What is the primary toxin in the substance above?

  1. Solanine
  2. Myristicin
  3. Lysergic acid amide
  4. Phytolacca toxin

2. Myristicin


Nutmeg, a common household spice, is made from the seed of the nutmeg tree, Myristica fragrans. Valued in many cultures as a treatment for numerous medical ailments [1,3], nutmeg is also used as a recreational psychotropic substance [2,3]. It is attractive to teens and young adults seeking a novel psychotropic experience because it is cheap and legal [3]. While accidental overdoses do occur, toxic ingestions are likely underreported, as nutmeg’s adverse effects are usually mild and self-resolving [3].

“You did what now?”

  • Nutmeg consumption has been reported by swallowing spoonfuls of nutmeg grounds, mixing nutmeg into other foods, or encapsulation of grounds in gel capsules [2,4].
  • Toxicity has resulted from accidental over-ingestion [2], intentional use for psychotropic purposes [3,4,7,8], and social media “challenges” for entertainment [9].
  • Effects are dose-dependent, with toxicity reported from 5g of nutmeg [2]; 10 g of ground nutmeg is usually required to produce neuropsychological symptoms, and 25 g or more often resulting in more severe symptoms [4-8].

The Magic is in the “Myrist-ery”

  • Nutmeg contains myristicin, which is thought to produce an amphetamine-derived metabolite, MMDA (3-methoxy-4,5-methylendioxy amphetamine), that shares structural characteristics with MDMA and amphetamine [2,4,5].
  • Other compounds in nutmeg include trimyristin, safrole, eugenol, and elemicin; these work synergistically with myristicin to produce serotonergic, mixed GABA receptor effects, and mild monoamine oxidase inhibitory effects [2-4,6].
  • Nutmeg can inhibit the activity of CYP1A2, 2E1, and 2C19, and may alter the duration of action of drugs metabolized by those CYP enzymes [6].

What are the clinical effects of nutmeg ingestion?

  • Patients can experience desired effects such as a dream-like state, sedation, anxiolysis, euphoria, or hallucinations [3,4].
  • Many nutmeg users experience fear, intense anxiety, an unpleasant trance-like state of which they are aware, or a sense of impending disaster [4,5,7,10].
  • Symptoms such as dry mouth, tachycardia, and hallucinations may resemble antimuscarinic toxidrome [2,3,5-9].
  • Headaches (aka “nutmeg hangover”) [2,7].
  • Miosis or mydriasis [10].
  • Seizures are reported following massive ingestion or when ingested with other substances [2,3,6,8,10].
  • Serotonin syndrome is reported with concomitant administration of SSRIs or MAO inhibitors [11].

How do I manage this?

  • Care for nutmeg toxicity is supportive [3].
  • The onset of symptoms occurs within 1-8 hours [10].
  • Effects typically resolve spontaneously within 1-2 days [10].
  • Benzodiazepines can be used for agitation, seizures, and anxiety [9,10].
  • Those with significant tachycardia or co-ingestion may require telemetry monitoring.
  • Inform patient and parent (if applicable) education regarding nutmeg intoxication including any potential interference with current medication regimen.
  • Observation of asymptomatic patients for at least 8 hours following significant ingestion has been recommended [10].

Bedside Pearls

  • Nutmeg ingestion can result in a spectrum of mental status effects from sedation to delirium to hallucinations or a dream-like state.
  • Onset is typically within hours and may persist for 1-2 days.
  • Treatment is supportive.
  • Benzodiazepines can be used for agitation and anxiety.


  1. Ashokkumar K, Simal-Gandara J, Murugan M, Dhanya MK, Pandian A. Nutmeg (Myristica fragrans Houtt.) essential oil: A review on its composition, biological, and pharmacological activities. Phytother Res. 2022;36(7):2839-2851. PMID: 35567294
  2. Roeters van Lennep JE, Schuit SC, van Bruchem-Visser RL, Özcan B. Unintentional nutmeg autointoxication. Neth J Med. 2015;73(1):46-48. PMID: 26219944
  3. Beckerman B, Persaud H. Nutmeg overdose: Spice not so nice. Complement Ther Med. 2019;46:44-46. PMID: 31519286
  4. Sangalli BC, Chiang W. Toxicology of nutmeg abuse. J Toxicol Clin Toxicol. 2000;38(6):671-678. doi:10.1081/clt-100102020. PMID: 11185977
  5. Rahman, N. A. A., Fazilah, A., & Effarizah, M. E. Toxicity of nutmeg (myristicin): a review. Int J Adv Sci Eng Inf Technol. 2015, 5(3), 61-64. doi:10.18517/ijaseit.5.3.518
  6. Seneme EF, Dos Santos DC, Silva EMR, Franco YEM, Longato GB. Pharmacological and Therapeutic Potential of Myristicin: A Literature Review. Molecules. 2021;26(19):5914. PMID: 34641457
  7. Barceloux DG. Nutmeg (Myristica fragrans Houtt.). Dis Mon. 2009;55(6):373-379. PMID: 19446681
  8. Ehrenpreis JE, DesLauriers C, Lank P, Armstrong PK, Leikin JB. Nutmeg poisonings: a retrospective review of 10 years’ experience from the Illinois Poison Center, 2001-2011. J Med Toxicol. 2014;10(2):148-151. PMID: 24452991
  9. Atherton R. The ‘nutmeg challenge’: a dangerous social media trend. Arch Dis in Childhood. 2020;106(5):517-518. PMID: 32620571
  10. Demetriades AK, Wallman PD, McGuiness A, Gavalas MC. Low cost, high risk: accidental nutmeg intoxication. Emerg Med J. 2005;22(3):223-225. PMID: 15735280
  11. Dhingra D, Sharma A. Antidepressant-like activity of n-hexane extract of nutmeg (Myristica fragrans) seeds in mice. J Med Food. 2006 Spring;9(1):84-9. PMID: 16579733
Steven M. Perry, MD

Steven M. Perry, MD

Emergency Medicine Resident
Atrium Health’s Carolinas Medical Center, Charlotte, NC
Steven M. Perry, MD

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Christine Murphy, MD

Christine Murphy, MD

Associate Professor of Emergency Medicine
Medical Toxicologist
Department of Emergency Medicine
Atrium Health’s Carolinas Medical Center