Appalachian bunchflower and Breastfeeding

Summary of use during lactation

Appalachian bunchflower (Veratrum parviflorum) found in the Southeastern United States that contains several cardiotoxic alkaloids, such as cyclopamine, jervine, veratramine. It has no known use in lactation. A woman who mistakenly ate Appalachian bunchflower had veratramine and cyclopamine in her milk, although the toxicological significance of their presence in milk for the breastfed infant is unknown.

Drug levels in milk and infant serum

Maternal Levels. A nursing mother developed nausea and vomiting approximately 2 hours after ingestion of approximately one tablespoon of cooked Veratrum parviflorum. She had sinus bradycardia with heart rate of 56, with incomplete right bundle branch block. After discharge from the emergency department, she provided 4 milk samples. The initial sample contained 405 mcg/L of veratramine. About 5 hours later, the milk concentration was 136 mcg/L and about 15.5 hours later on the next morning, the milk sample contained 303 mcg/L of veratramine. In a final milk sample 9 hours later, veratramine was undetectable (<44 mcg/L). The cyclopamine concentration of cyclopamine was above the limit of detection (11 mcg/L), but below but below the limit of quantification (32 mcg/L) in all samples.[1] Infant Levels. Relevant published information was not found as of the revision date.

Effects in breastfed infants

A nursing mother ingested one tablespoon of cooked Veratrum parviflorum. She had detectable levels of veratramine and cyclopamine in her milk, but no adverse effects were reported in her infant. The extent of nursing after the ingestion was not reported.[1]

Effects on lactation and breastmilk

Relevant published information was not found as of the revision date.

References

1. SealeJT CarpenterJE EisenstatMD Veratrum parviflorum poisoning: Identification of steroidal alkaloids in patient blood and breast milk. Clin Toxicol (Phila) 2022 60 1309 17 36301078 PubMed