Lionfish

The Bottom Line

Lionfish are invasive, meat-eating fish that reproduce quickly. They have spread to non-native waters and can quickly destroy reef ecosystems. They have defensive spines on the top and bottom of their bodies, and a sting from a lionfish can be very painful!

The Full Story

Lionfish look delicate as they use their fan-like fins to gently move through the ocean, but don’t be fooled by this flamboyant fish. They are an invasive, meat-eating species that reproduces quickly. A female lionfish can release up to 2 million eggs a year. While they are native to the South Pacific and Indian Oceans, they have spread rapidly into the North Atlantic, including the Gulf of Mexico and Caribbean Sea. They are popular aquarium fish, and it is thought that owners releasing their lionfish into the wild has facilitated their spread to non-native waters. Lionfish have big appetites and have no natural predators in Atlantic waters. When they arrive at a coral reef, they can eat so much that they reduce the local fish population by as much as 70%. The National Oceanic and Atmospheric Administration has launched a campaign urging people to eat lionfish to help reduce their numbers. However, the Food and Drug Administration warns that lionfish can contain a toxin known as ciguatera, so great care must be taken while preparing a meal including lionfish. There is no specific prevention when it comes to ciguatera exposure; however, eating fish smaller than about 4-6 pounds reduces the risk. The average lionfish weighs approximately 1-2 pounds. Properly prepared lionfish is supposed to be pretty tasty!

Although lionfish stings are very painful, most lionfish stings can be managed at home if pain is controlled and tetanus immunization is up to date. Symptoms following lionfish stings develop within minutes to a few hours and can include swelling, tenderness, warm skin directly surrounding the sting site, redness, sweating, muscle weakness, and tingling sensation. A lionfish sting involving multiple spines increases the risk of infection and body-wide symptoms such as changes in heart rate, abdominal pain, sweating, and fainting. Deaths from lionfish stings are rare. Symptoms can last anywhere from 8 hours to 30 days depending on the severity of the sting.

If you are stung by a lionfish, here are some first-aid steps:

  • Wearing gloves and using tweezers, carefully remove spines from the wound, trying not to squeeze the venom glands.
  • Wash the area with soap and water.
  • Soak the affected limb in water hot enough to tolerate but not to burn, or take a hot shower for 10–20 minutes. An adult should test the water to make sure it is not scalding hot for children.
  • Use over-the-counter medication to treat pain.
  • Call your doctor or pharmacist to make sure your tetanus immunization is up to date.

Visit an urgent care center or emergency room if you experience any of the following:

  • severe muscle aches or cramps
  • severe or persistent pain at bite or sting site
  • feeling faint
  • evidence of infection such as fever, expanding redness, swelling, or pus
  • paralysis
  • if there are spines still visible in the wound after attempts to remove them

If you suspect someone has been stung by a lionfish and is having a problem, check the webPOISONCONTROL® online tool for guidance or call Poison Control at 1-800-222-1222.

Lindsy Liu, PharmD
Certified Specialist in Poison Information

For More Information

Boehrer K. Eat the enemy: 3 ways to cook the lionfish, the new king of the underwater jungle. New York: HuffPost; updated 2017 Dec 6 [cited 2020 Mar 12].

Lionfish sting first aid and treatment. Lionfish.co [cited 2020 Mar 9].

Spencer E. Top five myths about lionfish. Washington: National Geographic; 2013 Jul 29 [cited 2020 Mar 11].

Lionfish sting. Champaign (IL): DoveMed; updated 2018 Oct 29 [cited 2020 Mar 9].


References

Aldred B, Erickson T, Lipscomb J. Lionfish envenomations in an urban wilderness. Wilderness Environ Med. 1996 Nov;7(4):291-6.

Garyfallou GT, Madden JF. Lionfish envenomation. Ann Emerg Med. 1996 Oct;28(4):456-7.

Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20.

Kizer KW, McKinney HE, Auerbach PS. Scorpaenidae envenomation. A five-year poison center experience. JAMA. 1985 Feb 8;253(6):807-10.

Resiere D, Cerland L, De Haro L, et al. Envenomation by the invasive Pterois volitans species (lionfish) in the French West Indies—a two-year prospective study in Martinique. Clin Toxicol (Phila). 2016;54(4):313-8.

Thomas L, Tharakaram S. Lionfish envenomation: relapses controlled by intralesional triamcinolone. Indian J Dermatol Venereol Leprol. 2016 Jul-Aug;82(4):438-9.

Trestrail JH 3rd, al-Mahasneh QM. Lionfish string experiences of an inland poison center: a retrospective study of 23 cases. Vet Hum Toxicol. 1989 Apr;31(2):173-5.

Vetrano SJ, Lebowitz JB, Marcus S. Lionfish envenomation. J Emerg Med. 2002 Nov;23(4):379-82.

Poisoned?

Call 1-800-222-1222 or

HELP ME online

Prevention Tips

  • For those who keep lionfish as pets, be aware of their location while cleaning the tank, and keep your hands well away from their spines.
  • Avoid touching or handling lionfish. Even a dead lionfish can sting!
  • Wear protective clothing if you plan to swim or dive in infested areas or if you are cleaning an aquarium with a lionfish.
  • Never return a live lionfish to the ocean.

This Really Happened

Case 1. A 62-year-old woman was stung on her finger by her dwarf lionfish while she was cleaning its aquarium. The finger immediately developed a bruise, became swollen, and there was pain at the sting site. She was instructed to soak her finger in tolerably hot water and to use over-the-counter pain medications. She was encouraged to see a medical provider to ensure that no spines were stuck in her finger and to get an updated tetanus vaccination. By the next day all of her symptoms had resolved.

Case 2. A 57-year-old man put too much fish food into an aquarium at his workplace. He was stung by a lionfish when he reached into the tank to remove the excess food. The finger was red and swollen, and there was some bleeding at the sting site. He was instructed to soak his hand in tolerably hot water. In an emergency room, he was given opioid medication to control his pain. He was started on antibiotics and allowed to go home; his tetanus vaccination was already up to date. Four days later, his symptoms had resolved.