alluding to a resemblance in the palmate leaf to the webbed foot of an aquatic bird. One of the popular names for the plant is duck's foot.2 A synonym of P. hexandrum is Podophyllum emodi Wall.

History

The American Indians and colonists used podophyllum resin as a cathartic and anthelmintic, an antidote for snakebites, and a poison.6 Podophyllum was included in the 1864 British Pharmacopoeia<...