Nicotinic toxicity from tincture of blue cohosh (Caulophyllum thalictroides) used as an abortifacient
Numerous natural products have been used as traditional abortifacients, each with their own efficacy and adverse effects. With the continued growth of the natural products industry, clinicians are more likely to see adverse effects from attempted abortions using these agents. A 21-y-old female developed tachycardia, diaphoresis, abdominal pain, vomiting and muscle weakness and fasciculations after using blue cohosh (Caulophyllum thalictroides) in an attempt to induce an abortion. These symptoms are consistent with nicotinic toxicity and probably resulted from methylcytisine known present in blue cohosh. The patient's symptoms resolved over 24 h and she was discharged. Whether successful or not, the use of natural agents to induce abortion is frequently associated with adverse effects in the mother or fetus. Clinicians should recognize the potential toxicity of these agents.