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Medical Uses of Belladonna Plant Alkaloids Drug & Extract

Written by Carlos Tello, PhD (Molecular Biology) | Reviewed by Ana Aleksic, MSc (Pharmacy) | Last updated:
Jonathan Ritter
Puya Yazdi
Medically reviewed by
Jonathan Ritter, PharmD, PhD (Pharmacology), Puya Yazdi, MD | Written by Carlos Tello, PhD (Molecular Biology) | Reviewed by Ana Aleksic, MSc (Pharmacy) | Last updated:

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Atropa Belladonna (Deadly Nightshade)

This article explores the medical uses of belladonna alkaloids and extracts as drugs in low (but quantifiable) doses. In low doses, belladonna may help with IBS, menopausal complaints, migraines, and flu-like symptoms. Nowadays, however, belladonna is rarely prescribed. Read on to learn how its alkaloids act and why safer alternatives have become widely available.

If you’re mainly interested in homeopathic belladonna remedies, check out this post.

What Are Belladonna Alkaloids?

Snapshot

Proponents

  • May help with menopausal complaints, flu-like symptoms, and migraines

Skeptics

  • Toxic at very low doses
  • Risk of serious adverse effects
  • Interactions with anticholinergic drugs
  • Insufficient evidence for several benefits
  • Safer and more effective remedies are available for most uses

Anticholinergic Compounds

Belladonna is very poisonous. It contains up to 20 different alkaloids. Its alkaloids are anticholinergics, substances that block the “rest-and-digest” action of acetylcholine in the body. One of the main active compounds is hyoscyamine, which is converted into a mixture called atropine in the body [1, 2].

Cholinergic activity in the body is generally beneficial, as opposed to fight-or-flight overdrive. However, blocking cholinergic activity is beneficial for some diseases, especially when it comes to respiratory disorders. Belladonna can be used to relax blocked airways, relieve headaches, irritable bowel syndrome, and menopausal symptoms [3, 4, 5, 6].

The plant uses the main active compounds of Belladonna, its alkaloids, as a defense against animals tempted to eat the plant. The roots contain approximately 0.7 % alkaloids, while the leaves contain slightly less (0.04%). The most abundant ones are [7, 8, 9]:

  • Hyoscyamine
  • Atropine (or apoatropine)
  • Scopolamine

Some other less concentrated alkaloids in the roots and leaves include:

  • Cuscohygrine
  • Aposcopolamine

In the seeds, the alkaloid content is approximately 0.06% and the most abundant ones are atropine and scopolamine [8, 10].

Ripe Belladonna fruits contain approximately 2 mg alkaloids per berry, with atropine accounting for up to 98% [11].

Consuming 2 – 5 berries or a single leaf can be fatal. Most cases of poisoning occur from eating the berries, either by mistaking them for blueberries or to cause deliberate self-harm. Unintentional poisoning from herbal extracts has also been reported [12].

Belladonna is extremely poisonous. A single leaf or 2-5 berries is enough to kill most people, and the berries look similar enough to blueberries to be mistaken for them.

Mechanism of Action

Acetylcholine is the main neurotransmitter of the rest-and-digest (parasympathetic) system, which opposes the action of the fight-or-flight (sympathetic) system. In the brain, acetylcholine stimulates memory and cognitive processes. Outside the brain, it activates muscles and aids digestion [13, 14, 15].

Belladonna alkaloids block the action of acetylcholine by binding to its receptors in nerves, muscles, and glands. They can also cross the blood-brain barrier and achieve effects in the brain, where they prevent nausea and cause hallucinations, memory loss, and sleepiness. Outside the brain, they enlarge the pupils, increase heart rate (except at low doses), decrease bodily secretions, reduce bowel movements, and tighten blood vessels [1, 16].

The alkaloids in belladonna slightly differ in their effects. Atropine is especially active in the heart, intestines, and bronchi. Hyoscyamine has stronger effects on the nervous system, and scopolamine has a shorter action with the greatest effects on the brain, eyes, and glands [2].

Belladonna’s alkaloids block acetylcholine receptors in the nerves, muscles, and endocrine glands. This causes hallucinations, memory loss, sleepiness, enlarged pupils, elevated heart rate, and other symptoms.

Medicinal Uses of Belladonna

Some of the studies on belladonna listed here date back to the 50s and 60s. Other more recent studies have also explored the potential benefits of low-dose belladonna in combination with other drugs. Its active alkaloid, atropine, is commonly used to dilate the pupils during eye procedures.

Although we present all the research to date, belladonna is very rarely used for these medical purposes today. Safer, more effective conventional and alternative therapies with sufficient evidence supporting their effectiveness exist. Discuss with your doctor if belladonna may help with your condition and never take it in place of what your doctor recommends or prescribes.

Possibly Effective for:

1) Poisoning

Organophosphates are highly poisonous pesticides that cause the buildup of acetylcholine in the body by blocking the enzyme that breaks it down (acetylcholinesterase). Belladonna’s alkaloid atropine is widely used to reduce the acetylcholine over-stimulation in such cases of poisoning. Anisodamine, a less powerful belladonna alkaloid, has been successfully tested as an alternative to atropine with fewer side effects [17, 18].

In rats and dogs with poisoning from the organophosphate pesticide parathion, belladonna alkaloids (atropine, hyoscyamine, and total alkaloid extract) reduced death rates [19].

A commercial extract of belladonna alkaloids (Bellafoline 0.5 mg) combined with the alkaloid ergotamine allowed rats to survive otherwise lethal injections of a scorpion toxin [20].

Belladonna powerfully blocks acetylcholine activity, while other poisons (such as organophosphates) increase acetylcholine activity. Alkaloids extracted from belladonna have successfully reversed the effects of such poisons. If you believe that you have been exposed to organophosphates, seek medical attention immediately.

Insufficient Evidence for:

The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of belladonna for any of the below-listed uses. Remember to speak with a doctor before using any type of belladonna or its extracts, and never use them in place of something your doctor recommends or prescribes.

2) Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a chronic inflammatory gut condition, with pain and altered bowel movements (diarrhea, constipation, or both). The combination of belladonna (8 mg) with an anticonvulsant (phenobarbital 30 mg) improved both the digestive and psychological (anxiety, tiredness, sleep difficulties) symptoms in 2 old clinical trials on 91 people [21, 3].

In two recent trials on almost 150 people with IBS, a medicine with 10 mg belladonna extract and an opium alkaloid (papaverine 50 mg) improved pain, cramps, and bowel movements, but two other commercial medicines were more effective [22, 23].

The belladonna alkaloid scopolamine (10 mg hyoscine butylbromide 4x/day) improved irritable bowel syndrome in an old trial on 12 people, especially in combination with the anti-anxiety drug (lorazepam) and the laxative ispaghula husk [24].

Symptoms of irritable bowel syndrome are more commonly managed with other medications in conventional medicine. Overall, IBS is a complex disease that often requires a more holistic approach (monitoring hormones, stress, inflammation, and other hidden imbalances in the body) [25].

Some clinical studies have found that small doses of belladonna improved symptoms of irritable bowel syndrome (IBS), especially pain, cramps, and bowel movements. However, conventional therapies were better.

3) Menopausal Complaints

Menopausal women often experience hot flashes, sweating, insomnia, irritability, and loss of libido. Although estrogens are the usual therapy, they may cause side effects such as headaches or water retention and are strongly discouraged in breast cancer survivors [26].

A medication containing 0.2 mg belladonna alkaloids (Bellergal) improved the symptoms in 2 clinical trials on over 100 menopausal women. In one of them, however, the effects were no longer distinguishable from those of placebo after 8 weeks [6, 27].

In an observational study on 31 postmenopausal breast cancer survivors, 8 used Bellergal for hot flashes [28].

Some small clinical trials have found a possible benefit for low-dose belladonna in menopausal complaints, but the evidence is considered insufficient.

4) Discomfort after Medical Procedures

Rectal suppositories of belladonna and opium may be used to ease discomfort after medical procedures. Belladonna’s atropine and scopolamine relax the muscles, while opium’s morphine reduces pain [29].

Belladonna and opium suppositories reduced pain, urinary urgency, and the need for pain-relief medication in 3 clinical trials on over 200 people undergoing urinary and prostate procedures (prostate removal, ureteral stent placement, ureteroscopy). However, they failed to reduce pain from vaginal surgery or bladder injections in 2 clinical trials on over 100 women [30, 31, 32, 33, 34].

5) Airway Blockage

Belladonna alkaloids reduce airway blockage by preventing the narrowing of the bronchi. Oral belladonna tinctures (supplying 0.01 mg/kg atropine 1 – 2x/day for 7 days) widened blocked airways and improved breathing in two studies on over 100 children [35, 5].

However, blocked airways, as in COPD, are more commonly managed with a combination of other drugs (other anticholinergics and beta activators) [36].

6) Headaches

In an old clinical trial on 55 people with frequent headaches, a complex with belladonna (0.2 mg alkaloids), ergotamine, and phenobarbital 2x/day for 4 weeks reduced pain and the need for pain medication. In a case series from the 1950s, a similar combination (Bellergal) had “satisfactory results” at relieving headaches in 73% of people [4, 37+].

Such combinations are no longer used, due to their high risk of toxicity, abuse, and overdose. In fact, the sedative phenobarbital was the “sleeping pill” responsible for numerous suicides and deaths in the 50s. It was one of the drugs in the cocktail that killed Marilyn Monroe. Its past is even darker than Belladonna’s, as it was also allegedly used in Nazi euthanasia programs in the 40s.

7) Premenstrual Symptoms

Premenstrual syndrome (PMS) can include various symptoms that vary between one woman and another. These include mood swings, irritability, fatigue, sleepiness, acne, tender breasts, and water retention [38].

In an old clinical trial on 25 women, a medication with 0.2 mg belladonna alkaloids (Bellergal) 3x/day during the 10 days before their period improved the symptoms [39].

Almost all women experience PMS at some point in their life, and the good news is that there are various safe medications and natural solutions that can help relieve the symptoms.

8) Excessive Drooling

Belladonna’s alkaloid atropine reduced drooling in 2 clinical trials on 7 adults and 19 children with disabilities. It also reduced the drooling caused by the sedative ketamine in a trial on 140 children, but not in an observational study on 164 [40, 41, 42, 43].

Pregnant women often experience increased salivation, which is linked to nausea. By blocking the rest-and-digest action of acetylcholine, belladonna reduces salivation. Belladonna alkaloids (4x/day for 5 days) combined with phenothiazine suppositories reduced the excessive drooling and resulting nausea in two pregnant women [44].

9) Anxiety

In an old clinical trial on 75 people with anxiety caused by digestive disorders, a medicine with 0.1 mg belladonna alkaloids (Bellergal) 4x/day for 4 weeks improved anxiety more effectively than the sedative chlordiazepoxide (Librium) [45].

However, both belladonna oral tincture (20 drops) and an atropine injection (0.4 mg) failed to reduce the anxiety caused by a contrast agent used for examining the urinary tract in an old clinical trial on over 1,100 people [46].

If you suffer from anxiety, we suggest you stay away from belladonna tinctures due to their lack of safety and effectiveness. Explore other safe, natural, and evidence-based behavioral strategies and supplements that may help instead.

Clinical studies have been conducted to investigate belladonna for anxiety, but safer and better-studied alternatives are available and should always be prioritized over this poisonous plant.

Belladonna Toxicity, Safety & Side Effects

Belladonna Drug

At the doses prescribed by doctors to people without certain risk factors, belladonna is possibly safe and doesn’t cause serious adverse effects.

Bellergal, used in 2 clinical trials for menopausal complaints, caused a high rate of withdrawal (30%) due to adverse effects such as [47, 6]:

  • Dry mouth
  • Dizziness
  • Skin rash
  • Sleepiness

In an observational study, children taking belladonna syrup for airway obstruction developed only minor side effects such as [5]:

  • Loss of appetite
  • Sleep difficulties
  • Constipation

A medicine for irritable bowel syndrome with 10 mg belladonna extract (Antispasmina) caused only minor adverse effects in clinical trials, nausea and headache being the most common ones [22, 23].

In rare cases, over-the-counter belladonna medicines have caused other side effects, such as:

  • Glaucoma (tablets for cold and flu) [48]
  • Contact dermatitis (plaster for backache) [49]
Side effects of belladonna-based medicines are similar to the symptoms of belladonna poisoning. They include drowsiness, dizziness, sleep difficulties, and constipation.

Herbal Belladonna

Although normally perceived as safer, herbal remedies can contain concentrated active compounds that are as likely as conventional medicines to cause adverse effects, especially at high doses.

One woman experienced severe poisoning after taking 50 mL of herbal belladonna tincture for insomnia with an unusually high atropine content (0.3 mg/mL). She experienced confusion, accelerated heart rate, and high blood pressure [12].

In a child with skin and eye yellowing (jaundice) caused by antibiotics for tuberculosis, a herbal remedy containing belladonna caused dry mouth, accelerated breathing, confusion, vomiting, loss of vision, and hallucinations [9].

Herbal remedies made from belladonna generally have lower concentrations of its toxic alkaloids, but they still have the potential to cause belladonna poisoning.

Caution in Sensitive Populations

Pregnancy and Breastfeeding

Both atropine and scopolamine can cross the placenta and come into contact with the developing fetus. Several studies have investigated their potential to cause birth defects and death, but the results were contradictory. The FDA concluded that risks cannot be ruled out when belladonna is used during pregnancy (category C) [50, 51, 52, 53].

Belladonna alkaloids can also accumulate in breast milk and expose babies to their potential toxicity, although this is insufficiently investigated. Belladonna may also reduce milk production and has been traditionally applied on the nipples for this purpose [2, 54].

The Elderly & Others at Risk

Belladonna’ scopolamine can have negative effects on memory, attention, and movement coordination at lower doses in elderly people [55].

Because it can worsen the symptoms, people with the following conditions should avoid belladonna [2, 56, 1]:

  • Allergy to belladonna, plants of the same family, and anticholinergic drugs
  • Glaucoma
  • Asthma
  • Psychiatric and neurodegenerative disorders (Alzheimer’s, schizophrenia)
  • Heart disease (coronary heart disease, congestive heart failure, irregular heart rate, high blood pressure)
  • Digestive disorders (GERD, ulcers, constipation, colitis)
  • Urinary disorders (urinary retention, prostatic obstruction)

Drug Interactions

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. Talk to your healthcare provider to find out how belladonna might interact with something else you are taking.

Belladonna alkaloids delay stomach emptying, which may reduce the rate at which many drugs are absorbed in the gut [57, 58].

Belladonna may enhance the effects of other drugs that block the action of acetylcholine and increase the risk of anticholinergic poisoning. Some of these drugs are [2]:

  • Antipsychotics (olanzapine, chlorpromazine, clozapine, haloperidol)
  • Antidepressants (amitriptyline, benztropine, imipramine, doxepin)
  • Antihistamines (promethazine, carbinoxamine, clemastine, cyproheptadine)
  • Anti-Parkinson’s medication (olanzapine, amantadine, biperiden, profenamine)
  • Muscle relaxants (cyclobenzaprine, pancuronium)
  • Drugs for respiratory disorders (tiotropium, ipratropium, oxitropium, fenoterol)
  • Drugs for digestive disorders (clidinium, dicycloverine)
  • Drugs for urinary disorders (bethanechol, oxybutynin)
  • Drugs for heart disease (quinidine)
  • Eye drops (cyclopentolate)

Conversely, Belladonna may reduce the effects of drugs that increase the action of acetylcholine such as [2, 59]:

  • Ambenonium (a drug for myasthenia gravis)
  • Cisapride (a drug used to increase gut flow)
  • Procainamide (a drug for irregular heart rate)
  • Drugs for Alzheimer’s disease (tacrine, donepezil, rivastigmine, galantamine)
Belladonna contains active compounds which can interact dangerously with a wide variety of drugs that block or enhance the action of acetylcholine.

Belladonna Drug & Extract Formulations

Conventional Drugs & Herbals

Belladonna normally comes in tablets combining its alkaloids with other drugs such as ergotamine, phenobarbital, and caffeine. Some popular combinations are [2]:

  • Bellergal (0.1 – 0.2 mg belladonna alkaloids, 0.3 – 0.6 mg ergotamine tartrate, and 20 – 40 mg phenobarbital)
  • Donnatal (0.1037 mg hyoscyamine sulfate, 0.0194 mg atropine sulfate, 0.0065 mg hyoscine hydrobromide, and 16.2 mg phenobarbital)
  • Cafergot (0.125 belladonna alkaloids, 100 mg caffeine, 1 mg ergotamine, and 30 mg pentobarbital sodium)

Other forms include [16, 31, 22, 49]:

  • Oral tincture (0.3% belladonna)
  • Capsules (10 mg belladonna extract and 50 mg papaverine)
  • Suppositories (15 – 16.2 mg belladonna and 30 – 65 mg opium)
  • Plasters (0.25% belladonna alkaloids)
  • Ointments
Tablets containing belladonna often come in combination with other drugs and natural substances including ergotamine, phenobarbital, and caffeine. We strongly recommend talking to your doctor before using any such products.

Dosage

Because belladonna is not approved by the FDA for any conditions, there is no official dose. Users and supplement manufacturers have established unofficial doses based on their experience.

Conventional Drugs & Herbals

In clinical trials, the most effective doses of medicines containing belladonna were:

  • Irritable bowel syndrome: belladonna 8 – 10 mg, 2x – 6x/day [3, 23]
  • Menopausal complaints: Bellergal (0.2 mg alkaloids), 2x/day [6, 27]
  • Headache: Bellergal-ergotamine-phenobarbital (0.2 mg alkaloids), 2x/day [4]
  • Premenstrual symptoms: Bellergal (0.2 mg alkaloids), 3x/day [39]
  • Anxiety: Bellergal (0.1 mg alkaloids), 4x/day [45]
  • Airway obstruction: Oral tincture (supplying 0.01 mg/kg atropine), 1x – 2x/day [35, 5]
  • Surgical pain: One suppository (16.2 mg belladonna) before surgery [31, 32]

User Experiences

The opinions expressed in this section are solely those of belladonna users who may or may not have medical or scientific training. Their reviews do not represent the opinions of SelfHacked. SelfHacked does not endorse any specific product, service, or treatment.

Do not consider user experiences as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare providers because of something you have read on SelfHacked. We understand that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified healthcare provider.

People used generic and brand-name (Bellergal, Donnatal, and Cafergot) tablets containing Belladonna mainly for menopausal complaints, irritable bowel syndrome, and headaches. Most of them were satisfied and reported a fast relief of symptoms such as hot flashes, night sweating, pain, diarrhea, and spasms.

Although most users noticed no side effects, a few experienced sleepiness, dizziness, nausea, skin rashes, involuntary movements, or memory losses. Some users became dependent on medications that combined belladonna and phenobarbital.

People using belladonna-opium suppositories for pain relief in the urinary and digestive tract were usually satisfied with the results and reported high reductions of pain, spasms, and urination frequency.

Limitations and Caveats

Most effects of medicines containing belladonna have been evaluated in only one or two clinical trials, a lot of which are from the 1950s – 1970s.

The effects of belladonna alkaloids as antidotes to some poisons have only been tested in animals.

Additionally, some studies were funded by the companies selling the remedies, most health claims were investigated in only one study, and one (improvement of epilepsy) was only tested in dogs.

Takeaway

Belladonna is a plant that contains poisonous alkaloids. In low doses, belladonna alkaloids can be combined with other drugs to potentially improve irritable bowel syndrome, menopausal complaints, headaches, and surgical pain.

At the doses prescribed by doctors or contained in properly diluted homeopathic remedies, belladonna is generally safe. However, exceeding the doses can result in severe poisoning.

Overall, safer and more effective alternatives are out there for most conditions belladonna can be used for.

Read Next

About the Author

Carlos Tello

Carlos Tello

PhD (Molecular Biology)
Carlos received his PhD and MS from the Universidad de Sevilla.
Carlos spent 9 years in the laboratory investigating mineral transport in plants. He then started working as a freelancer, mainly in science writing, editing, and consulting. Carlos is passionate about learning the mechanisms behind biological processes and communicating science to both academic and non-academic audiences. He strongly believes that scientific literacy is crucial to maintain a healthy lifestyle and avoid falling for scams.

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