Strychnos nux vomica (Family: Loganiaceae) is a widely distributed poisonous medicinal plant. Different parts of this plant mainly seeds have been used in traditional Chinese and Indian systems of medicine. Although nux vomica is extremely poisonous, still it considered to be useful for treating many diseases such as paralytic and neuralgic affections, dyspepsia, itching, urinary disorders, joint pain, dysentery, emotional disorders, epilepsy, rheumatism and insomnia. Phytochemical studies of different parts revealed the presence various constituents mainly alkaloids together with flavonoids, iridoids and phenolic glycosides. Various types of preparations and constituents of nux vomica exerted hepatoprotective, antioxidant, antinociceptive, anti-allergic, anti-inflammatory, antimicrobial, anticancer, antipyretic, gastroprotective, antidiabetic, antialcoholic, anti-snake venom and neuropharmacological properties. Moreover, clinical studies on nux vomica preparations showed positive outcome against sinusitis, insomnia and rhinitis. However, most of the pharmacological and clinical studies are too preliminary to conclude the effectiveness of nux vomica. In the future, more efforts should be required on in vitro and In vivo studies and also on clinical trials to confirm clinical efficacy and to determine the active constituent(s) and mode of actions involved in each activity of nux vomica. Moreover, nux vomica is extremely toxic and this is attributed to the presence of alkaloids, mainly strychnine and brucine. Therefore, more attention should also be paid to minimize its toxic potential through advanced detoxification processes without altering the therapeutic potential. Through this review, the authors are intended to integrate traditional ethno medicinal knowledge and modern scientific findings about nux vomica in order to understand its phytochemical, therapeutic potential as well as toxicity and future perspective.