Reevaluation of risks with the use of Ficus insipida latex as a traditional anthelmintic remedy in the Amazon

The anthelmintic remedy ojé, prepared latex of Ficus insipida, is still used by indigenous and local people in the Amazonian regions. However, overdosage leading to toxic reactions occurs despite the broadcasting of a clinically accepted dosage that is effective and safe. The intoxication of a 10-year-old girl in Pucallpa, who had received ojé in a dose close to the recommended one, led us to study retrospectively the records of all hospitalized patients with toxic reactions to ojé over a 12-year-period. The use of ojé in and around Pucallpa was estimated. Most cases with toxic reactions, out of a total of 39 for the 12-year-period, were probably due to an overdose, defined as more than 1.5 cm3/kg; the recommended dose being 1 cm3/kg. In only five cases did toxic reactions occur at doses up to 1.5 cm3/kg, which were interpreted as idiosyncratic reactions; all of them occurred in children, and in two cases it was a severe reaction. One fatal outcome was noted among the 37 hospitalized patients. Two other fatal outcomes were observed in the 12-year-period but they occurred outside the hospital. The mortality rate is estimated to have been 0.01-0.015% among patients supposedly treated with ojé in the area. Severe intoxication led to symptoms of cerebral edema. The main treatment was osmotic diuresis with mannitol which started in 1996. Although hypersensitivity reactions have been observed with other Ficus spp., there was apparently no such reaction in our cases. Recommendations are given so as to avoid toxic reactions from an expected continued use of ojé.