Eden Apothecary · Herb Profile
Azadirachta indica
Pronounced Neem: NEEM. Azadirachta indica: ah-zah-dih-RAK-tah IN-dih-kah.
Cold, dry, and intensely bitter: a cooling blood-cleanser that drains heat, damp, and infection out of the skin, gut, and liver.
Avoid in any form. Neem leaf, bark, and especially seed and seed oil are documented antifertility and abortifacient agents: purified neem extracts produce anti-implantation and pregnancy-terminating effects in rodent and primate models, and intravaginal neem oil is anti-implantation in rats and rabbits. There are no adequate human safety data and the reproductive-toxicity signal is strong, so neem is contraindicated in pregnancy. Sources: evidence-based review of A. indica as a contraceptive (J Ethnopharmacol, 2021, documenting antiovulatory, antispermatogenic, and abortifacient effects); Talwar and colleagues' antifertility research; AHPA Botanical Safety Handbook (avoid in pregnancy); Brinker, Herb Contraindications and Drug Interactions.
Avoid internal use. No reliable human lactation data exist, neem's constituents have not been characterized in breast milk, and the concentrated seed oil is overtly toxic. Given the absence of safety data and the availability of safer alternatives, avoid internal use while breastfeeding. Sources: NIH Drugs and Lactation Database (LactMed) provides no adequate data for neem; AHPA Botanical Safety Handbook; precautionary principle.
Neem seed oil is absolutely contraindicated in infants and children. Single doses of only a few drops to a few milliliters have caused toxic encephalopathy, metabolic acidosis, and hepatic failure, with a Reye-like syndrome and multiple reported deaths (one case series of 12 children reported 10 fatalities). Neem oil must never be given by mouth to a child. Leaf preparations lack pediatric safety data and should be reserved for external use under qualified supervision. Sources: Sinniah and Baskaran, Margosa (neem) oil poisoning as a cause of Reye's syndrome, Lancet 1981; Sundaravalli and colleagues' case series; Lai and colleagues; Dhongade and colleagues, Indian J Pediatr 2008; NCCIH.
Neem seed oil is potentially toxic and must never be taken internally. Ingestion, especially by infants and young children, has caused vomiting, drowsiness, metabolic acidosis, seizures, toxic encephalopathy, and a fatal Reye-like syndrome (fatty degeneration of the liver with cerebral edema); even a few milliliters can be dangerous to an infant. Leaf and bark preparations are far safer, but the concentrated seed oil is not. Prolonged or high-dose internal use may be hepatotoxic and nephrotoxic and can lower fertility in both sexes. Neem lowers blood sugar, so diabetics and anyone on glucose-lowering drugs should monitor closely. Its documented antifertility and abortifacient activity makes it unsuitable for anyone pregnant or trying to conceive.
Pregnancy and preconception in either partner (documented antifertility and abortifacient activity); lactation (insufficient data); infants and children for neem seed oil in any amount (risk of fatal encephalopathy); known liver or kidney disease with concentrated or prolonged internal use; brittle or unmonitored diabetes and hypoglycemia; organ transplant or medically induced immunosuppression (immunostimulant activity); known hypersensitivity.
Not at risk. Neem is abundantly cultivated across the tropics, fast-growing, drought-hardy, and in several regions naturalized to the point of being considered invasive; it carries no United Plant Savers at-risk or to-watch status and is of Least Concern. It is one of the more sustainable medicinal trees: leaf and prunings can be harvested without felling. Prefer organically grown, non-adulterated leaf and cold-pressed seed oil from managed plantations.
Not named in the canonical biblical texts and unknown to the ancient Mediterranean world. Native to the Indian subcontinent and Myanmar, neem is a cornerstone of Ayurveda, Siddha, and Unani medicine, praised in Sanskrit as sarva roga nivarini, the reliever of all disease, and as arishtha, the reliever of sickness. Its documented entry into Western materia medica is through Anglo-Indian colonial pharmacology (Dymock's Pharmacographia Indica, 1890, and Grieve, 1931, both under the name Margosa).
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