Mace, moschata, Myristica fragrans, myristicea nux

Nutmeg is an evergreen tree (Myristica fragrans) indigenous to the Molucca is lands and New Guinea. It has spread to Indonesia, the West Indies, and other tropical areas. The medicinal component is obtained from the nuts and seeds. Nutmeg oil, also known as myristica oil, is distilled from the nuts. The dried’aril of the nutmeg seed produces another herbal product, known as mace. The nuts contain 20% to 40% of a fixed oil called nutmeg butter. The oil contains myristic acid and glycerides of laureic, tridecanoic, stearic, and palmitic acids. Also present are starch, protein, saponin, and catechins.

The nuts also contain 8% to 15% of an aromatic oil containing d-camphene 60% to 80%), dipentene (8%), and myfisticin (4% to 8%), believed to be partially responsible for nutmeg intoxication. Nutmeg is known for its psychoactive and hallucinogenic properties resulting from central nervous system (CNS) effects. Nutmeg may also playa role in inhibiting prostaglandin synthesis and platelet aggregation. It’s available as a spice, and in products such as Vicks Vaporub.

Reported uses

Nutmeg is used internally for diarrhea, indigestion, loss of appetite, colic, flatulence, and insomnia. It’s also used as a larvicidal and as a hallucinogen. In Indian medicine, nutmeg is used to treat poor vision, headaches, fever, and malaria. It has also been used for cholera, impotence, and general debility.

Nutmeg is used externally for rheumatoid arthritis. Nutmeg butter is used in soaps and perfumes.

Administration

• Dried seed powder: 300 mg to 1,000 mg by mouth every day
• Fluid extract: 10 to 30 gtt by mouth up to four times a day
• Powder: 5 to 20 grains applied topically to affected area up to three times a day
• Spirits: 5 to 20 gtt by mouth up to four times a day.

Hazards

Although widely used as a spice and flavoring, nutmeg ingestion may cause flushing, allergic contact dermatitis, nausea, diarrhea, hallucinations, giddiness, disorientation, fear of impending death, loss of feeling in limbs, depolarization, tachycardia, decreased pulse, hypothermia, feeling of pressure in chest, and dry mouth. Nutmeg taken with monoamine oxidase (MAO) inhibitors and other psychoactive drugs may potentiate effects of these drugs via the herb’s mild MAO-inhibiting action.

Pregnant or breast-feeding patients, those with cardiac disorders, and those with psychotic disorders should avoid us ing nutmeg, as should patients who are hypersensitive to it.

Safety Risk Ingestion of several tablespoons of nutmeg can lead to potentially severe, stuporous intoxication. Symptoms of overdose (nausea and violent vomiting) occur 3 to 8 hours after ingestion of the herb. Episodes are characterized by weak pulse, hypothermia, disorientation, giddiness, and a feeling of pressure in the chest or lower abdomen. An extended period of alternating delirium and stupor persists for up to 24 hours, ending in heavy sleep. The patient may have a sensation of loss of limbs and a terrifying fear of death. Gastric lavage and supportive therapy, such as haloperidol, may be warranted. Recovery usually occurs within 24 hours but may take several days.

Clinical considerations

• Misuse and abuse of nutmeg is a growing problem. Assess patient’s level of use.
• Caution patient to use nutmeg in moderation because intoxication or death can occur after ingestion of large doses.
• Warn patient with cardiac problems not to use nutmeg.
• Advise pregnant or breast-feeding patients not to use nutmeg.
• Warn patient not to take herb for diarrhea, indigestion, or chronic GI distress before seeking appropriate medical evaluation because doing so may delay diagnosis of a potentially serious medical condition.
• Tell patient to remind prescriber and pharmacist of any herbal or dietary supplement that he’s taking when obtaining a new prescription.
• Advise patient to consult his health care provider before using an herbal preparation because a treatment with proven efficacy may be available.

Research summary

Nutmeg has been studied for its role in treating diarrhea, and inhibiting both prostaglandin synthesis and platelet aggregation.