HERBAL
MEDICINAL
PLANT
---------------------------------------------------
SQUILL, SEA ONION
Urginea maritima (L.)
Baker) X
(Asparagaceae)
BY
RETTODWIKART THENU
SQUILL,
SEA ONION !
(skwil)
Urginea maritima (L.)
Baker) X (Asparagaceae)
SUMMARY AND PHARMACEUTICAL COMMENT
Squill
is characterised by its cardiac glycoside components and unusual flavonoid
constituents. The reputed actions of
squill
as an expectorant, emetic and cathartic can be attributed to the cardioactive
components and squill has been used as an expectorant for many years. However,
in view of the documented cardioactive and emetic properties of the aglycones,
excessive use and use during pregnancy and lactation should be avoided. Red
squill is primarily used as a rodenticide.
Red
squill is distributed through the entire Mediterranean region and is sometimes
cultivated in Germany. The cardiotonic effects of the plant have been known
since ancient times.
DESCRIPTION
MEDICINAL PARTS: The medicinal
parts come from the bulbs of the white latex variety collected after flowering
and the fresh, fleshy bulb scales of the white variety and of the red variety.
FLOWER AND FRUIT: The flowering
stem is erect and 50 to 150 cm high. It is often a washed purple color and
glabrous. The flowers, which often number 100, are arranged in richly flowered,
dense racemes up to 60 cm long. The bracts are membranous and pointed. They are
shorter than the pedicles and drop early. The pedicles are up to 3 cm long,
thin and smooth. The flowers are white, radial and star-shaped. The ovary is
ovate to oblong triangular. The capsule is ovate to oblong, 3-valved, obtuse or
almost pointed. Each chamber has 1 to 4 seeds, which are elongate, flattened,
smooth, glossy and winged.
LEAVES, STEM AND ROOT: The plant is a
perennial bulb plant. The bulbs are pear-shaped, about 15 to 30 cm in diameter.
They are rarely sold whole commercially, as they tend to start growing. The
fracture is short, tough and flexible.
CHARACTERISTICS: The taste is
bitter and acrid.
HABITAT: Indigenous to
the Mediterranean and is cultivated there too.
PRODUCTION: Squill consists
of the sliced, dried, fleshy middle scales of the onion of the white variety of
Urginea maritima, harvested during the flowering season. It is collected mostly
from uncultivated regions.
SPECIES (FAMILY)
Drimia
maritima (L.) Stearn
(Asparagaceae), Urginea maritima
SYNONYM(S)
Scilla, Sea Onion, Urginea, Urginea maritima (L.) Baker, Urginea
scilla Steinh., White Squill
European squill, Indian squill,
Mediterranean squill, red squill, sea squill,
Gruenwald cites this under Drimia maritima in edition 1,
under this name in edition 2. HH2 maintains separate entries for U. indica (Roxb.)
Kunth and U. maritima, a practice I follow, so far resisting the
temptation to aggregate.
ORIGIN
Squill is found in Europe and
Mediterranean regions.
PHARMACOPODIAL AND OTHER MONOGRAPHS
BHC 1992(G6)
BHP 1996(G9)
BP 2007(G84)
Complete German Commission E(G3)
Martindale 35th edition(G85)
LEGAL CATEGORY (LICENSED PRODUCTS)
GSL(G37)
CONSTITUENTS
See
References 1 and 2 and General References G6 and G62.
Cardiac glycosides Scillaren
A and proscillaridin A (major constituents); others include glucoscillaren A,
scillaridin A, scillicyanoside, scilliglaucoside, scilliphaeoside,
scillicoeloside, scillazuroside and scillicryptoside. Scillaren B represents a
mixture of the squill glycosides.
Flavonoids Apigenin,
dihydroquercetin, isovitexin, iso-orientin, luteolin, orientin, quercetin,
taxifolin and vitexin.
Other constituents Stigmasterol, tannin,
volatile and fixed oils.
USES
USES
Traditionally, squill has been used for its cardiac
glycoside effect in the treatment of cardiac conditions such as congestive
heart failure. It is also used to treat cough and to promote diuresis.
FOOD USE
The
Food Additives and Contaminants Committee (FACC) recommended that squill be
prohibited as a food flavouring.(G45)
HERBAL USE
Squill
is stated to possess expectorant, cathartic, emetic, cardioactive and diuretic
properties. Traditionally, it has been used for chronic bronchitis, asthma with
bronchitis, whooping cough, and specifically for chronic bronchitis with scanty
sputum.(G6, G7, G8,G64)
ACTIONS
ACTIONS
In North Africa, squill has been found to be poisonous
to livestock, with ingestion of the plant leading to cardiac toxicity (El Bahri
et al, 2000). Toxicity was also reported in a 55-year-old woman with Hashimoto
thyroiditis who was taking squill to treat arthritis. Her symptoms were those
of cardiac glycoside toxicity (Tuncok et al, 1995). Squill has exerted cardiac glycoside
effects in humans but is considered to be milder than current cardiac glycoside
prescription drugs (Stauch et al, 1977).
PHARMACOLOGICAL ACTIONS
The
aglycone components of the cardiac glycoside constituents possess
digitalis-like cardiotonic properties.(G41) However, the squill aglycones are
poorly absorbed from the gastrointestinal tract and are less potent than
digitalis cardiac glycosides.(1, 2) Expectorant, emetic and diuretic properties
have been documented for white squill.(G41) Squill is reported to induce
vomiting by both a central action and local gastric irritation.(1, 2) Subemetic
or near-emetic doses of squill appear to exhibit an expectorant effect, causing
an increase in the flow of gastric secretions.(1, 2)
Antiseborrhoeic
properties have been documented for methanol extracts of red squill which have
been employed as hair tonics for the treatment of chronic seborrhoea and
dandruff.(G41) Squill extracts have been reported to exhibit peripheral vasodilatation
and bradycardia in anaesthetised rabbits.(1, 2)
PHARMACOLOGY
·
HERB: Squill (Scillae bulbus). The herb consists of the
dried, fleshy, central bulb sections of the white onion species Urginea maritima
(L.) B., collected after the
time of flowering and cut in to transverse or longitudinal strips, and
preparations of the same.
·
IMPORTANT
CONSTITUENTS: Steroid cardiac glycosides (bufadienolide, 1–3 %), glucoscillaren
A, proscillaridin A, and scillaren A.
·
PHARMACOLOGICAL PROPERTIES:
Squill has potent diuretic,
positive inotropic and negative chronotropic effects. It also lowers left
ventricular end diastolic pressure.
ACTIVITIES
Anticancer
(1; CRC); Cardiotonic (f; CRC); Diuretic (f; CRC); Emetic (f; CRC); Expectorant
(f; CRC); Hypotensive (2; KOM); Negative Chronotropic (2; KOM); Poison (f;
CRC); Positive Inotropic (2; KOM); Rodenticide (1; CRC).
INDICATIONS
Adenopathy
(f; CRC; JLH); Arrhythmia (2; CRC; PHR); Asthma (f; CRC); Bronchosis (f; CRC);
Bruise (f; CRC); Burn (f; CRC); Callus (f; CRC); Cancer (1; CRC); Cancer, eye
(f; CRC; JLH); Cancer, liver (f; CRC; JLH); Cancer, parotid (f; CRC; JLH);
Cancer, spleen (f; CRC; JLH); Cardiac Insufficiency (2; KOM); Catarrh (f; CRC);
Congestion (f; CRC); Corn (f; CRC); Cough (f; CRC); Croup (f; CRC); Dandruff
(f; CRC); Edema (f; CRC); Felon (f; CRC); Gas (f; CRC); Heart (f; CRC); High
Blood Pressure (2; KOM); Induration (f; CRC); Kidney Insufficiency (2; KOM);
Nephrosis (f; CRC); Nervous Cardiopathy (2; PHR); Pertussis (f; CRC); Seborrhea
(f; CRC); Sore (f; CRC); Stomachache (f; CRC); Tumor (f; CRC); Varicosis (2;
PHR); Wart (f; CRC); Water Retention (f; CRC); Wound (f; CRC).
INDICATIONS AND USAGE
Approved by
Commission E:
• Cardiac
insufficiency NYHA I and If
• Arrhythmia
• Nervous heart
complaints
• Venous
conditions
Unproven Uses: Squill is used
for reduced kidney capacity. In folk medicine it is used for catarrhal conditions
of the upper respiratory tract, bronchitis, asthma and whooping cough, also for
wounds and fractures, back pain and hemorrhoids and for the disinfection of
septic wounds.
Indications
– Heart failure (NYHA classes I
and II)
– Cardiac arrhythmias
– Nervous heart disorders
PRODUCT AVAILABILITY
Dried bulb, extract, tincture
PLANT PART USED: Bulb
DOSAGES
DOSAGES
·
Adult PO decoction: pour 8 oz boiling
water over 1 tsp dried bulb, let stand 15 min, allow to cool; may be taken tid
·
Adult PO tincture: 1⁄2-1 ml tid
DOSAGES
Dosages
for oral administration (adults) for traditional uses recommended in older and
contemporary standard herbal and pharmaceutical reference texts are given
below.
·
Dried Bulb 60–200 mg as an infusion three times daily.(G6,
G7)
·
Squill Liquid Extract (BPC 1973) 0.06–0.2
mL.
·
Squill Tincture (BPC 1973) 0.3–2.0 mL.
·
Squill Vinegar (BPC 1973) 0.6–2.0 mL.
DOSAGES
0.1–0.5 g StX sea onion powder (2; KOM).
DOSAGES
MODE OF ADMINISTRATION: Comminuted drug
and other galenic preparations for internal use.
PREPARATION: Stabilized powder
is standardized according to content, there are no more exact specifications in
the
literature, standardization according to
DABIO.
·
Squill Extract — Evaporated
extract l :4; drug: diluted spirit of wine (EB6)
·
Acetum Scillae — drug: spirit of wine l:l
(EB6)
·
Oxymel Scillae — 5 parts Acetum Scillae: 10
parts purified honey evaporated in a water bath to 10 parts
DAILY DOSAGE: Single dose: 60
to 200 mg; Daily dose: 180 to 200 mg; Average daily dosage: 0.1 to 0.5 gm of
standardized sea onion powder.
·
Squill Extract: 1.0 gm; Liquid
extract: 0.03 to 2.0 ml;
·
Tincture: 0.3 to 2.0 ml;
Acetum Scillae: 1.0 gm; Acetic acid maceration: 0.6 to 2.0 ml
·
Oxymel Scillae: 2.5 gm
STORAGE: Squill should be
protected from light and moisture at temperatures below 25 °C.
DOSAGE
AND DURATION OF USE
– One dose equals 60–200 mg herb.
– Daily dose: 180–200 mg herb.
– Standardized powder: 0.1–0.5 g.
– Extractum Scillae: 1.0 g.
– Fluid extract: 0.03–2.0 mL.
– Tincture: 0.3–2.0 mL.
Important: Because squill is so difficult to standardize,
the isolated glycosides (e. g., proscillaridin A) should preferentially be
used.
PRECAUTIONS AND ADVERSE REACTIONS
GENERAL: No health hazards
are known in conjunction with the proper administration of designated
therapeutic dosages. Because of the narrow therapeutic range of cardioactive steroid
glycosides, side effects could appear even with therapeutic dosages. Side effects
include tonus elevation of the gastrointestinal area, loss of appetite,
vomiting, diarrhea, ' headache and irregular pulse. Contact with the juice of
the fresh bulb can lead to skin inflammation (squill dermatitis). The
administration of pure glycoside is preferable due to the difficulties of
standardizing the drug (proscillaridin A).
DRUG INTERACTIONS: Increase of
effectiveness and thus also of side effects is possible with concomitant
administration of quinidine, calcium, saluretics, laxatives and extended
therapy with glucocorticoids. Squill potentiates the positive inotropic and
negative chronotropic effects of digoxin. The simultaneous administration of
arrhythmogenic substances (sympathomimetics, methylxanthines, phosphodiesterase
inhibitors, and quinidine) increases the risk of cardiac arrhythmias.
OVERDOSAGE
Besides
the already-mentioned symptoms, overdosage can lead to cardiac rhythm disorders,
life-threatening .ventricular tachycardia, atrial tachycardia with
atrioventricular block, stupor, vision disorders, depression, confused states,
hallucinations and psychosis. Fatal dosages lead to cardiac arrest or asphyxiation.
Treatment
of poisoning includes gastric lavage and instillation of activated charcoal.
All other measures are to be carried out according to the symptoms. In case of
potassium loss, careful replenishment; for ectopic impulse formation in the
ventricle, administration of phenytoin as antiarrhythmic drug; lidocaine for
ventricular extrasystole; for pronounced bradycardia, atropine or orciprenaline.
The prophylactic use of a pacemaker is recommended. Hemoperfusion for
eliminating the glycosides or the administration of cholestyramine for
interrupting the enterohepatic circulation are possible.
CONTRAINDICATIONS, INTERACTIONS, AND SIDE
EFFECTS
Commission E reports contraindications: potassium
deficiency, and therapy with digitalis glycosides; adverse effects: diarrhea, gastrosis,
irregular pulse, nausea, and vomiting; and interactions with other drugs:
potentiation of calcium, cardiac glycosides, extended glucocorticoid therapy,
laxatives, quinidine, and saluretics (AEH; KOM). I thought that was a pretty
big dose of Commission E, but here’s what Gruenwald has to say: Should not be
used in 2nd or 3rd degree atrioventricular blocks, carotid sinus syndrome, hypercalcemia,
hypokalemia, hypertropic cardiomyopathy, thoracic aortic aneurysm, ventricular tachycardia,
and WPW Syndrome (PHR).
CONTRAINDICATIONS
Until more research is available, squill should not be
used during pregnancy and breastfeeding. It should not be given to children.
Squill should not be used by persons with hypokalemia, hypertropic cardiomyopathy,
sick sinus syndrome, ventricular tachycardia, or second or third-degree heart
block. Persons who are hypersensitive to squill should not use it.
CONTRAINDICATIONS:
Individuals with AV block classes II or III,
hypercalcemia, hypokalemia, hypertrophic cardiomyopathy, carotid sinus
syndrome, ventricular tachycardia, aneurysm of the thoracic aorta, or Wolff–Parkinson–
White (WPW) syndrome should not use squill or glycosides isolated from it.
SIDE
EFFECTS/ADVERSE REACTIONS
CNS: Anxiety, headache, tremors, central nervous system
stimulation, seizures
CV: Arrhythmias,
heart block, asystole
GI: Nausea, vomiting, anorexia
INTEG: Hypersensitivity reactions
INTERACTIONS
Drug
Cardiac agents (antiarrhythmics,
beta-blockers, calcium channel blockers, cardiac glycosides): Squill may increase the effects of cardiac agents, causing life-threatening toxicity; do not use
concurrently.
INTERACTIONS—CONT’D
CNS stimulants (amphetamines,
cerebral stimulants), glucocorticoids, laxatives: Squill may increase the effects of central nervous
system
stimulants, glucocorticoids,
laxatives; avoid concurrent use.
Iron salts: Squill may decrease the absorption of iron salts;
separate by 2 hours.
Lab Test
Red blood cells:
Squill may cause a decrease in
red blood cells.
SIDE-EFFECTS, TOXICITY
CLINICAL DATA
Excessive use of
squill is potentially toxic because of the cardiotonic constituents. However,
squill is also a gastric irritant and large doses will stimulate a vomiting
reflex.
PRECLINICAL DATA
Red squill is
toxic to rats and is mainly used as a rodenticide, causing death by a centrally
induced convulsant action.(1, 2) A squill soft mass (crude extract) has been
stated to be toxic in guinea-pigs at a dose of 270 mg/kg body weight. A fatal
dose for Indian squill (Urginea indica Kunth.) is documented as 36 mg/kg.
ADVERSE EFFECTS:
Because steroid cardiac glycosides have a narrow
therapeutic range, therapeutic doses of these drugs can induce side effects in
some individuals. These include increased muscle tone in the gastrointestinal
region, lack of appetite, nausea, diarrhea, headaches, and irregular pulse.
CONTRA-INDICATIONS, WARNINGS
Squill may cause
gastric irritation and should be avoided by individuals with a cardiac
disorder. In view of the cardiotonic constituents, precautions applied to
digoxin therapy should be considered for squill.
DRUG INTERACTIONS
None documented. However, the potential for preparations of squill to interact
with other medicines administered concurrently, particularly those with similar
or opposing effects, should be considered. Squill contains cardiac glycosides, and
interactions listed for digoxin should be considered for squill.
PREGNANCY AND
LACTATION Squill is reputed to be an
abortifacient and to affect the menstrual cycle.(G30) In addition, cardioactive
and gastrointestinal irritant properties have been documented. The use of
squill during pregnancy and lactation should be avoided.
WARNING: Symptoms
of overdose
·
Cardiac symptoms can range from
cardiac arrhythmia to life-threatening tachycardia and/or atrial tachycardia
with AV block.
·
CNS symptoms are stupor,
impaired vision, depression, confusion, hallucination, and psychoses.
·
In lethal poisoning, the cause
of death is cardiac arrest or asphyxia.
➤
HERB–DRUG
INTERACTIONS: The concomitant administration
of arrhythmogenic substances such as sympathomimetics, methylxanthines,
phosphodiesterase inhibitors, and quinidine increases the risk of cardiac
arrhythmia.
CLIENT CONSIDERATIONS
ASSESS
·
Assess
for hypersensitivity reactions. If present, discontinue the use of squill and administer
an antihistamine or other appropriate therapy.
·
Assess
cardiac status (blood pressure, pulse, possibly ECG) if the client is taking squill
over an extended period of time.
·
Monitor
electrolytes and watch for decreasing potassium levels.
·
Determine
whether the client is taking other cardiac medications such as betablockers, calcium
channel blockers, cardiac glycosides, and antidysrhythmics. This herb should
not be used with these medications (see Interactions).
·
Assess
for the use of central nervous system stimulants, glucocorticoids, and laxatives
(see Interactions).
ADMINISTER
·
Instruct the client to store squill products
in a cool, dry place, away from heat and moisture.
TEACH
CLIENT/FAMILY
·
Caution
the client not to use squill in children or those who are pregnant or
breastfeeding until more research is available.
·
Advise
the client that other, more mainstream agents are available and are preferred
to squill.
REFERENCE
Barnes, J., Anderson, L. A., and Phillipson, J. D.
2007. Herbal Medicines Third Edition. Pharmaceutical
Press. Auckland and London.
Duke, J. A. with Mary Jo Bogenschutz-Godwin, Judi
duCellier, Peggy-Ann K. Duke. 2002. Handbook of Medicinal Herbs 2nd
Ed. CRC Press LLC. USA.
Gruenwald, J., Brendler, T., Jaenicke, Ch. 2000. PDR for
Herbal Medicines. Medical Economics Company, Inc. at
Montvale, NJ 07645-1742. USA
Kraft, K and Hobbs, C. 2004 . Pocket Guide to Herbal Medicine. Thieme. Stuttgart New York.
Linda S-Roth. 2010. Mosby’s Handbook Of
Herbs & Natural Supplements, Fourth Edition. Mosby Elsevier. USA
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