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Cerbera manghas contains potent cardiac glycosides, primarily cerberin, which inhibit the sodium-potassium ATPase pump in cardiac cells. This inhibition increases intracellular calcium concentration, initially strengthening cardiac contractions but ultimately disrupting normal electrical conduction. The result is severe cardiac arrhythmias that can progress to complete heart block and cardiac arrest. Unlike pharmaceutical cardiac glycosides such as digoxin, cerberin has an extremely narrow margin between therapeutic and lethal doses, making the plant highly dangerous (Evidence level: C).
Is Cerbera manghas safe to use during pregnancy?
No, Cerbera manghas is absolutely unsafe during pregnancy and breastfeeding. The cardiac glycosides present in all plant parts, including cerberin and neriine, can cross the placental barrier and may cause fetal cardiac arrhythmias, miscarriage, or stillbirth. These compounds can also pass into breast milk, posing serious risks to nursing infants. Given the well-documented potential for fatal cardiac toxicity in adults, pregnant and breastfeeding women must avoid any exposure to this plant (Evidence level: C, based on cardiac glycoside pharmacology).
What is the safe dosage of Cerbera manghas for medicinal use?
There is no established safe dosage for Cerbera manghas. All parts of the plant contain potentially lethal concentrations of cardiac glycosides, and no clinical trials have determined a therapeutic window. Traditional folk medicine used bark preparations topically for skin conditions, but even external application carries risk of systemic absorption through damaged skin. Self-medication with this plant is strongly contraindicated by medical herbalists and toxicologists alike. Internal consumption has caused fatal poisonings (Evidence level: C, Traditional).
Does Cerbera manghas interact with heart medications like digoxin?
Yes, Cerbera manghas poses severe and potentially fatal interaction risks with cardiac medications. Its cardiac glycosides can cause additive toxicity when combined with digoxin, other cardiac glycoside drugs, beta-blockers, calcium channel blockers, or antiarrhythmic medications. Concurrent use with diuretics may worsen electrolyte imbalances that increase cardiac glycoside toxicity. Patients taking any heart medications must strictly avoid this plant. The combination can precipitate life-threatening arrhythmias even at exposure levels that might otherwise be tolerated (Evidence level: C).
What happens if someone ingests Cerbera manghas leaves or fruit?
Ingestion of any part of Cerbera manghas is a medical emergency requiring immediate hospital care. Symptoms typically begin within 1-2 hours and include severe vomiting, abdominal pain, diarrhea, dizziness, and visual disturbances. Cardiac effects follow, including bradycardia, heart block, and potentially fatal arrhythmias leading to cardiac arrest. The fruit, sometimes called 'sea mango,' resembles a small mango and has caused accidental poisonings. There is no specific antidote; treatment involves supportive care, activated charcoal if early, and cardiac monitoring (Evidence level: C, based on case reports).
Fiche d'information compilée à partir de PubMed
Cette fiche a été compilée à partir de résumés PubMed (NIH) avec l'assistance d'une IA. Chaque affirmation factuelle est citée par un article PubMed réel (voir la liste des sources). Elle n'a pas encore été révisée par un humain — confirmez auprès d'un professionnel de santé avant utilisation.
Compilé à partir de 30 articles PubMed · modèle : gemma4:31b
Résumé
Cerbera manghas, also known as the sea mango or pink-eyed cerbera, is a tropical mangrove plant containing potent cardiac glycosides that can cause fatal poisoning [PMID:36044149, PMID:12807314].
Contexte
Cerbera manghas (Apocynaceae) is a tropical mangrove plant distributed throughout tropical and subtropical countries, including Asia, Australia, Madagascar, and the Western Pacific [PMID:36044149, PMID:24342777]. It is closely related to Cerbera odollam and Thevetia peruviana [PMID:36044149, PMID:33553627].
Usages traditionnels
In traditional folk medicine, the plant has been used as an analgesic, anticonvulsant, cardiotonic, and for hypotensive activity [PMID:33737498, PMID:24342777].
Composés actifs
The plant contains secondary metabolites including saponins, terpenoids, alkaloids, phenolic acids, flavonoids, steroids, iridoids, and lignans [PMID:33737498]. The primary active compounds are cardiac glycosides (cardenolides), specifically cerberin, neriifolin, tanghinin, and deacetyltanghinin found in the seeds [PMID:24878878, PMID:36044149]. Other identified compounds include quinic acid, protocatechuic acid, and phloridzin [PMID:33254874], as well as cerberic acids A and B in the bark [PMID:20546844].
Mécanisme d'action
Cardiac glycosides in the seeds, such as cerberin, block calcium ion channels in heart muscles, leading to disruption of the heartbeat [PMID:36044149]. Methanol extracts of the plant target c-Jun N-terminal kinase in the AP-1 pathway and inhibit the production of prostaglandin E2 and COX-2 mRNA expression to exert anti-inflammatory effects [PMID:27562319]. Certain glycosides like neriifolin and tanghinigenin induce apoptosis in cancer cells via activation of caspases (3, 8, and 9) and the Fas/FasL interaction [PMID:21459134, PMID:21787626].
Preuves cliniques
Preuve DInflammatory diseases
Methanol extract (Cm-ME) downregulated PGE2 and COX-2 expression in LPS-treated macrophages and showed inhibitory effects in mouse models of hepatitis and peritonitis [PMID:27562319].
Preuve DHepatocellular carcinoma (HepG2 cells)
Neriifolin and GHSC-74 induced cell cycle arrest (S and G2/M phases) and apoptosis [PMID:21459134, PMID:19874809].
Preuve DPromyelocytic leukemia (HL-60 cells)
Tanghinigenin reduced cell viability and induced apoptosis via caspase activation [PMID:21787626].
Preuve DAcute Myeloid Leukemia (THP-1 cells)
17β-neriifolin from unripe fruits suppressed cell proliferation by inhibiting HOXA9-dependent transcription [PMID:36266527].
Sécurité et effets indésirables
The plant is highly toxic and ranked among the deadliest on the southern Asian coastline [PMID:24878878]. Ingestion of seeds or fruits can lead to fatal cardenolide poisoning characterized by cardiac dysrhythmias, hyperkalemia, major bradycardia, low blood pressure, and asystolia [PMID:18803087, PMID:19591858]. It is frequently used for intentional self-poisoning (suicide) [PMID:12807314, PMID:18803087].
Synthèse des preuves
The available evidence consists primarily of in vitro studies, animal models, and clinical case reports of poisoning. There are no RCTs or systematic reviews provided; therefore, the evidence for medicinal use is low (Level D), while the evidence for toxicity is high based on multiple case reports (Level D).
Sources PubMed
1.PMID: 36044149 (2023) — Bintaro (Cerbera odollam and Cerbera manghas): an overview of its eco-friendly use, pharmacology, and toxicology. · Environmental science and pollution research international
2.PMID: 33737498 (2021) — Ethnobotanical, phytochemical, and pharmacological properties of Cerbera manghas L. · Journal of biosciences
3.PMID: 12807314 (2003) — Acute plant poisoning and antitoxin antibodies. · Journal of toxicology. Clinical toxicology
4.PMID: 27562319 (2016) — Cerbera manghas methanol extract exerts anti-inflammatory activity by targeting c-Jun N-terminal kinase in the AP-1 pathway. · Journal of ethnopharmacology
5.PMID: 24342777 (2014) — Syk and Src are major pharmacological targets of a Cerbera manghas methanol extract with kaempferol-based anti-inflammatory activity.
Sources gouvernementales
Aucune monographie gouvernementale directe n'est disponible pour cette plante. Le contenu ci-dessous est généré par IA et n'a pas été vérifié par rapport à une source gouvernementale faisant autorité. Utilisez les liens de recherche pour consulter les sources officielles avant de vous fier à ces informations.
6.PMID: 24878878 (2014) — The principal toxic glycosidic steroids in Cerbera manghas L. seeds: identification of cerberin, neriifolin, tanghinin and deacetyltanghinin by UHPLC-HRMS/MS, quantification by UHPLC-PDA-MS. · Journal of chromatography. B, Analytical technologies in the biomedical and life sciences
7.PMID: 33254874 (2021) — In vitro allelopathic effects of compounds from Cerbera manghas L. on three Dinophyta species responsible for harmful common red tides. · The Science of the total environment
8.PMID: 36266527 (2023) — 17β-neriifolin from unripe fruits of Cerbera manghas suppressed cell proliferation via the inhibition of HOXA9-dependent transcription and the induction of apoptosis in the human AML cell line THP-1. · Journal of natural medicines
9.PMID: 18803087 (2008) — Fatal injury in eastern Sri Lanka, with special reference to cardenolide self-poisoning with Cerbera manghas fruits. · Clinical toxicology (Philadelphia, Pa.)
10.PMID: 39921954 (2025) — One-pot polyhydroxyalkanoate (PHA) production from Cerbera odollam (sea mango) oil using Pseudomonas resinovorans: Optimal fermentation design and mechanism. · Journal of environmental management
11.PMID: 39225051 (2024) — A rapid optimization method for Sepbox system separation using HPTLC: an application of Cerbera manghas L. separation. · Analytical methods : advancing methods and applications
12.PMID: 33553627 (2020) — The complete chloroplast genome of the highly poisonous plant Cerbera manghas L. (Apocynaceae). · Mitochondrial DNA. Part B, Resources
13.PMID: 3086679 (1986) — Naturally occurring cardiac glycosides. · The Medical journal of Australia
14.PMID: 21036567 (2012) — β-D-Glucosyl-(1-4)-α-L-thevetosides of 17β-digitoxigenin from seeds of Cerbera manghas L. induces apoptosis in human hepatocellular carcinoma HepG2 cells. · Experimental and toxicologic pathology : official journal of the Gesellschaft fur Toxikologische Pathologie
15.PMID: 32324527 (2020) — Antifungal Mechanism of Rhodotorula mucilaginosa and Aureobasidium sp. nov. Isolated from Cerbera manghas L. against the Growth of Destructive Molds in Post Harvested Apples. · Recent patents on food, nutrition & agriculture
16.PMID: 20546844 (2010) — Phenylpropionic acid derivates from the bark of Cerbera manghas. · Fitoterapia
17.PMID: 28703032 (2018) — Cerbera manghas poisoning survived by using extracorporeal life support. · Clinical toxicology (Philadelphia, Pa.)
18.PMID: 21787626 (2010) — Tanghinigenin from seeds of Cerbera manghas L. induces apoptosis in human promyelocytic leukemia HL-60 cells. · Environmental toxicology and pharmacology
19.PMID: 34469771 (2021) — Wild Goffin's cockatoos flexibly manufacture and use tool sets. · Current biology : CB
20.PMID: 15305009 (2004) — New cytotoxic cardenolide glycoside from the seeds of Cerbera manghas. · Chemical & pharmaceutical bulletin
21.PMID: 21459134 (2011) — Neriifolin from seeds of Cerbera manghas L. induces cell cycle arrest and apoptosis in human hepatocellular carcinoma HepG2 cells. · Fitoterapia
22.PMID: 25918788 (2014) — Acaricidal activity against Panonychus citri and active ingredient of the mangrove plant Cerbera manghas. · Natural product communications
23.PMID: 19177242 (2009) — Chemical constituents from the bark of Cerbera manghas. · Journal of Asian natural products research
24.PMID: 18363136 (2008) — Cardiac glycoside poisoning following suicidal ingestion of Cerbera manghas. · Clinical toxicology (Philadelphia, Pa.)
25.PMID: 25116120 (2014) — Vermistatin derivatives with α-glucosidase inhibitory activity from the mangrove endophytic fungus Penicillium sp. HN29-3B1. · Planta medica
26.PMID: 19874809 (2010) — 2'-epi-2'-O-Acetylthevetin B extracted from seeds of Cerbera manghas L. induces cell cycle arrest and apoptosis in human hepatocellular carcinoma HepG2 cells. · Chemico-biological interactions
27.PMID: 40682205 (2025) — Potential of ethyl acetate and ethanol extracts of Bintaro (Cerbera manghas L.) seeds as bioinsecticides against Aedes aegypti (Diptera: Culicidae). · BMC research notes
28.PMID: 11078194 (2000) — Activity-guided isolation of constituents of Cerbera manghas with antiproliferative and antiestrogenic activities. · Bioorganic & medicinal chemistry letters
29.PMID: 40505452 (2025) — Development of an LC-MS/MS detection method for cardiac glycosides (cerberin, neriifolin, and tanghinin) in human blood serum: Application to a Cerbera odollam poisoning case. · Journal of pharmaceutical and biomedical analysis
30.PMID: 19591858 (2010) — Double lethal coconut crab (Birgus latro L.) poisoning. · Toxicon : official journal of the International Society on Toxinology