Nerium oleander, Cautions

No health hazards are known in conjunction with the proper administration of designated therapeutic dosages. Side effects can include, particularly in the case of overdosages, nausea, vomiting, diarrhea, headache, stupor and cardia arrhythmias.

Drug Interactions

MAJOR RISK

Digitoxin; concurrent use may result in increased risk of digoxin toxicity. Clinical management - Cardiac glycosides in oleander are detectable by a digoxin radioimmunoassay, however, the digoxin level obtained varies according to the assay used and cannot be used to guide dosing of digoxin specific Fab antibody fragments. Administration of digoxin specific Fab antibody fragments has been successful in treating cases of oleander toxicity.

POTENTIAL INTERACTIONS

Quinidine, Calcium Salts, Saluretics, Laxatives, or Glucocorticoids; Concurrent use may result in increases of oth efficacy and side effects.

• A non-fatal oleander poisoning.
• A fatal case of oleandrin poisoning.
• Unexpected double lethal oleander poisoning
• Probable hepatotoxicity related to Nerium oleander extract in a patient with metastatic synovial sarcoma of the knee.
• Interference of oleandrin and oleandrigenin in digitoxin immunoassays: minimal cross reactivity with a new monoclonal chemiluminescent assay and high cross reactivity with the fluorescence polarization assay.
• Rapid detection of oleander poisoning by Digoxin III, a new Digoxin assay: impact on serum Digoxin measurement.