Podophyllum Drug Interactions, Uses, Effectiveness, Safety & More

Podophyllum usually refers to American mayapple (Podophyllum peltatum), a low woodland plant native to eastern North America. It produces a single umbrella-shaped leaf, a white flower, and a small fruit. While the ripe fruit pulp is sometimes eaten in small amounts, the roots, leaves, seeds, and unripe fruit are poisonous.

The dried root and rhizome are the source of a resin called podophyllin, which contains the active compound podophyllotoxin. Today the most accepted use of these compounds is in prescription topical medicines for warts. A related Asian species, Podophyllum hexandrum (Himalayan mayapple), is also used as a source of podophyllotoxin.

The key active compound is podophyllotoxin (also called podofilox). It interferes with cell division by binding to a protein called tubulin and stopping cells from forming the structures they need to split. This stops fast-growing wart tissue from multiplying, which is why it is useful on warts when applied to the skin.

Because podophyllotoxin blocks cell division throughout the body, the crude plant taken by mouth is highly toxic. The same mechanism that helps with warts can damage healthy tissues and nerves when too much is absorbed. Much of what is known comes from laboratory work and clinical use of the purified compounds rather than from the whole plant.

Podophyllum is a poisonous plant. Taking the root, resin, or unripe fruit by mouth can cause serious, sometimes life-threatening poisoning. It should never be used as a homemade laxative or supplement.

Even topical prescription products must be used carefully. Applying too much, using it over a large area, or putting it on broken or moist skin can let too much be absorbed into the body and cause nerve and organ damage. Always follow the exact directions of your doctor or pharmacist.

Pregnancy and breastfeeding: Avoid podophyllum completely. It can harm a developing baby and has been linked to birth defects and pregnancy loss. Do not use it while breastfeeding because safety has not been established and the compounds are toxic. People with damaged skin, diabetes, poor circulation, or open wounds should also avoid it unless a clinician advises otherwise.

When applied to the skin, podophyllum products commonly cause local irritation, redness, burning, itching, soreness, and sometimes ulcers or peeling at the treated area.

If too much is absorbed, or if it is swallowed, serious effects can occur. These include severe nausea and vomiting, diarrhea, abdominal pain, confusion, numbness or tingling, muscle weakness, low blood counts, kidney or liver damage, seizures, and coma. These reactions can be life-threatening. Seek emergency care right away if the plant or resin is swallowed or if severe symptoms develop after use.

There is no safe self-care oral dose for podophyllum, and the whole plant should not be taken by mouth. For warts, dosing is determined entirely by the strength of the prescription product and your clinician's instructions.

If you are prescribed a topical podophyllin or podofilox product, use only the amount directed, apply it only to the warts, and follow the schedule and wash-off instructions exactly. Never increase the amount or frequency on your own. Always check with your pharmacist or doctor before using any product that contains podophyllum.