lily of the valley

Lily of the valley is a perennial plant known as Convallaria majalis, with fragrant flowers that grows in woodlands in Eurasia and North America, and also a common garden plant. Although the plant belongs to the asparagus family, all parts of lily of the valley are poisonous to humans and animals. Lily of the valley extracts have been traditionally used as an herbal remedy for certain cardiac conditions and many other ailments, however, there are no studies to establish the safety and efficacy of lily of the valley for any of its purported uses.

Lily of the valley contains many toxic compounds such as cardiac glycosides, also known as cardenolides, and saponins. The cardiac glycosides in lily of the valley are similar to those found in digitalis, another poisonous plant from which digoxin, a drug used to treat congestive heart failure and irregular heart rhythms, is derived. The cardiac glycosides in the lily of the valley, primarily convallarin, convallamarin and convallatoxin, increase the force of the heart contractions, while the saponins have gastrointestinal effects.

The suggested uses of lily of the valley include:

• Congestive heart failure
• Palpitations
• Irregular heart rhythm (cardiac arrhythmia)
• Cardiac edema
• Cardiac asthma
• Circulatory disorders
• Kidney and bladder stones
• Urinary tract infection

• Do not take lily of the valley if you have:
  • High blood pressure
  • Kidney or liver disease
  • Potassium deficiency
• Do not take lily of the valley if you are pregnant or breastfeeding.
• Lily of the valley should be used only under supervision by a qualified medical professional. Even small amounts can lead to overdose and potential fatality.

Common side effects of lily of the valley include:

• Nausea
• Vomiting
• Diarrhea
• Weakness
• General malaise
• Altered mental status
• Drop in blood potassium levels
• Chest pain
• Slow heart rate (bradycardia)
• Irregular heart rhythm (arrhythmia)
• Extra or missed heartbeat (ectopy)
• Cardiac arrest
• Headache
• Reduced responsiveness and consciousness
• Color vision disturbances

Call your doctor immediately if you experience any of the following symptoms or serious side effects while using this drug:

• Serious heart symptoms include fast or pounding heartbeats, fluttering in your chest, shortness of breath, and sudden dizziness;
• Severe headache, confusion, slurred speech, severe weakness, vomiting, loss of coordination, feeling unsteady;
• Severe nervous system reaction with very stiff muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, and feeling like you might pass out; or
• Serious eye symptoms include blurred vision, tunnel vision, eye pain or swelling, or seeing halos around lights.

This is not a complete list of all side effects or adverse reactions that may occur from the use of this drug. Call your doctor for medical advice about serious side effects or adverse reactions. You may also report side effects or health problems to the FDA at 1-800-FDA-1088.

Cardiac Glycosides

There isn’t enough reliable information to determine what might be an appropriate dosage. Suggested dosing:

• 600 mg/day oral average amount
• Tincture: 6 g/day divided three times daily orally
• Liquid extract: 600 mg/day divided three times daily orally
• Dried extract: 150 mg/day orally
• Insufficient reliable evidence available for effectiveness

Overdose

Lily of the valley is a poisonous plant and overdose can occur with ingestion of even small amounts. Symptoms of overdose include nausea, vomiting, weakness, general malaise, altered mental state, chest pain, low heart rate, irregular heartbeat, extra or skipped heartbeat (ectopy), heart block, fibrillation and cardiac arrest.

Overdose treatment is primarily symptomatic and supportive, including administration of activated charcoal to eliminate any undigested drug in the digestive tract. Potassium level is closely monitored and intravenous fluids may be administered, if required.

Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctor’s recommendation.

• Lily of the valley has no known severe interactions with other drugs.
• Serious interactions of lily of the valley include:
  • digoxin
• Moderate interactions of lily of the valley include:
  • bendroflumethiazide
  • bumetanide
  • chlorothiazide
  • chlorthalidone
  • cyclopenthiazide
  • ethacrynic acid
  • furosemide
  • hydrochlorothiazide
  • indapamide
  • methyclothiazide
  • metolazone
  • senna
  • torsemide
• Mild interactions of lily of the valley include:
  • acebutolol
  • adenosine
  • amiodarone
  • calcium acetate
  • calcium carbonate
  • calcium chloride
  • calcium citrate
  • calcium gluconate
  • diltiazem
  • disopyramide
  • encainide
  • esmolol
  • flecainide
  • ibutilide
  • lidocaine
  • mexiletine
  • phenytoin
  • procainamide
  • propafenone
  • propranolol
  • quinidine
  • sotalol
  • verapamil

The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

• There are no studies on the safety of using lily of the valley in pregnant women and is likely unsafe to use during pregnancy. Avoid use if you are pregnant.
• There is no information on the presence of lily of the valley in breastmilk or its effects on milk production and the breastfed infant. Avoid use if you are a nursing mother.
• Do not take any herbal product, including lily of the valley, without first checking with your healthcare provider, if you are pregnant or breastfeeding.

• There are no studies on the safety and efficacy of lily of the valley for its suggested uses. Lily of the valley is a poisonous plant. Ingestion of even small amounts are known to be toxic and potentially fatal.
• If you do take lily of the valley, follow label instructions exactly. Do not take a higher or more frequent dose than recommended. Natural products are not necessarily safe always and following suggested dosing is important.
• Check with your healthcare provider before taking any herbal product, including lily of the valley, particularly if you have any health conditions or if you are on any regular medication.
• Herbal products often contain many ingredients. Check labels for the components in the lily of the valley product you choose.
• Lily of the valley is marketed as an herbal supplement and is not regulated by the FDA. Products may differ in formulations and strengths, and labels may not always match contents. Exercise caution in choosing your product.
• Store lily of the valley products safely out of reach of children.
• In case of overdose, seek immediate medical help or contact Poison Control.