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Toxicity of Cyclamen Persium (Mill)
David G Spoerke, MS, RPh
Rocky Mountain Poison and
Drug Center;
Susan E Spoerke, MD
Denver Clinic West, Denver West Office Park, Golden, Colorado
80401;
Alan Hall, MD
Rocky Mountain Poison and Drug Center;
and
Barry H Rumack, MD
Rocky Mountain Poison and Drug Center,
645
Bannock Street, Denver Colorado
80204-4507
(Received January
29, 1987;
Accepted
February
3, 1987)
ABSTRACT. Cyclamen spp contain toxic saponins, although
the number of
serious exposures is very low. The
plant was investigated
for
toxic and pharmacologic properties in the
1950's
and
1960's,
but there is little
current investigation. Cyclamens have been found both as woodland plants and houseplants in Europe
for
years, and the plant is becoming increasingly popular in the US. Poison centers should be aware of the
potential toxicity of this plant, especially that
of the rhizomatous tubers. Additional data on exposures
reported to poison centers may be helpful in further defining the toxicity of this plant.
CASE HISTORY
In December 1986, one of the authors re-
ceived a call from a parent asking if the
cyclamen, a common houseplant, was toxic.
A 14 month-old child had been playing with
this plant, but was not thought to have
ingested it. The parent was referred to the
local poison center where she was told the
plant was potentially toxic. Since none
of the plant material was missing, the child
was observed for gastroenteritis but not given
additional care. No signs or symptoms oc-
curred over the next 24 hrs. This incident
prompted the mother to contact her florist
to complain about being sold a poisonous
plant. Shortly thereafter, the poison cen-
ter received an inquiry call from the
florist.
The cyclamen is a popular winter flowering
pot plant in Europe which is finding in-
creasing popularity in the US. The peak
demand time for these plants is around
Christmas (1). Cyclamens are found in gar-
dens, as
a
house plant, and as a wildflower.
There are about 20 species mentioned in Hor-
tus Third, a standard botanic identification
text (2). Common names used include Per-
sian violet, alpine violet, and sowbread
(2,3). The houseplant is usually Cyclamen
persium (Mill), a native
of
the eastern
Mediterranean area. Many greenhouse varie-
ties have been derived and named for the
colors of their flowers. Common names in-
clude afterglow (crimson), crimson king
(crimson), rosalie (light salmon-rose),
salmon king (salmon pink), rose von aalsmeer
(rose-pink), white swan (white) and grandi-
flora (white with a salmon base) (1).
We contacted 10 floral shops in the Denver
metropolitan area and found that none were
aware that this plant had the potential to
cause toxicity. Not all texts on poisonous
plants include a listing for cyclamen (4-6),
but others list it as both toxic and poten-
tially deadly (7,8). A Medline search back
to 1965 produced only 3 articles on the
topic; 2 of these were in Russian.
TOXICITY
The toxic principles are triterpenoid
saponins, with cylcamin (Fig 1) being the
most prevalent. Cyclamin is fungitoxic and
provides the plant with a barrier to fungal
infection (9). These saponins are irritants
which, besides causing local effects of
nausea, vomiting and diarrhea, are absorbed
and reported to cause convulsions and
paralysis. The local irritant effect has
been known for years (12). The herbal com-
pound Rhizoma cyclaminis was once recommend-
ed as a drastic purgative (7). Kupchan et
al (10), while investigating the potential
anti-tumor effect of C persium fractions,
measured cytotoxicity by using the ED5O
(dose inhibiting 507. of control cell growth).
The ED5O ranged from 2.1 to greater than
100 ug/ml, showing great variability in
cytotoxicity. Cyclamin itself is not
volatile, but it is water soluble and may
occur as either small white crystals or
an amorphous, lusterless mass. It has a
very acrid, rancid taste, a fact that may
keep ingestions to a minimum (11).
DISCUSSION
If this plant has been known to be toxic
since the late 1700's (12), then why are
not exposures more commonly reported to
poison centers? First, this plant has
become a popular houseplant only in the last
few years, and opportunities for children
250
Vet Hum
Toxicol 29 (3)
June 1987
Gluc' Arab-Glue -O
Xyl
Figure 1. Structure of Cyclamin
to be exposed have probably been minimal
(1). Second, all available references ex-
cept one (13) list the rhizomes (under-
ground stems) as the toxic part, not the
flowers or foliage. The quantity of foliage
and/or rhizome necessary to cause symptoms
may be greater than that usually required
for a typical childhood ingestion. The
saponin content of the foliage is unclear.
The toxic tuberous rhizomes are not especial-
ly attractive, are usually on or under the
soil, and have a bitter, acrid taste. These
facts together would be likely to decrease
the incidence of childhood exposures.
Although it is well established that cycla-
men rhizomes are toxic, the exact danger is
difficult to ascertain. References list
this plant as "may be fatal" (8), but do
not specify potentially lethal amounts. One
reference states that ingestion of only a
small piece of the tubers may produce con-
vulsions and paralysis, but does not cite
case histories (7). Hybrids of C persium
are suspected of causing hand eczema and
other hand dermatoses because of patch test
results, but even this has not been abso-
lutely proven (14). Current investigation
with cyclamen have not centered around its
GI effects, but rather on the use of various
fractions from the plant as an anti-tumor
agent (10), a cardiovascular agent (15),
and as an agent in the management of athero-
sclerosis (16).
REFERENCES
1.
Compton J: Houseplants. Bantam Book, New York,
NY,
1973.
2.
Bailey LH and Bailey EZ:
Hortus Third. Mac-
Millian Publishing Company Inc, New York, NY,
1976.
3.
Grey
-
Wilson C:
The Alpine Flowers of Britain
and Europe, Williams Collins Sons & Company
Ltd, London,
1979.
4.
Lampe KF and McCann MA: AMA Handbook of Poison-
ous and Injurious Plants. American Medical
Association, Chicago, Illinois, 1985.
5.
Copper MR and Johnson AW: Poisonous Plants
in Britain and Their Effects on Animals and
Man.
Reference Book 161, Her Majesty's Station-
ery Office, 1984.
6.
Hardin JW and Arena JM: Human Poisoning from
Native and Cultivated Plants, 2nd ed.
Duke
University Press, Durham, North Carolina, 1974.
7.
Frohne D and Pfander HJ: Poisonous Plants,
A Handbook for Pharmacists, Doctors, Toxicolo-
gists and Biologists.
Wolfe Publishing Ltd,
London, 1984.
8.
Tampion J: Dangerous Plants. Universe Books,
New York,
NY, 1977.
9.
Harbone JB: Toxins of plant-fungal interactions.
In:
Keeler RF and Tu AT: Handbook of Natural
Toxins, vol 1, Plant and Fungal Toxins.
Marcel
Dekker Inc, New York, NY, 1983.
10.
Kupchan SM, Hemingway RJ, Knox JR et al: Tumor
Inhibitors XXI.
Active principles of Acer
negundo and Cyclamen persium. J Pharm Sci
56:603-608, 1967.
11.
Millspaugh CF:
American Medicinal Plants.
Dover Publications Inc, New York, 1974.
12.
Kingsburg JM: Poisonous Plants of the United
States and Canada. Prentice-Hall Inc, New
Jersey, 1964.
13.
Schneider MF: Plants Poisonous to Children and
Other People.
Blue Cross-Blue Shield of the
Rochester Area. Rochester, NY, 1984.
14.
Mitchell J and Rook A:
Plants and Plant Pro-
ducts Injurious to the Skin. Greengrass Press,
Vancouver, 1974.
15.
Gladkikh AS:
Deistvie saponina iz tsiklamena
gruzinskogo na nekotorye pokazateli sostoigniia
serdechnososudistoi sistemy zhivotnykhi, Farma-
kol Toksikol
29:559
-
562, 1966.
16.
Gladkikh AS:
Vliianie sapinia iz tsiklamena
gruzinskogo na razvitie eksperimental' nogo
ateroskleroza u kralikov.
Farmakol Toksikol
28:147-152, 1965.
NON
-
EMERGaCY PHONE NUMBER AVAILABLE
BIBLIOGRAPHY AVAILABLE
Dr FE Russell has a small number of copies of the
Bibliograohv of Venomous and Poisonous Marine Animals
and Their Toxins, which he will make available on a
first-come, first-serve basis. All requests must be
written on University or Poison Control Center
stationery. Please enclose $1.00 for handling and
shipping: FE Russell, MD, College of Pharmacy,
University of Arizona, Tucson, AZ 85721.
The Chemical Manufactures Association (CMA) has
established a toll-free phone number -- 800/262-8200 --
to provide non-emergency health and safety information
about any chemical or chemical based product. Calls
received at this number are referred to various
government agencies, companies involved with the
chemical in question. This CMA sponsored service
is available Monday through Friday from 8:00 am to
9:00 pm Eastern time.
Vet Hum Toxicol 29 (3) June 1987
251
