Scopolamine

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Scopolamine
L-Scopolamin.svg
Scopolamine3DanBS.gif
Systematic (IUPAC) name
(–)-(S)-3-Hydroxy-2-phenylpropionic acid (1R,2R,4S,7S,9S)-9-methyl-3-oxa-9-azatricyclo[3.3.1.02,4]non-7-yl ester
Clinical data
Trade names Transdermscop
AHFS/Drugs.com monograph
Pregnancy cat. B2 (AU) C (US)
Legal status Prescription Only (S4) (AU) -only (CA) POM (UK) -only (US)
Routes transdermal, ocular, oral, subcutaneous, intravenous, sublingual, rectal, buccal transmucousal, intramuscular
Pharmacokinetic data
Bioavailability 0.13-8% (Oral),[1][2] 3% (Rectal)[1]
Metabolism Hepatic (liver)[2]
Half-life 4.5 hours[3]
Excretion Renal[2]
Identifiers
CAS number 51-34-3 YesY
ATC code A04AD01 N05CM05, S01FA02
PubChem CID 5184
IUPHAR ligand 330
DrugBank DB00747
ChemSpider 10194106 YesY
UNII DL48G20X8X YesY
KEGG D00138 YesY
ChEBI CHEBI:16794 YesY
ChEMBL CHEMBL1201024 N
Chemical data
Formula C17H21NO4 
Mol. mass 303.353 g/mol
 N (what is this?)  (verify)

Scopolamine (USAN), hyoscine (BAN) also known as levo-duboisine or burundanga,[4] sold as Scopoderm, is a tropane alkaloid drug with muscarinic antagonist effects. It is among the secondary metabolites of plants from Solanaceae (nightshade) family of plants, such as henbane, jimson weed (Datura), angel's trumpets (Brugmansia), and corkwood (Duboisia).[5][6] Scopolamine exerts its effects by acting as a competitive antagonist at muscarinic acetylcholine receptors, specifically M1 receptors[citation needed]; it is thus classified as an anticholinergic, antimuscarinic drug. (See the article on the parasympathetic nervous system for details of this physiology.)

Its use in medicine is relatively limited, with its chief uses being in the treatment of motion sickness and postoperative nausea and vomiting.[2][7][8]

Scopolamine is named after the plant genus Scopolia.[6] The name "hyoscine" is from the scientific name for henbane, Hyoscyamus niger.[9]

Medical use[edit]

Scopolamine has a number of uses in medicine where it is used to treat:[10][11]

  • Postoperative nausea and vomiting and sea sickness, leading to its use by scuba divers.[12][13]
  • Motion sickness (where it is often applied as a transdermal patch behind the ear)
  • Gastrointestinal spasms
  • Renal or biliary spasms
  • Aid in GI radiology and endoscopy
  • Irritable bowel syndrome (IBS)
  • Clozapine-induced hypersalivation (drooling)
  • Bowel colic

and is sometimes used as a premedication (especially to reduce respiratory tract secretions) to surgery, mostly commonly via injection.[10][11]

Adverse effects[edit]

Adverse effect incidence:[1][2][7][8][14]

Uncommon (0.1%-1% incidence) adverse effects include
  • Dry mouth
  • Dyshidrosis (reduced ability to sweat to cool off)
  • Tachycardia (usually occurs at higher doses and is succeeded by bradycardia)
  • Bradycardia
  • Urticaria
  • Pruritus
Rare (<0.1% incidence) adverse effects include
  • Constipation
  • Urinary retention (being unable to urinate)
  • Hallucinations
  • Agitation
  • Confusion
  • Restlessness
  • Seizures
Unknown frequency adverse effects include
  • Anaphylactic shock
  • Anaphylactic reactions
  • Dyspnea (shortness of breath)
  • Rash
  • Erythema
  • Other hypersensitivity reactions
  • Blurred vision
  • Mydriasis
  • Drowsiness
  • Dizziness
  • Somnolence

Overdose[edit]

Physostigmine is an acetylcholinesterase inhibitor that readily crosses the blood-brain barrier, and has been used to treat the CNS depression symptoms of scopolamine overdose.[15] Other than this supportive treatment, gastric lavage and induced emesis (vomiting) are usually recommended as treatments for overdoses.[14] The symptoms of overdose include:[1][14]

  • Tachycardia
  • Arrhythmia
  • Blurred vision
  • Photophobia
  • Urinary retention
  • Drowsiness or paradoxical excitement which can present with hallucinations
  • Cheyne-Stokes respiration
  • Dry mouth
  • Skin reddening
  • Inhibition of gastrointestinal motility

Biosynthesis in plants[edit]

The steps of the biosynthesis of scopolamine are:

History[edit]

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 isolation by the German scientist Albert Ladenburg in 1880, 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 of and methods for total synthesis of scopolamine and/or 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 opioid analgesic, known as Dolatin and Demerol amongst many other trade names.

Scopolamine was used in conjunction with morphine, oxycodone, or other opioids from before 1900 into the 1960s to put mothers in labor into a kind of "twilight sleep". The analgesia from scopolamine plus a strong opioid is deep enough to allow higher doses to be used as a form of anaesthesia.

Scopolamine mixed with oxycodone (Eukodal) and ephedrine was marketed by Merck as SEE (from the German initials of the ingredients) and Scophedal starting in 1928, and the mixture is sometimes mixed on site on rare occasions in the area of its greatest historical usage, namely Germany and Central Europe.

Scopolamine was also one of the active ingredients in Asthmador, an over-the-counter (OTC) smoking preparation marketed in the 1950s and '60s claiming to combat asthma and bronchitis. In November 1990, the US Food and Drug Administration forced OTC products with scopolamine and several hundred other ingredients that had allegedly not been proved effective off the market. Scopolamine shared a small segment of the OTC sleeping pill market with diphenhydramine, phenyltoloxamine, pyrilamine, doxylamine, and other first-generation antihistamines, many of which are still used for this purpose in drugs such as Sominex, Tylenol PM, NyQuil, etc.

Methods of administration[edit]

Scopolamine can be administered orally, subcutaneously, ophthalmically and intravenously, as well as via a transdermal patch.[18] The transdermal patch (e.g., Transderm Scōp) for prevention of nausea and motion sickness employs scopolamine base, and is effective for up to three days.[19] The oral, ophthalmic, and intravenous forms have shorter half-lives and are usually found in the form scopolamine hydrobromide (for example in Scopace, soluble 0.4 mg tablets or Donnatal).

NASA is currently developing 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.[20]

Recreational use[edit]

While it is occasionally used recreationally for its hallucinogenic properties, the experiences are often mentally and physically extremely unpleasant, and frequently physically dangerous, so repeated use is rare.[21]

Scopolamine related hospitalizations[edit]

About one in five emergency room admissions for poisoning in Bogotá, Colombia, have been attributed to scopolamine.[4] In June 2008, more than 20 people were hospitalized with psychosis in Norway after ingesting counterfeit Rohypnol tablets containing scopolamine.[22]

Use in interrogation[edit]

The effects of scopolamine were studied by criminologists in the early 20th century.[23] In 2009, it was proved that Czechoslovak communist State Security secret police used scopolamine at least three times to obtain confessions from alleged anti-state conspirators.[24] Because of a number of undesirable side effects, scopolamine was shortly disqualified as a truth serum.[25]

Criminal use[edit]

In 1910, scopolamine was detected in the remains believed to be those of Cora Crippen, wife of Dr. Hawley Harvey Crippen, and was accepted at the time as the cause of her death, since her husband was known to have bought some at the start of the year.[26]

Per the United States State Department (March 4, 2012): "One common and particularly dangerous method that criminals use in order to rob a victim is through the use of drugs. The most common has been scopolamine. Unofficial estimates put the number of annual scopolamine incidents in Colombia at approximately 50,000. Scopolamine can render a victim unconscious for 24 hours or more. In large doses, it can cause respiratory failure and death. It 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. To avoid becoming a victim of scopolamine, one should never accept food or beverages offered by strangers or new acquaintances or leave food or beverages unattended. Victims of scopolamine or other drugs should seek immediate medical attention."[27]

Research as treatment for depression and anxiety[edit]

Scopolamine has been shown in multiple studies to be a potent antidepressant and anxiolytic medication. Two methods of administration have been studied. The first is in-patient sessions where the patients receive an intravenous infusion of a relatively large quantity of scopolamine during a session that lasts 1–2 hours. The patients are monitored during the infusion and released soon after as the effects wear-off quickly.[28] The second route of administration is oral scopolamine in a pill.

Intravenous infusions[edit]

In research assessing intravenous infusions, scopolamine has been found to produce rapid and robust antidepressant effects in patients with major depressive disorder.[29]

In another, randomized, double-blind, placebo-controlled study of intravenously infused scopolamine for patients with bipolar depression, it again showed rapid and robust antidepressant effects, as well as strong anti-anxiety effects.[28]

In November 2010, results of another experiment about the impacts of scopolamine infusions were reported, this time assessing the reductions in depression and anxiety for the two sexes and for unipolar vs. bipolar depression with and without co-morbid anxiety. The experiment followed a block design where all patients first received a placebo infusion and then were assessed as base-line (in order to capture some of the placebo effect in the base-line). They then received either three placebo infusions or three scopolamine infusions (block one) followed by the opposite treatment - three scopolamine infusions or three placebo infusions, respectively (block two). They were assessed after each infusion, and statistical inference was performed using the results at the end of each block. The infusions were very effective in reducing both anxiety (as measured by HAM-A) and depression (as measured by MADRS) for all groups - men, women, unipolar depressives, patients with biploar disorder, patients with and without co-morbid anxiety.[30]

For depression, the infusion treatment was especially effective for the women. Their results achieved statistical significance on each block even analyzed separately. For example, of the 16 women treated with scopolamine in block one, seven had a MADRS decrease of over 50% and six of them had complete remission, defined as a MADRS of less than 10. In contrast, of the 15 women receiving placebo infusions in block one, none of them achieved the 50% decrease or remission. The female group had a larger sample and a larger treatment effect than the male group - hence the statistical significance in each block separately. For men, 14 out of 21 patients had a decrease in MADRS of more than 25% during the study, and 9 had a decrease of over 50%. Six out of 21 had complete remission (although one of those six remissions occurred entirely during a placebo block). For men, both blocks needed to be analyzed in tandem in some way for statistical significance, but if so, the study-end treatment effect was statistically significant and very large (an average MADRS reduction of 14.0 with an average starting MADRS of 31.5). Over 40% of the men reduced MADRS by more than 50%, and 28% had full remission. The positive effects for the women were even larger. For example, over 70% of the women had a MADRS decrease of more than 50%, and well over half (58%) had total remission of their major depressive disorder.

For anxiety, the treatment effect (as measured by HAM-A) for the men was again positive (beneficial) and relatively large for each block, but was again too small to reach statistical significance with a sample of 21 if the blocks were considered as two separate experiments. As in the case of depression, combining the men's blocks yielded a treatment effect that was again statistically significant, but not as large as the men's depression treatment effect. The anxiety treatment effect had a greater difference between the men and women than the depression treatment effect had, with both effects being larger for the women. For example, for anxiety, the study-end results for men were a HAMS-A decrease from 17.7 to 11.7, and for the women, the average change was an impressive drop from 20.3 to 7.9.

Oral scopolamine[edit]

In a forty-patient, randomized, double-blind, placebo-controlled study of oral scopolamine as an augmentation to citalopram, adding oral scopolamine more than tripled the number of patients who achieved remission in 6 weeks (13 out of 20 vs. 4 out of 20; treatment group = citalopram and scopolamine, control group = citalopram and placebo; remission = HDRS score below 7). The experiment was performed in 2010. Study participants were diagnosed with major depressive disorder and had a minimum HDRS of 22.[31]

Based on the results, the researchers concluded that oral scopolamine-hydrobromide augmentation of 1 mg/day was a safe and effective adjunct for patients with moderate to severe major depressive disorder. A 2013 expert review of the same study was published in the journal "Expert Review of Neurotherapeutics". The reviewers agreed with the conclusion.[32]

References[edit]

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