NEEM

OTHER NAME(S):

Antelaea azadirachta, Arishta, Arishtha, Azadirachta indica, Bead Tree, Holy Tree, Huile de Neem, Indian Lilac, Indian Neem, Lilas des Indes, Lilas de Perse, Margosa, Margosa Tree, Margousier, Margousier à Feuilles de Frêne, Margousier d'Inde, Melia azadirachta, Neem Oil, Neem Tree, Melia azadirachta, Nim, Nimb, Nimba, Persian Lilac, Pride of China.

Overview

Overview Information

Neem is a tree. It grows in tropical regions such as India and Myanmar. The bark, leaves, and seeds are used to make medicine. Less often, the root, flower, and fruit are also used.

Neem is used for tooth plaque, gum disease (gingivitis), lice, to repel insects, and for other conditions, but there is no good scientific evidence to support most of these uses.

How does it work?

Neem contains chemicals that might help reduce blood sugar levels, heal ulcers in the digestive tract, prevent pregnancy, kill bacteria, and prevent plaque formation in the mouth.

Uses

Uses & Effectiveness?

Possibly Effective for

  • Tooth plaque. Most research shows that applying a gel containing neem leaf extract to the teeth or using a neem mouthwash can reduce the amount of plaque on the teeth. But it might not be as helpful as using chlorhexidine mouthwash.
  • A mild form of gum disease (gingivitis). Most research shows that applying a gel containing neem leaf extract or using a neem mouthwash can reduce gingivitis in some people, but it doesn't seem to be as helpful as chlorhexidine mouthwash and it may not be effective for people with long-standing gingivitis.
  • Lice. Clinical research shows that applying a neem extract shampoo to the scalp once completely cures head lice in children.

Insufficient Evidence for

More evidence is needed to rate the effectiveness of neem for these uses.

Side Effects

Side Effects & Safety

When taken by mouth: Neem bark extract is POSSIBLY SAFE for most adults when taken by mouth, short-term. Doses of up to 60 mg daily for up to 10 weeks have been safely used in humans. Neem is POSSIBLY UNSAFE when taken by mouth in large doses or for long periods of time. It might harm the kidneys and liver.

When applied to the skin: Neem leaf extract gel is POSSIBLY SAFE when applied inside the mouth for up to 6 weeks. Neem oil or cream is POSSIBLY SAFE when applied to the skin for up to 2 weeks.

Special Precautions & Warnings:

Pregnancy: Neem oil and neem bark are LIKELY UNSAFE when taken by mouth during pregnancy. They can cause a miscarriage.

Breast-feeding: There isn't enough reliable information to know if neem is safe to use when breast-feeding. Stay on the safe side and avoid use.

Children: Neem extract shampoo is POSSIBLY SAFE in children when applied once or twice to the head for 10 minutes, then rinsed with warm water. Neem seeds and seed oil are LIKELY UNSAFE when taken by mouth in children. Serious side effects in infants and small children can happen within hours after taking neem oil. These serious side effects include vomiting, diarrhea, drowsiness, blood disorders, seizures, loss of consciousness, coma, brain disorders, and death.

"Auto-immune diseases" such as multiple sclerosis (MS), lupus (systemic lupus erythematosus, SLE), rheumatoid arthritis (RA), or other conditions: Neem might cause the immune system to become more active. This could increase the symptoms of auto-immune diseases. If you have one of these conditions, it's best to avoid using neem.

Diabetes: There is some evidence that neem can lower blood sugar levels and might cause blood sugar to go too low. If you have diabetes and use neem, monitor your blood sugar carefully. It might be necessary to change the dose of your diabetes medication.

Reduced ability to have children (infertility): There is some evidence that neem can harm sperm. It might also reduce fertility in other ways. If you are trying to have children, avoid using neem.

Organ transplant: There is a concern that neem might decrease the effectiveness of medications that are used to prevent organ rejection. Do not use neem if you have had an organ transplant.

Surgery: Neem might lower blood sugar levels. There is a concern that it might interfere with blood sugar control during and after surgery. Stop using neem at least 2 weeks before a scheduled surgery.

Interactions

Interactions?

Moderate Interaction

Be cautious with this combination

!

  • Lithium interacts with NEEM

    Neem might have an effect like a water pill or "diuretic." Taking neem might decrease how well the body gets rid of lithium. This could increase how much lithium is in the body and result in serious side effects. Talk with your healthcare provider before using this product if you are taking lithium. Your lithium dose might need to be changed.

  • Medications for diabetes (Antidiabetes drugs) interacts with NEEM

    Neem might decrease blood sugar. Diabetes medications are also used to lower blood sugar. Taking neem along with diabetes medications might cause your blood sugar to go too low. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.

    Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.

  • Medications that decrease the immune system (Immunosuppressants) interacts with NEEM

    Neem might increase the immune system. By increasing the immune system, neem might decrease the effectiveness of medications that decrease the immune system.

    Some medications that decrease the immune system include azathioprine (Imuran), basiliximab (Simulect), cyclosporine (Neoral, Sandimmune), daclizumab (Zenapax), muromonab-CD3 (OKT3, Orthoclone OKT3), mycophenolate (CellCept), tacrolimus (FK506, Prograf), sirolimus (Rapamune), prednisone (Deltasone, Orasone), corticosteroids (glucocorticoids), and others.

Dosing

Dosing

The following doses have been studied in scientific research:

ADULTS

APPLIED TO THE SKIN:

  • For a mild form of gum disease (gingivitis): A neem leaf extract gel has been applied to the teeth and gums twice daily for 6 weeks. 15 mL of 2% neem solution used as a mouthwash for 30 seconds after brushing daily for 3 weeks.
  • For tooth plaque: A neem leaf extract gel has been applied to the teeth and gums twice daily for 6 weeks. 15 mL of 2% neem solution used as a mouthwash for 30 seconds after brushing daily for 3 weeks. 5 mL of neem solution used as a mouthwash twice daily for 30 days.
CHILDREN

APPLIED TO THE SKIN:
  • For lice: 100 mL of a specific neem extract shampoo (Licener, Pronovo Laboratories) applied to dry hair for 10 minutes then rinsed with warm water once or repeated for a second application.

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Next: Uses

View References

REFERENCES:

  • Abdel-Ghaffar, F. and Semmler, M. Efficacy of neem seed extract shampoo on head lice of naturally infected humans in Egypt. Parasitol.Res 2007;100(2):329-332. View abstract.
  • Balakrishnan, V., Pillai, N. R., and Santhakumari, G. Ventricular fibrillation and cardiac arrest due to neem leaf poisoning. J.Assoc.Physicians India 1986;34(7):536. View abstract.
  • Balappanavar, A. Y., Nagesh, L., Ankola, A. V., Tangade, P. S., Kakodkar, P., and Varun, S. Antimicrobial efficacy of various disinfecting solutions in reducing the contamination of the toothbrush -- a comparative study. Oral Health Prev.Dent. 2009;7(2):137-145. View abstract.
  • Bandyopadhyay, U., Biswas, K., Sengupta, A., Moitra, P., Dutta, P., Sarkar, D., Debnath, P., Ganguly, C. K., and Banerjee, R. K. Clinical studies on the effect of Neem (Azadirachta indica) bark extract on gastric secretion and gastroduodenal ulcer. Life Sci. 10-29-2004;75(24):2867-2878. View abstract.
  • Bhaskar, M. V., Pramod, S. J., Jeevika, M. U., Chandan, P. K., and Shetteppa, G. MR imaging findings of neem oil poisoning. AJNR Am J Neuroradiol. 2010;31(7):E60-E61. View abstract.
  • Dua, V. K., Nagpal, B. N., and Sharma, V. P. Repellent action of neem cream against mosquitoes. Indian J.Malariol. 1995;32(2):47-53. View abstract.
  • Gandhi, M., Lal, R., Sankaranarayanan, A., Banerjee, C. K., and Sharma, P. L. Acute toxicity study of the oil from Azadirachta indica seed (neem oil). J Ethnopharmacol 1988;23(1):39-51. View abstract.
  • Iyyadurai, R., Surekha, V., Sathyendra, S., Paul, Wilson B., and Gopinath, K. G. Azadirachtin poisoning: a case report. Clin Toxicol.(Phila) 2010;48(8):857-858. View abstract.
  • Jones, I. W., Denholm, A. A., Ley, S. V., Lovell, H., Wood, A., and Sinden, R. E. Sexual development of malaria parasites is inhibited in vitro by the neem extract azadirachtin, and its semi-synthetic analogues. FEMS Microbiol.Lett. 7-15-1994;120(3):267-273. View abstract.
  • Kant, R. and Bhatt, R. M. Field evaluation of mosquito repellent action of neem oil. Indian J.Malariol. 1994;31(3):122-125. View abstract.
  • Khalid, S. A., Duddeck, H., and Gonzalez-Sierra, M. Isolation and characterization of an antimalarial agent of the neem tree Azadirachta indica. J Nat Prod. 1989;52(5):922-926. View abstract.
  • Koga, Y., Yoshida, I., Kimura, A., Yoshino, M., Yamashita, F., and Sinniah, D. Inhibition of mitochondrial functions by margosa oil: possible implications in the pathogenesis of Reye's syndrome. Pediatr.Res 1987;22(2):184-187. View abstract.
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  • Mbah, A. U., Udeinya, I. J., Shu, E. N., Chijioke, C. P., Nubila, T., Udeinya, F., Muobuike, A., Mmuobieri, A., and Obioma, M. S. Fractionated neem leaf extract is safe and increases CD4+ cell levels in HIV/AIDS patients. Am J Ther 2007;14(4):369-374. View abstract.
  • Mukherjee, S. and Talwar, G. P. Termination of pregnancy in rodents by oral administration of praneem, a purified neem seed extract. Am J Reprod.Immunol. 1996;35(1):51-56. View abstract.
  • Pai, M. R., Acharya, L. D., and Udupa, N. The effect of two different dental gels and a mouthwash on plaque and gingival scores: a six-week clinical study. Int.Dent.J 2004;54(4):219-223. View abstract.
  • Pandey, S., Jha, A., and Kaur, V. Aqueous extract of neem leaves in treatment of psoriasis vulgaris. Indian Journal of Dermatol Venereol Leprol 1994;60(2):63-67.
  • Paul, R., Prasad, M., and Sah, N. K. Anticancer biology of Azadirachta indica L (neem): a mini review. Cancer Biol Ther 9-15-2011;12(6):467-476. View abstract.
  • Raizada, R. B., Srivastava, M. K., Kaushal, R. A., and Singh, R. P. Azadirachtin, a neem biopesticide: subchronic toxicity assessment in rats. Food Chem Toxicol. 2001;39(5):477-483. View abstract.
  • Rasheed, A., Avinash Kumar, Reddy G., Mohanalakshmi, S., and Ashok Kumar, C. K. Formulation and comparative evaluation of poly herbal anti-acne face wash gels. Pharm Biol. 2011;49(8):771-774. View abstract.
  • Reutemann, P. and Ehrlich, A. Neem oil: an herbal therapy for alopecia causes dermatitis. Dermatitis 2008;19(3):E12-E15. View abstract.
  • Sam-Wobo, S. O., Adeleke, M. A., Mafiana, C. F., and Surakat, O. H. Comparative repellent activities of some plant extracts against Simulium damnosum complex. Vector.Borne.Zoonotic.Dis. 2011;11(8):1201-1204. View abstract.
  • Schmahl, G., Al-Rasheid, K. A., Abdel-Ghaffar, F., Klimpel, S., and Mehlhorn, H. The efficacy of neem seed extracts (Tre-san, MiteStop on a broad spectrum of pests and parasites. Parasitol.Res 2010;107(2):261-269. View abstract.
  • Semmler, M., Abdel-Ghaffar, F., Al-Rasheid, K., and Mehlhorn, H. Nature helps: from research to products against blood-sucking arthropods. Parasitol.Res 2009;105(6):1483-1487. View abstract.
  • Senanayake, M. P., Rupasinghe, S., and Dissanayake, P. V. Margosa (Kohomba) oil induced toxic encephalopathy following home remedy for intestinal worms. Ceylon Med.J 2009;54(4):140. View abstract.
  • Sharma, S. K., Dua, V. K., and Sharma, V. P. Field studies on the mosquito repellent action of neem oil. Southeast Asian J.Trop.Med.Public Health 1995;26(1):180-182. View abstract.
  • Sharma, S., Saimbi, C. S., Koirala, B., and Shukla, R. Effect of various mouthwashes on the levels of interleukin-2 and interferon-gamma in chronic gingivitis. J Clin Pediatr.Dent. 2008;32(2):111-114. View abstract.
  • Sinniah, D., Sinniah, R., Baskaran, G., Pathmanathan, R., Yamashita, F., and Yoshino, M. Evaluation of the possible role of glucose, carnitine, coenzyme Q10 and steroids in the treatment of Reye's syndrome using the margosa oil animal model. Acta Paediatr.Jpn. 1990;32(4):462-468. View abstract.
  • Sivashanmugham, R., Bhaskar, N., and Banumathi, N. Ventricular fibrillation and cardiac arrest due to neem leaf poisoning. J.Assoc.Physicians India 1984;32(7):610-611. View abstract.
  • Sundaravalli, N., Raju, B. B., and Krishnamoorthy, K. A. Neem oil poisoning. Indian J.Pediatr. 1982;49(398):357-359. View abstract.
  • Talwar, G. P., Pal, R., Singh, O., Garg, S., Taluja, V., Upadhyay, S. N., Gopalan, S., Jain, V., Kaur, J., and Sehgal, S. Safety of intrauterine administration of purified neem seed oil (Praneem Vilci) in women & effect of its co-administration with the heterospecies dimer birth control vaccine on antibody response to human chorionic gonadotropin. Indian J.Med.Res. 1995;102:66-70. View abstract.
  • Talwar, G. P., Shah, S., Mukherjee, S., and Chabra, R. Induced termination of pregnancy by purified extracts of Azadirachta Indica (Neem): mechanisms involved. Am J Reprod.Immunol. 1997;37(6):485-491. View abstract.
  • Trost, L. C. and Lemasters, J. J. The mitochondrial permeability transition: a new pathophysiological mechanism for Reye's syndrome and toxic liver injury. J Pharmacol Exp Ther 1996;278(3):1000-1005. View abstract.
  • Vanka, A., Tandon, S., Rao, S. R., Udupa, N., and Ramkumar, P. The effect of indigenous Neem Azadirachta indica [correction of (Adirachta indica)] mouth wash on Streptococcus mutans and lactobacilli growth. Indian J.Dent.Res. 2001;12(3):133-144. View abstract.
  • Verma, S. P. HIV: a raft-targeting approach for prevention and therapy using plant-derived compounds (review). Curr Drug Targets. 2009;10(1):51-59. View abstract.
  • Yamasaki, S., Asakura, M., Neogi, S. B., Hinenoya, A., Iwaoka, E., and Aoki, S. Inhibition of virulence potential of Vibrio cholerae by natural compounds. Indian J Med.Res 2011;133:232-239. View abstract.
  • Aladakatti RH, Ahamed RN. Effect of Azadirachta indica leaves on rat spermatozoa. Indian J Exp Biol 1999;37:1251-4. View abstract.
  • Ali BH. Toxicology of Azadirachta indica. J Ethnopharmacol 1994;42:71-2. View abstract.
  • Balappanavar AY, Sardana V, Singh M. Comparison of the effectiveness of 0.5% tea, 2% neem and 0.2% chlorhexidine mouthwashes on oral health: a randomized control trial. Indian J Dent Res. 2013;24(1):26-34. View abstract.
  • Bandyopadhyay U, Biswas K, Sengupta A, et al. Clinical studies on the effect of Neem (Azadirachta indica) bark extract on gastric secretion and gastroduodenal ulcer. Life Sci 2004;75:2867-78. View abstract.
  • Bhanwra S, Singh J, Khosla P. Effect of Azadirachta indica (Neem) leaf aqueous extract on paracetamol-induced liver damage in rats. Indian J Physiol Pharmacol 2000;44:64-8. View abstract.
  • Biswas K, Chattopadhyay I, Banerjee RK, Bandyopadhyay U. Biological activities and medicinal properties of neem (Azadirachta indica). Curr Sci 2002;82:1336-45.
  • Boeke SJ, Boersma MG, Alink GM, et al. Safety evaluation of neem (Azadirachta indica) derived pesticides. J Ethnopharmacol 2004;94:25-41. View abstract.
  • Chattopadhyay RR, Sarkar SK, Ganguly S, et al. Hepatoprotective activity of Azadirachta indica leaves on paracetamol induced hepatic damage in rats. Indian J Exp Biol 1992;30:738-40. View abstract.
  • Chinnasamy N, Harishankar N, Kumar PU, Rukmini C. Toxicological studies on debitterized Neem oil (Azadirachta indica). Food Chem Toxicol 1993;31:297-301. View abstract.
  • Elson L, Randu K, Feldmeier H, Fillinger U. Efficacy of a mixture of neem seed oil (Azadirachta indica) and coconut oil (Cocos nucifera) for topical treatment of tungiasis. A randomized controlled, proof-of-principle study. PLoS Negl Trop Dis. 2019;13(11):e0007822. View abstract.
  • Environmental Protection Agency. Azadirachtin (121701) Clarified Hydrophobic Extract of Neem Oil (025007) Fact Sheet. Available at: https://www.epa.gov/pesticides/biopesticides/ingredients/ factsheets/factsheet_025007.htm.(Accessed 9 March 2005).
  • Etebu E, Tasie AA, Daniel-Kalio LA. Post-harvest fungal quality of selected chewing sticks. Oral Dis 2003;9:95-8. View abstract.
  • Garg S, Talwar GP, Upadhyay SN. Immunocontraceptive activity guided fractionation and characterization of active constituents of neem (Azadirachta indica) seed extracts. J Ethnopharmacol 1998;60:235-46. View abstract.
  • Giuggioli D, Lumetti F, Spinella A, et al. Use of Neem oil and Hypericum perforatum for treatment of calcinosis-related skin ulcers in systemic sclerosis. J Int Med Res 2019:300060519882176. Online ahead of print. View abstract.
  • Greenblatt DT, Banerjee P, White JM. Allergic contact dermatitis caused by neem oil. Contact Dermatitis. 2012;67(4):242-3. View abstract.
  • Halim EM. Lowering of blood sugar by water extract of Azadirachta indica and Abroma augusta in diabetes rats. Indian J Exp Biol 2003;41:636-40. View abstract.
  • Iabichella ML, Caruso C, Lugli M. The use of an extract of Hypericum perforatum and Azadirachta indica in a neuropathic patient with advanced diabetic foot. BMJ Case Rep. 2014. pii: bcr2014205706. View abstract.
  • Ibrahim IA, Khalid SA, Omer SA, Adam SE. On the toxicology of Azadirachta indica leaves. J Ethnopharmacol 1992;35:267-73. View abstract.
  • Jadhav PB. Leucoderma on the lips induced by neem (Azadirachta indica): case series. Clin Exp Dermatol. 2018;43(8):943-6. View abstract.
  • Jalaluddin M, Rajasekaran UB, Paul S, Dhanya RS, Sudeep CB, Adarsh VJ. Comparative evaluation of neem mouthwash on plaque and gingivitis: a double-blind crossover study. J Contemp Dent Pract 2017;18(7):567-71. View abstract.
  • Khillare B, Shrivastav TG. Spermicidal activity of Azadirachta indica (neem) leaf extract. Contraception 2003;68:225-9. View abstract.
  • Lai SM, Lim KW, Cheng HK. Margosa oil poisoning as a cause of toxic encephalopathy. Singapore Med J 1990;31:463-5. View abstract.
  • Nishad A, Sreesan NS, Joy J, Lakshmanan L, Thomas J, Anjali VA. Impact of mouthwashes on antibacterial activity of subjects with fixed orthodontic appliances: a randomized clinical trial. J Contemp Dent Pract 2017;18(12):1112-6. View abstract.
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  • Pai MR, Acharya LD, Udupa N. Evaluation of antiplaque activity of Azadirachta indica leaf extract gel--a 6-week clinical study. J Ethnopharmacol 2004;90:99-103. View abstract.
  • Semmler M, Abdel-Ghaffar F, Gestmann F, et al. Randomized, investigator-blinded, controlled clinical study with lice shampoo (Licener®) versus dimethicone (Jacutin® Pedicul Fluid) for the treatment of infestations with head lice. Parasitol Res 2017;116(7):1863-70. View abstract.
  • Sinniah D, Baskaran G, Looi LM, Leong KL. Reye-like syndrome due to margosa oil poisoning: report of a case with postmortem findings. Am J Gastroenterol 1982;77:158-61.
  • Sinniah D, Baskaran G. Margosa oil poisoning as a cause of Reye's syndrome. Lancet 1981;1:487-9. View abstract.
  • Sinniah R, Sinniah D, Chia LS, Baskaran G. Animal model of margosa oil ingestion with Reye-like syndrome. Pathogenesis of microvesicular fatty liver. J Pathol 1989;159:255-64. View abstract.
  • Upadhyay SN, Dhawan S, Garg S, Talwar GP. Immunomodulatory effects of neem (Azadirachta indica) oil. Int J Immunopharmacol 1992;14:1187-93. View abstract.

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CONDITIONS OF USE AND IMPORTANT INFORMATION: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.

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