Scientific Name: Mayapple
Other Names: American Mandrake, Bajialian, Duck's Foot, Ground Lemon, Indian Apple, May Apple, Podophyllin, Podophyllum, Podophyllum peltatum, Raccoon Berry, Umbrella Plant, Wild Lemon

Who is this for?

Uses

Note: Mayapple, which is often called American mandrake, is very different from European mandrake. They have very different properties and different uses. They are not interchangeable.

Podophyllum (sometimes called podophyllin) is a resin from mayapple roots and rhizomes. A resin is a sticky substance, such as pine tree tar, that comes from plants. Resins usually burn easily but do not dissolve in water. When it is applied to the skin, podophyllum (mayapple resin) is used mainly to remove warts.

Podophyllum (mayapple resin) is not safe to take by mouth.

Podophyllum (mayapple resin) is not meant to be used orally.

Precautions

Podophyllum and all other mayapple products should never be used by women who are pregnant or who may be pregnant. Documented cases of birth defects and fetal deaths have been associated with podophyllum used during pregnancy. In clinical studies, laboratory animals exposed to podophyllum before birth have developed defective hearts or limbs.

Because podophyllum is believed to stimulate the production of bile in the gallbladder, individuals with gallbladder disease or gallstones should not use it.

If topically applied podophyllum is absorbed through the skin, it may cause irritation of the stomach and intestines. Therefore, individuals with conditions such as Crohn's disease or irritable bowel syndrome should avoid using it.

What side effects should I watch for?

Note: The side effects of oral podophyllum (mayapple resin) may not appear until several hours after a potentially harmful dose has been taken. Additionally, possible side effects from applying podophyllum to the skin may be similar to side effects from taking it by mouth, because chemicals in podophyllum are absorbed extensively through the skin.

Major Side Effects

Severe side effects from oral or topical podophyllum may include:

• Bloody diarrhea
• Severe stomach pain
• Hallucinations
• Muscle paralysis
• Kidney failure
• Breathing failure
• Coma
• Death

Less Severe Side Effects

Other side effects from using podophyllum on the skin may include:

• Confusion
• Headache
• Irritation at the site of application
• Low blood pressure
• Nausea
• Vomiting

What interactions should I watch for?

Topical podophyllum (mayapple resin) has not been shown to interact with prescription or non-prescription drugs, other herbal products, or foods. However, it is absorbed through the skin, so it may possibly interfere with other medications. The application of podophyllum should be supervised by a healthcare professional.

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how podophyllum (mayapple resin) interacts with drugs, other herbals, and foods and the severity of those interactions, please use our Drug Interactions Checker to check for possible interactions.

Should I take it?

Mayapple plants are common spring sights in the woodlands of North America where they often form extensive colonies in the damp ground under hardwood forests. They are perennial plants that spread primarily through rhizomes, which are fleshy extensions of their stems. Rhizomes run along or under the ground and often produce shoots and roots for new plants. Mayapple plants have big, characteristically shaped leaves that hide an attractive, but strong-smelling white flower that blooms very briefly—usually in May. The berries that follow the blossoms resemble tiny lemons when they are ripe. The ripe fruits occasionally are eaten or made into jelly or jam. However, all other parts of the mayapple—including the unripe fruits, seeds, and roots—are toxic. They should never be eaten or taken orally.

The parts of mayapple used for medicine are the roots and rhizomes. Dug up in the fall, these underground parts of mayapple are shredded, mixed with alcohol, and then condensed into a thick, sticky liquid. Further processing of the liquid with cold water causes a powdery substance to settle out. This powder, usually called podophyllum resin, is dried for use as a topical wart remover. It is often combined with alcohol and benzoin, another resin.

Native Americans used a powder made from dried mayapple plants as an insecticide on crops. They also took oral forms of mayapple as a very strong laxative and as a cure for intestinal worms. Other historical uses of mayapple range from treating hepatitis to causing abortion. Today, drugs made from synthetic derivatives of mayapple are used as prescription drugs to treat some forms of cancer. Eating any part of the mayapple plant except for the ripe fruits is strongly discouraged, however.

Dosage and Administration

Neither mayapple nor podophyllum (the resin obtained from it) should ever be taken by mouth. The U.S. Food and Drug Administration (FDA) has judged podophyllum unsafe to be used orally.

Podophyllum (mayapple resin) should be applied only to small areas of the skin in very small amounts and for limited times, because it is easily absorbed through the skin. Systemic side effects may result. Typically, podophyllum will be applied by a healthcare professional. If it is used at home, care must be taken to keep it out of the reach of children or pets and to avoid getting it in the eyes or on mucous membranes, such as inside the mouth. After the application of podophyllum, the hands should be washed thoroughly with soap and water.

A typical dose for removing a wart is either one drop of 0.5% podophyllum solution or a small dab of 0.25% podophyllum cream, applied twice a day for three days. Warts treated with podophyllum generally turn white, then break off in tiny pieces.

Podophyllum preparations should never remain in contact with the skin for more than 6 hours at a time. Most recommendations are to wash them off with soap and warm water after one hour to 4 hours. Areas of normal skin surrounding the wart should be protected by covering them with petroleum jelly before applying podophyllum.

Summary

Today, podophyllum resin derived from mayapple plants is used mainly to remove warts from the skin.

Risks

Podophyllum and other products containing mayapple should never be used by pregnant women due to their potential to cause birth defects or death of the fetus. Children and women who are breast-feeding should not use mayapple and individuals with gallbladder, intestinal, or stomach conditions should also avoid using it.

Side Effects

Taking podophyllum orally or applying large amounts of it topically may result in:

• Hallucinations
• Paralysis
• Kidney failure
• Breathing failure
• Coma
• Death

Other side effects from podophyllum may include confusion, headache, irritated skin, low blood pressure, and nausea.

Interactions

Although no interactions have been associated with using podophyllum (mayapple resin), it has not been well studied and interactions may exist. Individuals who have questions about its use should discuss using it with a doctor or pharmacist.

Last Revised June 6, 2007

References

Anon: Podophyllum. In: DerMarderosian A, Beutler JA, eds. Facts and Comparisons: The Review of Natural Products. St. Louis, MO, Facts and Comparisons. January 1992.

Auburn University. Mayapple (Podophyllum peltatum). No date given. Available at: http://www.auburn.edu/~deancar/wfnotes/mayap.htm. Accessed June 19, 2003.

Cassidy DE, Drewry J, Fanning JP. Podophyllum toxicity: a report of a fatal case and a review of the literature. Journal of Toxicology and Clinical Toxicology. 1982;19(1):35-44.

Chamberlain MJ, Reynolds AL, Yeoman WB. Medical memoranda. Toxic effect of podophyllum application in pregnancy. British Medical Journal. 1972;3(823):391-392.

Chang LW, Yang CM, Chen CF, Deng JF. Experimental podophyllotoxin (bajiaolian) poisoning: I. Effects on the nervous system. Biomedical and Environmental Sciences. 1992;5(4):283-292.

Chang LW, Yang CM, Chen CF, Deng JF. Experimental podophyllotoxin (bajiaolian) poisoning: II. Effects on the liver, intestine, kidney, pancreas and testis. Biomedical and Environmental Sciences. 1992;5(4):293-302.

Fisher AA. Severe systemic and local reactions to topical podophyllum resin. Cutis. 1981;28(3):233, 236, 242 passim.

Fondren BT. Mayapple. Ethnobotanical Leaflet. Southern Illinois University at Carbondale. May 15, 1998. Available at: http://www.siu.edu/~ebl/leaflets/mayapple.htm. Accessed June 19, 2003.

Frasca T, Brett AS, Yoo SD. Mandrake toxicity. A case of mistaken identity. Archives of Internal Medicine. 1997;157(17):2007-2009.

Grieve M. Mandrake, American. In: A Modern Herbal. New York: Dover Publishers, 1971. Available at: http://www.botanical.com/botanical/mgmh/mgmh.html Posted 1995. Accessed June 19, 2003.

Jellin JM, Gregory P, Batz F, Hitchens K, et al, eds. Pharmacist's Letter/Prescriber's Letter. Natural Medicines Comprehensive Database, 3rd Edition. Stockton CA: Therapeutic Research Facility, 2000.

Kao WF, Hung DZ, Tsai WJ, Lin KP, Deng JF. Podophyllotoxin intoxication: toxic effect of Bajiaolian in herbal therapeutics. Human Experimental Toxicology. 1992;11(6):480-487.

Karol MD, Conner CS, Watanabe AS, Murphrey KJ. Podophyllum: suspected teratogenicity from topical application. Clinical Toxicology. 1980;16(3):283-286.

Kumar R, Singh PK, Sharma A, et al. Podophyllum hexandrum (Himalayan mayapple) extract provides radioprotection by modulating the expression of proteins associated with apoptosis. Biotechnology and Applied Biochemistry. 2005;42(Pt 1):81-92.

Moraes RM, Momm HG, Silva B, et al. Geographic information system method for assessing chemo-diversity in medicinal plants. Planta Medica. 2005;71(12):1157-1164.

Moher LM, Maurer SA. Podophyllum toxicity: case report and literature review. Journal of Family Practice. 1979;9(2):237-240.

Rosenstein G, Rosenstein H, Freeman M, Weston N. Podophyllum- a dangerous laxative. Pediatrics. 1976;57(3):419-421.

Schwartz J, Norton SA. Useful plants of dermatology. VI. The mayapple (Podophyllum). Journal of the American Academy of Dermatology. 2002;47(5):774-775.

Last Reviewed June 6, 2007

Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.

In general, herbal products are not subject to review or approval by the U.S. Food and Drug Administration (FDA). They are not required to be standardized, meaning that the amounts of active ingredients or contaminants they contain may vary between brands or between different batches of the same brand. Not all of the risks, side effects, or interactions associated with the use of herbal products are known because few reliable studies of their use in humans have been done.

This information is provided for your education only. Please share this information with your healthcare provider and be sure that you talk to your doctor and pharmacist about all the prescription and non-prescription medicines you take before you begin to use any herbal product.

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