Other Name(s):

Ciguatera Poisoning, Gambierdiscus toxicus, Gratelle, Intoxication à la ciguatera, ICP, Intoxication Ciguatérique par les Poisson.


Ciguatera is a poison that can accumulate in certain fish. It is not used as a medicine.

People can get ciguatera poisoning by eating normally safe, bottom-feeding, coral reef fish that have collected the poison from the food chain. Ciguatera poisoning tends to occur near areas of disturbed reef, including waterfront construction. Ciguatera poisoning is most common in Florida and Hawaii. Red snapper, barracuda, parrotfish, jacks, and grouper are most commonly contaminated, but over 400 normally safe fish species may contain the poison. There are no good “rules of thumb” for detecting tainted fish. They look, taste, and smell normal. Testing for ciguatera is available in some areas.

How does it work?

Ciguatera interferes with the normal function of nerve cells.

Uses & Effectiveness

Insufficient Evidence to Rate Effectiveness for...

  • Ciguatera does not have any medicinal uses.

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, and Insufficient Evidence to Rate (detailed description of each of the ratings).


Next to red peppers, you can get the most vitamin C from ________________. See Answer

Side Effects

Ciguatera is UNSAFE when taken by mouth. One bite of contaminated fish can be enough to cause symptoms. The most common symptoms include stomach cramps, nausea, vomiting, and diarrhea. Other symptoms include itching; numbness of lips, tongue, and throat; blurred vision; low blood pressure; slowed heart rate; alternating hot and cold sensations; and coma. In severe cases, shock, muscular paralysis, and death can occur. Up to 20 percent of people who get ciguatera poisoning die.

Special Precautions & Warnings

Pregnancy and breast-feeding: Ciguatera is UNSAFE for anyone, including pregnant and breast-feeding women. One pregnant woman who was poisoned suffered a miscarriage. Breast-feeding women should be especially careful to avoid ciguatera because it passes into breast milk and can affect the nursing infant.


The appropriate dose of ciguatera depends on several factors such as the user's age, health, and several other conditions. At this time there is not enough scientific information to determine an appropriate range of doses for ciguatera. Keep in mind that natural products are not always necessarily safe and dosages can be important. Be sure to follow relevant directions on product labels and consult your pharmacist or physician or other healthcare professional before using.


Vitamin D Deficiency: How Much Vitamin D Is Enough? See Slideshow

Health Solutions From Our Sponsors

Reviewed on 6/14/2021

Allsop JL, Martini L, Lebris H, et al. [Neurologic manifestations of ciguatera. 3 cases with a neurophysiologic study and examination of one nerve biopsy]. Rev Neurol (Paris) 1986;142(6-7):590-597. View abstract.

Anderson BS, Sims JK, Wiebenga NH, et al. The epidemiology of ciguatera fish poisoning in Hawaii, 1975-1981. Hawaii Med J 1983;42(10):326-334. View abstract.

Angibaud G, Leveque JM, Laurent D, et al. [Neurological features after consumption of a variety of neo-caledonian shellfish]. Rev Neurol (Paris) 2000;156(1):65-66. View abstract.

Angibaud G, Rambaud S. Serious neurological manifestations of ciguatera: is the delay unusually long? J Neurol Neurosurg Psychiatry 1998;64(5):688-689. View abstract.

Arcila-Herrera H, Castello-Navarrete A, Mendoza-Ayora J, et al. [Ten cases of Ciguatera fish poisoning in Yucatan]. Rev Invest Clin 1998;50(2):149-152. View abstract.

Asaeda G. The transport of ciguatoxin: a case report. J Emerg Med 2001;20(3):263-265. View abstract.

Asis Fernandez RF, Quesada RR, Otero S, V, et al. [A new case of ciguatera fish poisoning and favorable evolution with corticotherapy]. An Med Interna 1998;15(3):172. View abstract.

Bagnis R, Kuberski T, Laugier S. Clinical observations on 3,009 cases of ciguatera (fish poisoning) in the South Pacific. Am J Trop Med Hyg 1979;28(6):1067-1073. View abstract.

Bagnis R, Rouanet M, Renambot J. [3 cases of "ciguatera" (1 of which was fatal) in Tuamotu Islands]. Med Trop (Mars ) 1970;30(4):489-493. View abstract.

Bagnis R, Spiegel A, Boutin JP, et al. [Evaluation of the efficacy of mannitol in the treatment of ciguatera in French Polynesia]. Med Trop (Mars ) 1992;52(1):67-73. View abstract.

Bagnis R. [Beginnings and development of ciguatera poisoning in an atoll of Tuamotu]. Rev Corps Sante Armees Terre Mer Air 1969;10(6):783-795. View abstract.

Bagnis RA, Bronstein JA, Jouffe G, et al. [Neurologic complications of ciguatera]. Bull Soc Pathol Exot Filiales 1977;70(1):89-93. View abstract.

Baratta RO, Tanner PA, Jr. Ichthyosarcotoxism--Ciguatera intoxication. J Fla Med Assoc 1970;57(6):39-42. View abstract.

Barton ED, Tanner P, Turchen SG, et al. Ciguatera fish poisoning. A southern California epidemic. West J Med 1995;163(1):31-35. View abstract.

Berlin RM, King SL, Blythe DG. Symptomatic improvement of chronic fatigue with fluoxetine in ciguatera fish poisoning. Med J Aust 1992;157(8):567. View abstract.

Blume C, Rapp M, Rath J, et al. [Ciguatera poisoning. Growing differential diagnostic significance in the age of foreign tourism]. Med Klin (Munich) 1999;94(1):45-49. View abstract.

Blythe DG, De Sylva DP, Fleming LE, et al. Clinical experience with i.v. Mannitol in the treatment of ciguatera. Bull Soc Pathol Exot 1992;85(5 Pt 2):425-426. View abstract.

Blythe DG, De Sylva DP. Mother's milk turns toxic following fish feast. JAMA 1990;264(16):2074. View abstract.

Bourdeau P, Bagnis R. [Risk factors of ciguatera in the French West Indies in Saint-Barthelemy, Saint-Martin and Anguilla]. Rev Elev Med Vet Pays Trop 1989;42(3):393-410. View abstract.

Butera R, Prockop LD, Buonocore M, et al. Mild ciguatera poisoning: Case reports with neurophysiological evaluations. Muscle Nerve 2000;23(10):1598-1603. View abstract.

Calvert GM, Hryhorczuk DO, Leikin JB. Treatment of ciguatera fish poisoning with amitriptyline and nifedipine. J Toxicol Clin Toxicol 1987;25(5):423-428. View abstract.

Cameron J, Capra MF. The basis of the paradoxical disturbance of temperature perception in ciguatera poisoning. J Toxicol Clin Toxicol 1993;31(4):571-579. View abstract.

Cameron J, Flowers AE, Capra MF. Electrophysiological studies on ciguatera poisoning in man (Part II). J Neurol Sci 1991;101(1):93-97. View abstract.

Chan TY, Kwok TC. Chronicity of neurological features in ciguatera fish poisoning. Hum Exp Toxicol 2001;20(8):426-428. View abstract.

Chan TY, Wang AY. Life-threatening bradycardia and hypotension in a patient with ciguatera fish poisoning. Trans R Soc Trop Med Hyg 1993;87(1):71. View abstract.

Chanteau S, Lechat I, Parc F, et al. [Assay for detection of ciguatoxin using an immunoenzyme technic]. Bull Soc Pathol Exot Filiales 1981;74(2):227-232. View abstract.

Crump JA, McLay CL, Chambers ST. Ciguatera fish poisoning. Postgrad Med J 1999;75(889):678-679. View abstract.

Davis RT, Villar LA. Symptomatic improvement with amitriptyline in ciguatera fish poisoning. N Engl J Med 1986;315(1):65. View abstract.

de Haro L, Hayek-Lanthois M, Joossen F, et al. [Mass ciguatera poisoning after eating barracuda in Mexico: prognostic and therapeutic implications]. Med Trop (Mars ) 1997;57(1):55-58. View abstract.

de la Rosa LA, Alfonso A, Vilarino N, et al. Maitotoxin-induced calcium entry in human lymphocytes: modulation by yessotoxin, Ca(2+) channel blockers and kinases. Cell Signal 2001;13(10):711-716. View abstract.

DeFusco DJ, O'Dowd P, Hokama Y, et al. Coma due to ciguatera poisoning in Rhode Island. Am J Med 1993;95(2):240-243. View abstract.

Delord JM, Maceno R, Arfi S. [Pruritus vulvae as a symptom of ciguatera]. Presse Med 1984;13(25):1577. View abstract.

Derouiche F, Cohen E, Rodier G, et al. [Ciguatera and peripheral neuropathy: a case report]. Rev Neurol (Paris) 2000;156(5):514-516. View abstract.

Dobi S, Horvath A, Prinz G, et al. [Imported food poisoning caused by fish toxins (ciguatoxin)]. Orv Hetil 1990;131(40):2201-2203. View abstract.

Donnet A, Habib M, Vigouroux RA, et al. [Persistent myasthenia-like manifestations after ciguatera poisoning. Beneficial effect of anticholinesterases]. Presse Med 1987;16(15):734. View abstract.

Eastaugh J, Shepherd S. Infectious and toxic syndromes from fish and shellfish consumption. A review. Arch Intern Med 1989;149(8):1735-1740. View abstract.

Fleming LE, Baden DG, Ayyar RA, et al. A pilot study of a new ELISA test for ciguatoxin in humans. Bull Soc Pathol Exot 1992;85(5 Pt 2):508-509. View abstract.

Gascon J, Macia M, Oliveira I, et al. [Ciguatera poisoning in Spanish travellers]. Med Clin (Barc ) 2003;120(20):777-779. View abstract.

Geller RJ, Benowitz NL. Orthostatic hypotension in ciguatera fish poisoning. Arch Intern Med 1992;152(10):2131-2133. View abstract.

Germain R, Paul B. [Symptomatic treatment of ichtyosarcotoxic disease by associated dexamethasone, cobalamine and tiapride (author's transl)]. Med Trop (Mars ) 1981;41(2):173-179. View abstract.

Gillespie NC, Lewis RJ, Pearn JH, et al. Ciguatera in Australia. Occurrence, clinical features, pathophysiology and management. Med J Aust 1986;145(11-12):584-590. View abstract.

Glaziou P, Martin PM. Study of factors that influence the clinical response to ciguatera fish poisoning. Bull Soc Pathol Exot 1992;85(5 Pt 2):419-420. View abstract.

Gollop JH, Pon EW. Ciguatera: a review. Hawaii Med J 1992;51(4):91-99. View abstract.

Goodman A, Williams TN, Maitland K. Ciguatera poisoning in Vanuatu. Am J Trop Med Hyg 2003;68(2):263-266. View abstract.

Hamburger HA. The neuro-ophthalmologic signs of ciguatera poisoning: a case report. Ann Ophthalmol 1986;18(10):287-288. View abstract.

Hashmi MA, Sorokin JJ, Levine SM. Ciguatera fish poisoning. N J Med 1989;86(6):469-471. View abstract.

Heir GM. Ciguatera neurotoxin poisoning mimicking burning mouth syndrome. Quintessence Int 2005;36(7-8):547-550. View abstract.

Ho AM, Fraser IM, Todd EC. Ciguatera poisoning: a report of three cases. Ann Emerg Med 1986;15(10):1225-1228. View abstract.

Hokama Y, Asahina AY, Hong TW, et al. Evaluation of the stick enzyme immunoassay in Caranx sp. and Seriola dumerili associated with ciguatera. J Clin Lab Anal 1990;4(5):363-366. View abstract.

Hokama Y, Asahina AY, Shang ES, et al. Evaluation of the Hawaiian reef fishes with the solid phase immunobead assay. J Clin Lab Anal 1993;7(1):26-30. View abstract.

Hokama Y. Simplified solid-phase immunobead assay for detection of ciguatoxin and related polyethers. J Clin Lab Anal 1990;4(3):213-217. View abstract.

Holmes MJ, Teo SL. Toxic marine dinoflagellates in Singapore waters that cause seafood poisonings. Clin Exp Pharmacol Physiol 2002;29(9):829-836. View abstract.

Holt RJ, Miro G, Del Valle A. An analysis of poison control center reports of ciguatera toxicity in Puerto Rico for one year. J Toxicol Clin Toxicol 1984;22(2):177-185. View abstract.

Inoue M, Miyazaki K, Uehara H, et al. First- and second-generation total synthesis of ciguatoxin CTX3C. Proc Natl Acad Sci U S A 2004;101(33):12013-12018. View abstract.

Isbister GK, Kiernan MC. Neurotoxic marine poisoning. Lancet Neurol 2005;4(4):219-228. View abstract.

Juranovic LR, Park DL. Foodborne toxins of marine origin: ciguatera. Rev Environ Contam Toxicol 1991;117:51-94. View abstract.

Karalis T, Gupta L, Chu M, et al. Three clusters of ciguatera poisoning: clinical manifestations and public health implications. Med J Aust 2000;172(4):160-162. View abstract.

Katz AR, Terrell-Perica S, Sasaki DM. Ciguatera on Kauai: investigation of factors associated with severity of illness. Am J Trop Med Hyg 1993;49(4):448-454. View abstract.

Kodama AM, Hokama Y, Yasumoto T, et al. Clinical and laboratory findings implicating palytoxin as cause of ciguatera poisoning due to Decapterus macrosoma (mackerel). Toxicon 1989;27(9):1051-1053. View abstract.

Lange WR, Kreider SD, Hattwick M, et al. Potential benefit of tocainide in the treatment of ciguatera: report of three cases. Am J Med 1988;84(6):1087-1088. View abstract.

Lange WR, Lipkin KM, Yang GC. Can ciguatera be a sexually transmitted disease? J Toxicol Clin Toxicol 1989;27(3):193-197. View abstract.

Lange WR, Snyder FR, Fudala PJ. Travel and ciguatera fish poisoning. Arch Intern Med 1992;152(10):2049-2053. View abstract.

Lange WR. Ciguatera fish poisoning. Am Fam Physician 1994;50(3):579-584. View abstract.

Lange WR. Ciguatera toxicity. Am Fam Physician 1987;35(4):177-182. View abstract.

Lawrence DN, Enriquez MB, Lumish RM, et al. Ciguatera fish poisoning in Miami. JAMA 1980;244(3):254-258. View abstract.

Lehane L, Lewis RJ. Ciguatera: recent advances but the risk remains. Int J Food Microbiol 2000;61(2-3):91-125. View abstract.

Levine DZ. Ciguatera: current concepts. J Am Osteopath Assoc 1995;95(3):193-198. View abstract.

Lewis ND. Disease and development: ciguatera fish poisoning. Soc Sci Med 1986;23(10):983-993. View abstract.

Lewis RJ, Hoy AW, McGiffin DC. Action of ciguatoxin on human atrial trabeculae. Toxicon 1992;30(8):907-914. View abstract.

Lewis RJ. The changing face of ciguatera. Toxicon 2001;39(1):97-106. View abstract.

Lipkin KM. Ciguatera poisoning presenting as psychiatric disorder. Arch Gen Psychiatry 1989;46(4):384-385. View abstract.

Louhija A. [Ciguatera--a tropical fish poisoning. 400 hundred years of history and the present situation]. Duodecim 2000;116(23):2671-2680. View abstract.

Marquais M, Sauviat MP. [Effect of ciguatoxins on the cardiocirculatory system]. J Soc Biol 1999;193(6):495-504. View abstract.

Matta J, Navas J, Milad M, et al. A pilot study for the detection of acute ciguatera intoxication in human blood. J Toxicol Clin Toxicol 2002;40(1):49-57. View abstract.

Miller RM, Pavia S, Keary P. Cardiac toxicity associated with ciguatera poisoning. Aust N Z J Med 1999;29(3):373-374. View abstract.

Morris JG, Jr., Lewin P, Hargrett NT, et al. Clinical features of ciguatera fish poisoning: a study of the disease in the US Virgin Islands. Arch Intern Med 1982;142(6):1090-1092. View abstract.

Morris JG, Jr., Lewin P, Smith CW, et al. Ciguatera fish poisoning epidemiology of the disease on St. Thomas, U.S. Virgin Islands. Am J Trop Med Hyg 1982;31(3 Pt 1):574-578. View abstract.

Morris PD, Campbell DS, Freeman JI. Ciguatera fish poisoning: an outbreak associated with fish caught from North Carolina coastal waters. South Med J 1990;83(4):379-382. View abstract.

Oreihaka E. Ciguatera fish poisoning in the Solomon Islands. Bull Soc Pathol Exot 1992;85(5 Pt 2):421-422. View abstract.

Palafox NA, Jain LG, Pinano AZ, et al. Successful treatment of ciguatera fish poisoning with intravenous mannitol. JAMA 1988;259(18):2740-2742. View abstract.

Palafox NA. Review of the clinical use of intravenous mannitol with ciguatera fish poisoning from 1988 to 1992. Bull Soc Pathol Exot 1992;85(5 Pt 2):423-424. View abstract.

Park DL. Evolution of methods for assessing ciguatera toxins in fish. Rev Environ Contam Toxicol 1994;136:1-20. View abstract.

Pearn J. Neurology of ciguatera. J Neurol Neurosurg Psychiatry 2001;70(1):4-8. View abstract.

Pearn JH, Lewis RJ, Ruff T, et al. Ciguatera and mannitol: experience with a new treatment regimen. Med J Aust 1989;151(2):77-80. View abstract.

Pearn JH. Chronic fatigue syndrome: chronic ciguatera poisoning as a differential diagnosis. Med J Aust 1997;166(6):309-310. View abstract.

Perez CM, Vasquez PA, Perret CF. Treatment of ciguatera poisoning with gabapentin. N Engl J Med 2001;344(9):692-693. View abstract.

Poli MA, Lewis RJ, Dickey RW, et al. Identification of Caribbean ciguatoxins as the cause of an outbreak of fish poisoning among U.S. soldiers in Haiti. Toxicon 1997;35(5):733-741. View abstract.

Poon-King CM, Chen A, Poon-King T. Ciguatera fish poisoning in industrial ship crewmembers: a retrospective study in a seaport general practice in Trinidad and Tobago. West Indian Med J 2004;53(4):220-226. View abstract.

Pottier I, Hamilton B, Jones A, et al. Identification of slow and fast-acting toxins in a highly ciguatoxic barracuda (Sphyraena barracuda) by HPLC/MS and radiolabelled ligand binding. Toxicon 2003;42(6):663-672. View abstract.

Pottier I, Vernoux JP, Lewis RJ. Ciguatera fish poisoning in the Caribbean islands and Western Atlantic. Rev Environ Contam Toxicol 2001;168:99-141. View abstract.

Pottier I, Vernoux JP. [Evaluation of Antilles fish ciguatoxicity by mouse and chick bioassays]. Bull Soc Pathol Exot 2003;96(1):24-28. View abstract.

Puente PS, Cabrera MA, Lago NM, et al. [Ciguatera: eight imported cases]. Rev Clin Esp 2005;205(2):47-50. View abstract.

Quod JP, Turquet J. Ciguatera in Reunion Island (SW Indian Ocean): epidemiology and clinical patterns. Toxicon 1996;34(7):779-785. View abstract.

Racciatti D, Vecchiet J, Ceccomancini A, et al. Chronic fatigue syndrome following a toxic exposure. Sci Total Environ 2001;270(1-3):27-31. View abstract.

Raikhlin-Eisenkraft B, Bentur Y. Rabbitfish ("aras"): an unusual source of ciguatera poisoning. Isr Med Assoc J 2002;4(1):28-30. View abstract.

Ruprecht K, Rieckmann P, Giess R. [Ciguatera: clinical relevance of a marine neurotoxin]. Dtsch Med Wochenschr 2001;126(28-29):812-814. View abstract.

Sanders WE, Jr. Intoxications from the seas: ciguatera, scombroid, and paralytic shellfish poisoning. Infect Dis Clin North Am 1987;1(3):665-676. View abstract.

Sanner BM, Rawert B, Henning B, et al. Ciguatera fish poisoning following travel to the tropics. Z Gastroenterol 1997;35(5):327-330. View abstract.

Savaloja J. Diphenhydramine hydrochloride helps symptoms of ciguatera fish poisoning. J Emerg Nurs 1996;22(5):373. View abstract.

Schiazza L, Bleidl D, Occella C, et al. [Xenodermatoses: ciguatera. A case]. G Ital Dermatol Venereol 1988;123(1-2):41-45. View abstract.

Schnorf H, Taurarii M, Cundy T. Ciguatera fish poisoning: a double-blind randomized trial of mannitol therapy. Neurology 2002;58(6):873-880. View abstract.

Settipane, G. A. The restaurant syndromes. N.Engl.Reg Allergy Proc 1987;8(1):39-46. View abstract.

Sozzi G, Marotta P, Aldeghi D, et al. Polyneuropathy secondary to ciguatoxin poisoning. Ital J Neurol Sci 1988;9(5):491-495. View abstract.

Stewart MP. Ciguatera fish poisoning: treatment with intravenous mannitol. Trop Doct 1991;21(2):54-55. View abstract.

Stommel EW, Jenkyn LR, Parsonnet J. Another case of polymyositis after ciguatera toxin exposure. Arch Neurol 1993;50(6):571. View abstract.

Stommel EW, Parsonnet J, Jenkyn LR. Polymyositis after ciguatera toxin exposure. Arch Neurol 1991;48(8):874-877. View abstract.

Swift AE, Swift TR. Ciguatera. J Toxicol Clin Toxicol 1993;31(1):1-29. View abstract.

Ting JY, Brown AF. Ciguatera poisoning: a global issue with common management problems. Eur J Emerg Med 2001;8(4):295-300. View abstract.

Wetsteyn JC, Kothe MJ, Zijlstra EE, et al. [Unrecognized neurological symptoms following a visit to the Caribbean Region: ciguatoxin poisoning]. Ned Tijdschr Geneeskd 1995;139(22):1144. View abstract.

Williamson J. Ciguatera and mannitol: a successful treatment. Med J Aust 1990;153(5):306-307. View abstract.

Andro MC, Riffaud JP. Pygeum africanum extract for the treatment of patients with benign prostatic hyperplasia. A review of 25 years of published experience. Curr Ther Res 1995;56:796-817.

Pearn J, Harvey P, De Ambrosis W, Lewis R, McKay R. Ciguatera and pregnancy. Med J Aust. 1982 Jan 23;1(2):57-8. View abstract.

Health Solutions From Our Sponsors