Caramboxin stimulates the glutamate receptors in neurons, being an agonist of both NMDA and AMPA glutamatergic ionotropic receptors with potent excitatory, convulsant, and neurodegenerative properties,[2] resulting in symptoms of central nervous system disorder, including mental confusion, seizures, and status epilepticus.

[5] A possible interaction between caramboxin and oxalic acid in starfruit can lead to both neurotoxic and nephrotoxic effects.

[6] Consuming large amounts of starfruit or its juice on an empty stomach is not recommended, even for individuals with normal kidney function.

[6][7] As caramboxin is water soluble, intense hemodialysis has often been used to improve the outcome for patients.

It involves a catalytic phase-transfer alkylation of a glycine imine by ethyl acetoacetate.