Synonyms/Common Names/Related Substances:

• Alkavevir, American false hellebore, American white hellebore, cevadine, corn lily, cryptenamine, cyclopamine, false hellebore, germidine, germitrine, green corn lily, green false hellebore, green hellebore, green veratrum, hellebore, Indian poke, itch weed, jervine, jervine alkaloids, Liliaceae (family), Melanthiaceae (subfamily), muldamine, O-acetyljervine, protoveratrine, poison lily, proveratrine, swamp hellebore, verat-v., veratramine, veratridine, Veratrum viride, Veratrone®, Veriloid®, Vergitryl®, Vertavis®, white American hellebore.
• Selected products: Vergitryl® (pharmaceutical product containing jervine alkaloids), Veratrone® (pharmaceutical product containing jervine alkaloids), Vertavis® (pharmaceutical product containing jervine alkaloids), Veriloid® (alkavevir, a pharmaceutical product containing jervine alkaloids).
• Note: Much of the toxicological data in this monograph is based on the European white hellebore (Veratrum album), as both American hellebore and European white hellebore contain jervine alkaloids, the constituents responsible for the plants' toxic cardiovascular effects.

Clinical Bottom Line/Effectiveness

Brief Background:

• American hellebore is a perennial plant native to the swampy areas and moist meadows of the eastern and western United States. The root and rhizome of American hellebore have been used historically for fever, pain, and high blood pressure, with a decoction (boiled in water) of the root being used in chronic coughs and constipation. Historically, the whole plant was not routinely used medicinally, only the root and rhizome.
• According to some references, the term "Hellebore" refers to a genus unrelated to, but commonly confused with, the genus Veratrum. Various species of the genus Veratrum are known as false hellebore or American hellebore, and white hellebore, but they are unrelated plants of the family Liliaceae and/or subfamily Melanthiaceae. The plant "hellebore" (not the genus) can refer to either genus Helleborus or Veratrum.
• American hellebore is very similar botanically to several other species of Veratrum, including Western false hellebore (Veratrum californicum, Veratrum tenuipetalum) and the European white hellebore (Veratrum album L., Veratrum grandiflorum O. Loes). European white hellebore is commonly used as a homeopathic medicine with several human studies supporting its use in mental conditions (1;​2;​3;​4;​5).
• Protoveratrine, which was isolated in 1890 initially from the European white hellebore (6), was the first pure steroidal alkaloid from the Veratrum species that was reported to have hypotensive properties in humans without the significant side effects of the whole plant (7). Later, other jervine alkaloids were isolated and purified from both the American hellebore and the European white hellebore with resulting pharmaceutical products tested for their therapeutic use in hypertension related to various clinical conditions, including cardiovascular and renal dysfunction, and pre-eclampsia/pregnancy-induced hypertension (7;​8;​9;​10;​11;​12;​13;​14;​15;​16;​17;​18;​19;​20). Jervine alkaloids are common to Veratrum species (21).
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Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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