Ingestion of any part of the common oleander (Nerium oleander) or the yellow oleander (Thevetia peruviana) produces toxic effects similar to those induced by digoxin. Accidental oleander poisoning occurs throughout the tropics and subtropics, but a recent phenomenon in Sri Lanka is deliberate self-poisoning with yellow oleander, usually the seeds, by women and children in particular. This results in hundreds of deaths each year from cardiac arrest.
In the Lancet for March 18 is a report of the value of antidigoxin Fab treatment for acute thevetia poisoning. About 10 per cent of oleander poisoned patients in Sri Lanka die after reaching hospital after unavoidable delays. However, antidigoxin Fab fragments by injection reverse the toxicity just as they do after digitalis intoxication. The affinity of the antidote for thevetia glycosides appears to be less than for digitalis glycosides, so that an initial dose of at least 800mg of Fab has been recommended. This has produced an adverse response in 23 per cent of patients treated.
No evidence has yet been produced that thevetia poisoned individuals in Sri Lanka have benefited from activated charcoal treatment but there seems to be no reason why it should not prove as effective as in digitalis poisoning. If found effective, activated charcoal would reduce the need for the expensive antidigoxin Fab and also diminish the chance of undesirable reactions.