Scopolamine enters breast milkbysecretion. Although no human studies exist to document the safety of scopolamine while nursing, the manufacturer recommends that caution be taken if scopolamine is administered to a breastfeeding woman.[27]
The likelihood of experiencing adverse effects from scopolamine is increased in the elderly, relative to younger people. This phenomenon is especially true for older people who are also on several other medications. Scopolamine use should be avoided in this age group because of these potent anticholinergic adverse effects, which have also been linked to an increased risk for dementia.[28][29]
Due to interactions with metabolism of other drugs, scopolamine can cause significant unwanted side effects or unpredictable synergies when taken with other medications or compounds. Specific attention should be paid to other medications in the same pharmacologic class as scopolamine, also known as anticholinergics.
Scopolamine undergoes first-pass metabolism and about 2.6% is excreted unchanged in urine. Grapefruit juice decreases metabolism of scopolamine, consequently increasing plasma concentration.[35]
The pharmacological effects of scopolamine are mediated through the drug's competitive antagonism of the peripheral and central muscarinic acetylcholine receptors. Scopolamine acts as a nonspecific muscarinic antagonist at all four (M1, M2, M3, and M4) receptor sites.[36][37]
In doses higher than intended for medicinal use; the hallucinogenic alteration of consciousness, as well as the deliriousness in particular are tied to the compound's activity at the M1 muscarinic receptor. M1 receptors are located primarily in the central nervous system and are involved in perception, attention and cognitive functioning. Delirium is only associated with the antagonism of postsynapticM1 receptors and currently other receptor subtypes have not been implicated.[38]
Peripheral muscarinic receptors are part of the autonomic nervous system. M2 receptors are located in the brain and heart, M3 receptors are in salivary glands and M4 receptors are in the brain and lungs.[38] Due to the drug's inhibition of various signal transduction pathways, the decrease in acetylcholine signaling is what leads to many of the cognitive deficits, mental impairments and delirium associated with psychoactive doses. Medicinal effects appear to mostly be tied to activation of the peripheral receptors and only from marginal decreases in acetylcholine signaling.[39]
Although often broadly referred to as simply being 'anticholinergic', antimuscarinic would be more specific and accurate terminology to use for scopolamine, as, for example, it is not known to block nicotinic receptors.[38]
Aputrescine oxidase that specifically recognizes methylated putrescine catalyzes the deamination of this compound to 4-methylaminobutanal, which then undergoes a spontaneous ring formation to N-methyl-pyrrolium cation. In the next step, the pyrrolium cation condenses with acetoacetic acid yielding hygrine. No enzymatic activity could be demonstrated to catalyze this reaction. Hygrine further rearranges to tropinone.[41]
Plants naturally containing scopolamine such as Atropa belladonna (deadly nightshade), Brugmansia (angels trumpet), Datura (Jimson weed), Hyoscyamus niger, Mandragora officinarum, Scopolia carniolica, Latua and Duboisia myoporoides have been known about and used for various purposes in both the New and Old Worlds since ancient times.[43][44][45] Being one of the earlier alkaloids isolated from plant sources, scopolamine has been in use in its purified forms, such as various salts, including hydrochloride, hydrobromide, hydroiodide, and sulfate, since its official isolation by the German scientist Albert Ladenburg in 1880,[46] and as various preparations from its plant-based form since antiquity and perhaps prehistoric times.
Following the description of the structure and activity of scopolamine by Ladenburg, the search for synthetic analogues, and methods for total synthesis, of scopolamine and atropine in the 1930s and 1940s resulted in the discovery of diphenhydramine, an early antihistamine and the prototype of its chemical subclass of these drugs, and pethidine, the first fully synthetic opioidanalgesic, known as Dolantin and Demerol amongst many other trade names.[citation needed]
In 1899, a Dr. Schneiderlin recommended the use of scopolamine and morphine for surgical anaesthesia, and it started to be used sporadically for that purpose.[12][47] The use of this combination in obstetric anesthesiology (childbirth) was first proposed by Richard von Steinbuchel in 1902 and was picked up and further developed by Carl Gauss in Freiburg, Germany, starting in 1903.[48] The method, which was based on a drug synergy between both scopolamine and morphine came to be known as Dämmerschlaf ("twilight sleep") or the "Freiburg method".[47][48] It spread rather slowly, and different clinics experimented with different dosages and ingredients. In 1915, the Canadian Medical Association Journal reported, "the method [was] really still in a state of development".[47] It remained widely used in the US until the 1960s, when growing chemophobia and a desire for more natural childbirth led to its abandonment.[49]
While it has been occasionally used recreationally for its hallucinogenic properties, the experiences are often unpleasant, mentally and physically. It is also physically dangerous and officially classified as a deliriant drug, so repeated recreational use is rare.[52] In June 2008, more than 20 people were hospitalized with psychosis in Norway after ingesting counterfeit rohypnol tablets containing scopolamine.[53] In January 2018, 9 individuals were hospitalized in Perth, Western Australia, after reportedly ingesting scopolamine.[54]
Historically, the various plants that produce scopolamine have been used psychoactively for spiritual and magical purposes, particularly by witches in western culture and indigenous groups throughout the Americas such as Native American tribes like the Chumash.[16][57][58][59] When entheogenic preparations of these plants were used, scopolamine was considered to be the main psychoactive compound and was largely responsible for the hallucinogenic effects, particularly when the preparation was made into a topical ointment, most notably flying ointment.[60]
Scopolamine is reported to be the only active alkaloid within these plants that can effectively be absorbed through the skin to cause effects.[11] Different recipes for these ointments were explored in European witchcraft at least as far back as the Early Modern period and included multiple ingredients to help with the transdermal absorption of scopolamine, such as animal fat, as well as other possible ingredients to counteract its noxious and dysphoric effects.[60]
In the Bible, there are multiple mentions of Mandrake, a psychoactive and hallucinogenic plant root that contains scopolamine. It was associated with fertility and (sexual) desire where it was yearned for by Rachel, who apparently was "barren" (infertile) but trying to conceive.[61][62]
The effects of scopolamine were studied for use as a truth serum in interrogations in the early 20th century,[63] but because of the side effects, investigations were dropped.[64] In 2009, the Czechoslovakstate security secret police were proven to have used scopolamine at least three times to obtain confessions from alleged antistatedissidents.[65]
Scopolamine can render a victim unconscious for 24 hours or more. In large doses, it can cause respiratory failure and death. The most common seems to be recorded in Colombia, where unofficial estimates put the number of annual scopolamine incidents at approximately 50,000. A travel advisory published by the U.S. Overseas Security Advisory Council (OSAC) in 2012 stated:
One common and particularly dangerous method that criminals use in order to rob a victim is through the use of drugs. Scopolamine is most often administered in liquid or powder form in foods and beverages. The majority of these incidents occur in night clubs and bars, and usually men, perceived to be wealthy, are targeted by young, attractive women. It is recommended that, to avoid becoming a victim of scopolamine, a person should never accept food or beverages offered by strangers or new acquaintances, nor leave food or beverages unattended in their presence. Victims of scopolamine or other drugs should seek immediate medical attention.[66]
Between 1998 and 2004, 13% of emergency-room admissions for "poisoning with criminal intentions" in a clinic of Bogotá have been attributed to scopolamine, and 44% to benzodiazepines.[15] Most commonly, the person has been poisoned by a robber who gave the victim a scopolamine-laced beverage, in the hope that the victim would become unconscious or unable to effectively resist the robbery.[15]
Beside robberies, it is also allegedly involved in express kidnappings and sexual assault.[67] In 2008, the Hospital Clínic in Barcelona introduced a protocol to help medical workers identify cases. In February 2015, Madrid hospitals adopted a similar working document.[67] Hospital Clínic has found little scientific evidence to support this use and relies on the victims' stories to reach any conclusion.[67] Although poisoning by scopolamine appears quite often in the media as an aid for raping, kidnapping, killing, or robbery, the effects of this drug and the way it is applied by criminals (transdermal injection, on playing cards and papers, etc.) are often exaggerated,[68][69][70] especially skin exposure, as the dose that can be absorbed by the skin is too low to have any effect.[67] Scopolamine transdermal patches must be used for hours to days.[34]
There are certain other aspects of the usage of scopolamine in crimes. Powdered scopolamine is referred to as "devil's breath". In popular media and television, it is portrayed as a method to brainwash or control people into being defrauded by their attackers.[71][72][73][74] There is debate whether these claims are true.[75][76] It is not verified if the powdered form is capable of inducing a suggestive state. The danger is real enough that in addition to the Overseas Security Advisory Council (OSAC) in 2012, the US Department of State, as well as the Government of Canada, published[77][78] travel advisories warning travelers about the possibility of targeting.
Scopolamine is used as a research tool to study memory encoding. Initially, in human trials, relatively low doses of the muscarinic receptor antagonist scopolamine were found to induce temporary cognitive defects.[83] Since then, scopolamine has become a standard drug for experimentally inducing cognitive defects in animals.[84][85] Results in primates suggest that acetylcholine is involved in the encoding of new information into long-term memory.[86] Scopolamine has been shown to exert a greater impairment on episodic memory, event-related potentials, memory retention and free recall compared to DPH (an anticholinergic and antihistamine).[82]
Scopolamine produces detrimental effects on short-term memory, memory acquisition, learning, visual recognition memory, visuospatial praxis, visuospatial memory, visuoperceptual function, verbal recall, and psychomotor speed.[87][84][85] It does not seem to impair recognition and memory retrieval, though.[85] Acetylcholine projections in hippocampal neurons, which are vital in mediating long-term potentiation, are inhibited by scopolamine.[85][88] Scopolamine inhibits cholinergic-mediated glutamate release in hippocampal neurons, which assist in depolarization, potentiation of action potential, and synaptic suppression. Scopolamine's effects on acetylcholine and glutamate release in the hippocampus favor retrieval-dominant cognitive functioning.[85] Scopolamine has been used to model the defects in cholinergic function for models of Alzheimer's, dementia, fragile X syndrome, and Down syndrome.[85][89][90][91]
Scopolamine has been identified as a psychoplastogen, which refers to a compound capable of promoting rapid and sustained neuroplasticity in a single dose.[92] It has been, and continues to be investigated as a rapid-onset antidepressant, with a number of small studies finding positive results, particularly in female subjects.[93][94][95][96]
NASA agreed to develop a nasal administration method. With a precise dosage, the NASA spray formulation has been shown to work faster and more reliably than the oral form to treat motion sickness.[97]
Although a fair amount of research has been applied to scopolamine in the field of medicine, its hallucinogenic (psychoactive) effects as well as the psychoactive effects of other antimuscarinic deliriants haven't been extensively researched or as well understood compared to other types of hallucinogens such as psychedelic and dissociative compounds, despite the alkaloid's long history of usage in mind-altering plant preparations.[98]
^World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^ abRossi S, ed. (2013). Australian Medicines Handbook (2013 ed.). Adelaide: The Australian Medicines Handbook Unit Trust. ISBN978-0-9805790-9-3.
^Bitterman N, Eilender E, Melamed Y (May 1991). "Hyperbaric oxygen and scopolamine". Undersea Biomedical Research. 18 (3): 167–174. PMID1853467. Archived from the original on 20 August 2008. Retrieved 13 August 2008.{{cite journal}}: CS1 maint: unfit URL (link)
^ abBriggs GG, Freeman RK, Yaffe SJ (1994). "Scopolamine". Drugs in Pregnancy and Lactation. Baltimore, Maryland: Williams and Wilkins. pp. 777–778. ISBN978-0-683-01060-2.
^"DBL HYOSCINE INJECTION BP". TGA eBusiness Services. Hospira Australia Pty Ltd. 30 January 2012. Archived from the original on 30 March 2017. Retrieved 22 October 2013.
^Muranaka T, Ohkawa H, Yamada Y (1993). "Continuous Production of Scopolamine by a Culture of Duboisia leichhardtii Hairy Root Clone in a Bioreactor System". Applied Microbiology and Biotechnology. 40 (2–3): 219–223. doi:10.1007/BF00170370. S2CID45125074.
^Freye E (2010). "Toxicity of Datura Stramonium". Pharmacology and Abuse of Cocaine, Amphetamines, Ecstasy and Related Designer Drugs. Netherlands: Springer. pp. 217–218. doi:10.1007/978-90-481-2448-0_34. ISBN978-90-481-2447-3.
^Fatur K, Kreft S (April 2020). "Common anticholinergic solanaceaous plants of temperate Europe - A review of intoxications from the literature (1966-2018)". Toxicon. 177: 52–88. doi:10.1016/j.toxicon.2020.02.005. PMID32217234. S2CID213559151.
^Preissel U, Preissel HG (2002). Brugmansia and Datura: Angel's Trumpets and Thorn Apples. Buffalo, NY: Firefly Books. pp. 106–129. ISBN1-55209-598-3.
^House RE (September 1922). "The Use of Scopolamine in Criminology". Texas State Journal of Medicine. 18: 256–263.
Reprinted in: House RE (July–August 1931). "The Use of Scopolamine in Criminology". American Journal of Police Science. 2 (4): 328–336. doi:10.2307/1147361. JSTOR1147361.
^Forest E (27 July 2008). "Atypical Drugs of Abuse". Articles & Interviews. Student Doctor Network. Archived from the original on 27 May 2013.
^ abCurran HV, Pooviboonsuk P, Dalton JA, Lader MH (January 1998). "Differentiating the effects of centrally acting drugs on arousal and memory: an event-related potential study of scopolamine, lorazepam and diphenhydramine". Psychopharmacology. 135 (1): 27–36. doi:10.1007/s002130050482. PMID9489931. S2CID9872819.
^Drachman DA, Leavitt J (February 1974). "Human memory and the cholinergic system. A relationship to aging?". Archives of Neurology. 30 (2): 113–121. doi:10.1001/archneur.1974.00490320001001. PMID4359364.
^ abHasselmo ME, Wyble BP (December 1997). "Free recall and recognition in a network model of the hippocampus: simulating effects of scopolamine on human memory function". Behavioural Brain Research. 89 (1–2): 1–34. doi:10.1016/s0166-4328(97)00048-x. PMID9475612. S2CID584350.
^Ridley RM, Bowes PM, Baker HF, Crow TJ (1984). "An involvement of acetylcholine in object discrimination learning and memory in the marmoset". Neuropsychologia. 22 (3): 253–263. doi:10.1016/0028-3932(84)90073-3. PMID6431311. S2CID7110504.
^Flicker C, Serby M, Ferris SH (February 1990). "Scopolamine effects on memory, language, visuospatial praxis and psychomotor speed". Psychopharmacology. 100 (2): 243–250. doi:10.1007/bf02244414. PMID2305013. S2CID24645744.
^Lisboa SF, Vila-Verde C, Rosa J, Uliana DL, Stern CA, Bertoglio LJ, et al. (January 2019). "Tempering aversive/traumatic memories with cannabinoids: a review of evidence from animal and human studies". Psychopharmacology. 236 (1): 201–226. doi:10.1007/s00213-018-5127-x. PMID30604182. S2CID58655082.
^Hasselmann H (2014). "Scopolamine and depression: a role for muscarinic antagonism?". CNS & Neurological Disorders Drug Targets. 13 (4): 673–683. doi:10.2174/1871527313666140618105710. PMID24938776.
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