Herb Poisoning Treatment & Management

Updated: Jan 12, 2021
  • Author: David Vearrier, MD, MPH; Chief Editor: Michael A Miller, MD  more...
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Approach Considerations

Prehospital care is supportive. Emergency personnel should do the following, as needed:

  • Stabilize the airway, assess respiration, and initiate respiratory assistance
  • Assess blood pressure and pulse; initiate advanced cardiac life support (ACLS) resuscitation

Emergency department care consists of supportive care, ACLS, and decontamination protocols. Decontamination with activiated charcoal may be considered in patients who present shortly after (within 1 hour) a potentially toxic herbal preparation ingestion. However, it carries the risk of vomiting and charcoal aspiration pneumonitis and should not be used for non-toxic ingestions. Clinicians should consider risks and benefits of decontamination with activated charcoal on a patient-by-patient basis.

Antidotal therapy may be indicated following ingestion of specific herbal preparations, including: 

  • Consider anti-digoxin antibodies in patients with severe cardiac glycoside toxicity from an herbal preparation, although there is very limited evidence for their benefit (see Cardiac Glycoside Plant Poisoning)
  • N-acetylcysteine should be administered for hepatotoxicity from pennyroyal oil
  • Physostigmine may be used both diagnostically and therapeutically for anticholinergic toxicity from belladonna alkaloid preparations
  • Chelation may be indicated for heavy metal poisonings (see Heavy Metal Toxicity, Arsenic Toxicity, Lead Toxicity, and Mercury Toxicity)


Consider consultation with the local poison control center (800-222-1222) and medical toxicologist. They may know of recent similar case presentations in the area and assist with management.

Information on adverse reactions (eg, product recalls because of contamination) can be obtained at the US Food and Drug Administration (FDA) Safety Information and Adverse Event Reporting Program Report (MedWatch). Serious drug interactions or toxicity from herbal preparations should also be reported to MedWatch for further investigation. The telephone number for reporting is 1-800-FDA-1088.