Scopolamine, also known as hyoscine, or Devil's Breath, is a muscarinic antagonist and tropane alkaloid used to treat motion sickness and postoperative nausea and vomiting. It is also sometimes used before surgery to decrease saliva. When used by injection, effects begin after about 20 minutes and last for up to 8 hours. It may also be used orally and as a transdermal patch since it has been long known to have transdermal bioavailability. Scopolamine is in the muscarinic acetylcholine antagonist group of drugs and works by blocking the binding of acetylcholine within the central nervous system and peripheral tissues. Scopolamine was first written about in 1881 and started to be used for anesthesia around 1900. Scopolamine is also the main active component produced by certain plants of the nightshade family, which historically have been used as psychoactive drugs, known as deliriants, due to their antimuscarinic-induced hallucinogenic effects in higher doses. In these contexts, its mind-altering effects have been utilized for recreational and occult purposes. The name scopolamine is derived from one type of nightshade known as Scopolia, while the name hyoscine is derived from another type known as Hyoscyamus niger, or black henbane. It is on the World Health Organization's List of Essential Medicines.
Medical uses Scopolamine has a number of formal uses in modern medicine where it is used in its isolated form and in low doses to treat:
Postoperative nausea and vomiting Motion sickness, including sea sickness, leading to its use by scuba divers (where it is often applied as a transdermal patch behind the ear) Gastrointestinal spasms Kidney or liver spasms Aid in gastrointestinal radiology and endoscopy Adjunct Nerve agent countermeasure Irritable bowel syndrome Clozapine-induced drooling Bowel colic Eye inflammation It is sometimes used as a premedication, especially to reduce respiratory tract secretions in surgery, most commonly by injection. Common side effects include sleepiness, blurred vision, dilated pupils, and dry mouth. It is not recommended in people with angle-closure glaucoma or bowel obstruction. Whether its use during pregnancy is safe remains unclear, and use during breastfeeding is still cautioned by health professionals and manufacturers of the drug. Scopolamine can be taken by mouth, subcutaneously, in the eye, and intravenously, as well as via a transdermal patch.
Breastfeeding Scopolamine enters breast milk by secretion. 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.
Adverse effects Adverse effect incidence: Uncommon (0.1–1% incidence) adverse effects include:
Dry mouth Anhidrosis (reduced ability to sweat to cool off) Tachycardia (usually occurs at higher doses and is succeeded by bradycardia) Bradycardia Urticaria (hives) Pruritus (itching)
Rare (<0.1% incidence) adverse effects include:
Constipation Urinary retention Hallucinations Agitation Delirium Restlessness Seizures
Unknown frequency adverse effects include:
Anaphylactic shock or reactions Dyspnea (shortness of breath) Rash Erythema Other hypersensitivity reactions Blurred vision Mydriasis (dilated pupils) Drowsiness Dizziness Somnolence
Overdose Physostigmine, a cholinergic drug that readily crosses the blood–brain barrier, has been used as an antidote to treat the central nervous system depression symptoms of a scopolamine overdose. Other than this supportive treatment, gastric lavage and induced emesis (vomiting) are usually recommended as treatments for oral overdoses. The symptoms of overdose include:
Tachycardia Arrhythmia Blurred vision Photophobia Urinary retention Drowsiness or paradoxical reaction, which can present with hallucinations Cheyne–Stokes respiration Dry mouth Skin reddening Inhibition of gastrointestinal motility
Pharmacology
Pharmacodynamics 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. In doses higher than intended for medicinal use, the hallucinogenic alteration of consciousness, as well as the delirium 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 associated solely with the antagonism of postsynaptic M1 receptors; currently no other receptor subtypes have been implicated. 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. 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. 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.
Pharmacokinetics Scopolamine undergoes first-pass metabolism and about 2.6% is excreted unchanged in urine. It has a bioavailability of 20–40%, reaches peak plasma concentration in about 45 minutes, and in healthy subjects has an average half-life of 5 hours (observed range 2–10 hours). Scopolamine is primarily metabolized by the CYP3A4 enzyme, and grapefruit juice decreases metabolism of scopolamine, consequently increasing plasma concentration.
Chemistry
Biosynthesis in plants Scopolamine is among the secondary metabolites of plants from the Solanaceae (nightshade) family of plants, including henbane (Hyoscyamus niger), jimson weed (Datura), angel's trumpets (Brugmansia), deadly nightshade (Belladonna), mandrake (Mandragora officinarum), and corkwood (Duboisia).
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