Belladonna Alkaloids Research Articles

Exploring the History, Uses, and Dangers of Belladonna: Unveiling the Mysteries of the Deadly Nightshade

Belladonna (Atropa belladonna) is a plant with a rich history, renowned for its beauty and lethality. This review synthesizes existing literature to provide an overview of belladonna, covering its historical significance, medicinal uses, toxicity, regulatory status, and cultural references. Belladonna's alkaloids, such as atropine and scopolamine, have medicinal value but pose significant risks due to their high toxicity. Recent research explores their pharmacotherapeutic potential, yet controversies persist regarding their safety and regulation. Safety precautions are paramount due to the plant's extreme toxicity. This review underscores the need for informed decision-making and further research to navigate the complexities of belladonna's use in contemporary healthcare.

Medicinal importance of Atropa belladonna plant (tropane alkaloids) (Review)

The name Atropa is thought to have been derived from the Greek goddess Atropos while, meaning a beautiful lady. Belladonna has also been used over the past centuries to relax muscles, especially of the stomach and intestines, to help relieve intestinal colic, and to treat peptic ulcers. It also relaxes the urinary tract, removing spasms. The ancients used the plant to treat Parkinson's disease, as it works to reduce tremors and stiffness. Modern medicine proved that belladonna alkaloids inhibit the parasympathetic central nervous system that controls the various involuntary activities of the body. These alkaloids increase heartbeats. It has been shown that belladonna is a sedative used to remove the pain of diseases accompanied by bouts of muscle contractions.

Antiviral and anti-inflammatory activity of novel belladonna formulation against Japanese encephalitis virus via inhibition of p65 nuclear translocation and TNF-α mediated NF-kB signaling

ABSTRACT Japanese encephalitis (JE) is a mosquito-borne flavivirus infection, a major cause of viral encephalitis in South-East Asia with a CFR of ~30% and no specific treatment. Therefore, a novel belladonna formulation (BCT) was prepared and its antiviral and anti-inflammatory activity was elucidated during Japanese encephalitis virus (JEV) infection. Anti-JEV role of BCT was investigated aiming to prevent the infection in the peripheral immune cells. Antiviral activity of BCT was evaluated by plaque reduction assay, cell survival and apoptosis assay. BCT-mediated reduction in JEV-envelope expression was measured by indirect immunofluorescence, RT-PCR and Western blot assays. NF-κB expression and p65 nuclear translocation assays were determined to explore the mechanism of the action of BCT. TNF-α level was measured to evaluate the anti-inflammatory role of BCT during JEV infection. Consequently, molecular docking was performed with the TRAF2-TRADD complex. Our data suggested that BCT treatment reduces the JEV-plaque formation, JEV-induced cytopathic effects and increases cell survival. The antiviral effect of BCT was confirmed by reduction in the JEV-envelope protein expression. Moreover, BCT treatment and prevents the NF-κB activation via preventing the nuclear translocation of p65 and reduces the TNF-α levels. Our molecular docking analysis suggested that belladonna alkaloids interfere with the TRAF2-TRADD complex that results in inhibition of TNF-induced NF-κB signaling. For the first time, our data suggested that BCT reduces JEV expression and interferes with TNF-induced NF-κB signaling, thereby increasing cell survival via preventing the p65 nuclear translocation and may be used for the treatment and prevention of JE. Abbreviation: CFR: Case fatality rate; CAM: Complementary and alternative medicines; COX-2: Cyclooxygenase-2; IκB: Inhibitor kappa B; JE: Japanese encephalitis; JEV: Japanese encephalitis virus; NF-κB: Nuclear factor kappa-light-chain-enhancer of activated B cells; ORF: Open reading frame; TNFR: Tumor necrosis factor receptor; TNF-α: Tumor necrosis factor-α; TRADD: TNFR1-associated death domain protein; TRAF2: TNF Receptor Associated Factor 2.

Physostigmine: A Plant Alkaloid Isolated from Physostigma venenosum: A Review on Pharmacokinetics, Pharmacological and Toxicological Activities

Medicinal plants have been documented as an important source for discovering new pharmaceutical molecules that have been used to treat serious diseases. Strikingly, previous reports stated that natural products and their derived compounds exhibit lesser side effects and improved efficacy than other synthetic counterparts. Physostigmine, a parasympathomimetic plant alkaloid isolated from the West African perennial shrub Physostigma venenosum, it shows a narrow therapeutic index and a short life span, despite its ability to penetrate the blood-brain barrier (BBB). It is a widely known reversible butyrylcholinesterase (BuChE) and acetylcholinesterase (AChE) inhibitor and has been documented to treat various ailments such as Alzheimer’s disease. Pharmacologically, physostigmine was first reported as an antidote for atropine scopolamine and belladonna alkaloids toxicity. Recently, it has been documented as a therapy for treating several ailments including glaucoma, myasthenia gravis and the intoxication caused by tricyclic antidepressant overdoses, anti-histamines, antipsychotics, and benzodiazepines. Physostigmine has been reported to be absorbed from the gastrointestinal tract and showed short half-life, as, after the oral administration of 2 mg of physostigmine salicylate, the peak plasma concentration reached to 30 minutes. This review examines the biological activities, pharmacokinetics, and toxicity of physostigmine extracted from P. venenosum.
 Keywords: Physostigma venenosum, Physostigmine, pharmacological activities, acetylcholinesterase and butyrylcholinesterase inhibitor.

Anisodamine Ameliorates Hyperkalemia during Crush Syndrome through Estradiol-Induced Enhancement of Insulin Sensitivity.

Hyperkalemia is a major cause of on-site death in crush syndrome (CS), which is more severe and common in male victims. Anisodamine is a belladonna alkaloid and widely used in China for treatment of shock through activation of α7 nicotinic acetylcholine receptor (α7nAChR). The present work was designed to study the protective effect of anisodamine in CS and the possible role of estradiol involved. Male and ovariectomized female CS mice exhibited lower serum estradiol and insulin sensitivity, and higher potassium compared to the relative female controls at 6 h after decompression. There was no gender difference in on-site mortality in CS mice within 24 h after decompression. Serum estradiol increased with similar values in CS mice of both gender compared to that in normal mice. Anisodamine decreased serum potassium and increased serum estradiol and insulin sensitivity in CS mice, and methyllycaconitine, selective antagonist of α7nAChR, counteracted such effects of anisodamine. Treatment with anisodamine or estradiol increased serum estradiol and insulin sensitivity, decreased serum potassium and on-site mortality, and eliminated the difference in these parameters between CS mice received ovariectomy or its sham operation. Anisodamine could also increase blood pressure in CS rats within 3.5 h after decompression, which could also be attenuated by methyllycaconitine, without influences on heart rate. These results suggest that activation of α7nAChR with anisodamine could decrease serum potassium and on-site mortality in CS through estradiol-induced enhancement of insulin sensitivity.

Belladonna Alkaloids and Phenobarbital Use in the Treatment of Irritable Bowel Syndrome: A Review

Belladonna Alkaloids and Phenobarbital Use in the Treatment of Irritable Bowel Syndrome: A Review

Randomized controlled trial of belladonna and opiate suppository during intravesical onabotulinum toxin A injection

Intravesical injection with onabotulinum toxin A injection can be performed in-office under local anesthesia. Rectally administered pain medication presents a potentially feasible and previously uninvestigated adjunct to office-based anesthesia protocols. The primary aim of this study was to determine whether adding a belladonna and opiate suppository to standard lidocaine instillation resulted in reduction of bladder injection pain during onabotulinum toxin A injection procedure. This was a prospective, randomized, double-blind, placebo-controlled study of patients undergoing onabotulinum toxin A bladder injection at a single clinic. Patients age ≥18 years, who met clinical criteria for invasive treatment of refractory urinary symptoms, had previously documented postvoid residual volumes <150 mL, and elected for in-office intravesical onabotulinum toxin A injection were eligible to participate. Participants were randomized by computer-generated block randomization to receive a belladonna and opiate (belladonna alkaloid with morphine 16.2/7.5 mg) or placebo suppository. Suppositories were placed immediately prior to lidocaine-based anesthesia, which all participants received. All participants underwent a standardized injection procedure using the same rigid cystoscope, needle type, and injection pattern (20 injections total). A 0-10 numeric rating scale was used to assess pain intensity before anesthesia and suppository, 40 minutes after administration of anesthesia and suppository, after first 10 bladder injections, and immediately after completion of 20 injections. Pain increase during procedure was calculated using the difference between score 40 minutes after administration of anesthesia and suppository and score after first 10 bladder injections. Postvoid residual were measured immediately postprocedure and 2 weeks later. Patient satisfaction with pain control was measured using a Likert scale. Our primary outcome was change in pain level from anesthetic baseline to midprocedure (score after first 10 bladder injections to score 40 minutes after administration of anesthesia and suppository). A final sample size of 26 patients was needed to have 80% power (alpha= 0.05) to detect a 50% reduction in bladder injection pain during the procedure as defined by our primary outcome. An intent-to-treat approach was used for all analyses. In all, 26 participants were enrolled and randomized with 13 in each study arm. Participants in the treatment group were slightly older than in the placebo group (P= .05); there were no statistically significant differences in medical comorbidities. Median score after first 10 bladder injections to score 40 minutes after administration of anesthesia and suppository for the placebo group and treatment group was 4 (range 1-10) and 5 (range 0,9), respectively (P= .94). Median scores immediately after completion of 20 injections for the placebo group and treatment group were 3 (range 0-10) and 2 (range 0,8), respectively (P=.29). There were no significant differences in preinjection pain scores reported before anesthesia and suppository and at 40 minutes after administration of anesthesia and suppository. Postprocedure postvoid residual >200 mL was noted in 5 (38%) of the placebo group and 3 (23%) of the treatment group (P= .67). Two-week postprocedure postvoid residual >200 mL was noted in 3 (25%) of the placebo group and 2 (15%) of the treatment group (P= .64) for an overall rate of 20%. Eleven (84%) participants in each group reported being "mostly satisfied" or "very much satisfied" with pain control. Belladonna and opiate suppository use did not significantly reduce bladder injection pain, or increase risk of urinary retention immediately postprocedure or 2 weeks later. Satisfaction with pain control among onabotulinum toxin A injection patients is high.

15: Randomized controlled trial of belladonna and opiate suppository during intradetrusor onabotulinum toxin-A injection

Intradetrusor onabotulimun toxin A (BTX-A) injection can be performed in the doctor’s office under local anesthesia. We aimed to evaluate the effectiveness of belladonna and opiate (BO) suppository in adjunct to standard anesthesia for in-office BTX-A treatment. We hypothesized the addition of a BO suppository would reduce bladder injection pain. This was a prospective, randomized, double-blind, placebo-controlled study of patients undergoing BTX-A bladder injection at a single clinic. Participants were randomized by computer generated block randomization to receive a BO (belladonna alkaloid with morphine 16.2/7.5 mg) or placebo suppository. Suppositories were placed immediately prior to lidocaine-based anesthesia, which all participants received. All participants underwent a standardized injection procedure using the same rigid cystoscope, needle type, and injection pattern (20 injections total). Participants reported bladder pain using a 0-10 numeric rating scale. Pain scores were obtained before anesthesia and suppository (P0), 40 minutes after administration of anesthesia and suppository (PA), after first 10 bladder injections (P10), and immediately after completion of 20 injections (P20). Pain increase during procedure was calculated using the difference between PA and P10. Post void residuals (PVRs) were measured immediately post-procedure and two weeks later. Patient satisfaction with pain control was measured using a Likert scale. Our primary outcome was change in pain level from anesthetic baseline to mid-procedure (P10-PA). Secondary outcomes were PVR >200 mL and satisfaction with pain control. A needed sample size of 26 was calculated in order to detect a 50% difference in P10-PA with 80% power. Categorical variables and median pain scores were compared using Fisher’s exact and Kruskal-Wallis tests, respectively. An intent-to-treat approach was used for all analyses. Twenty-six participants were enrolled and randomized with 13 in each study arm. One participant was lost to follow-up. There were no statistically significant differences in demographic variables or medical comorbidities between the groups. Median P10-PA for the placebo group and treatment group was 4 (range, 1-10) and 5 (range, 0-9), respectively (p = 0.94). Median P20 scores for the placebo group and treatment group were 3 (range, 0-10) and 2 (range, 0-8), respectively (p = 0.29). There were no significant differences in pre-injection pain scores reported at P0 and PA. Post-procedure PVR >200 mL was noted in 5 (38%) of the placebo group and 3 (23%) of the treatment group (p = 0.67). Two-week post-procedure PVR >200 mL was noted in 3 (25%) of the placebo group and 2 (15%) of the treatment group (p = 0.64) for an overall rate of 20%. Eleven (84%) participants in each group reported being “mostly satisfied” or “very much satisfied” with pain control. Addition of BO suppository to standard lidocaine-based anesthesia provided no added benefit to significantly reduce bladder injection pain. Suppository use did not increase risk of urinary retention immediately post-procedure or two weeks later. Satisfaction with pain control among BTX-A injection patients is high.

A 200-year history of Parkinson's disease

In 1817, Dr. James Parkinson firstly described the concept, duration, and clinical characteristics of (PD). However, it was widely known until 1877 when it was named Parkinson's disease by Dr. Jean-Martin Charcot. In 1912, Frederic Henry Lewy, a neuropathologist, found a special abnormal protein in nerve cells of PD patients. Medical profession began to learn about the pathology of PD only when Konstantin Tretiakoff named the special abnormal protein body (LB) in 1919 and believed the main lesion of PD was in substantia nigra. In 1867, the German psychiatrist Leopold Ordenstein found that PD patients had symptoms of excitement of parasympathetic nerve, such as salivation, and treated them with belladonna alkaloids, thus creating a precedent for medical treatment of PD. After 1950's, the researchers gradually found that Lewy body was common in substantia nigra and locus coeruleus of PD patients and then gradually determined the pathological features of PD. The Swedish scientist Arvid Carlsson and Japanese neurologist Isamu Sano found dopamine abnormalities in the brain of PD patients, and thus researched and developed levodopa. PD has a history of 200 years, and we expect new research of PD studies. DOI: 10.3969/j.issn.1672-6731.2017.01.002

Datura poisoning, clinical and laboratory findings. Report of five cases

Introduction. Plants of Datura species contain belladonna alkaloids that can cause central and peripheral anticholinergic effects. Abuse of Datura plants for their hallucinogenic effects is growing among adolescents and young adults. Datura poisoning has caused a diagnostic challenge in medical emergency wards. In this article we report 5 cases of Datura toxicity at Clinical Toxicology Emergency of Baharloo Hospital, Tehran, Iran during Summer-Fall 2015, and discuss their clinical presentations and laboratory findings. Cases Description. All 5 cases with Datura toxicity were young males and had intentionally used the plants. Mean duration of hospitalization was 3.2 days. ree cases were multiple drug abusers. Mydriasis, tachycardia, tachypnea and ushing alongside with psychotic-like signs and symptoms were observed in all cases. Elevation of liver enzymes was present in three of cases but without clinical signi cance. Raised LDH or CPK in four patients were without myoglubinuria and evidence of rhabdomyolysis and these biomarkers returned to normal by supportive care. All patients discharged with complete recovery and there was no need to ICU admission. Discussion. With the absence of routine laboratory screening tests for alkaloids and complex and confusing presentations of Datura intoxication, diagnosis of such cases is difficult. Physicians' clinical suspicion and su cient knowledge plays the mainstay role in appropriate and timely diagnosis and management of cases with Datura toxicity. Since regulatory legislation wouldn't be successful in halting the availability of natural plants, the best strategy to prevent Datura abuse is informing people about the adverse e ects of these plants. Key Words: datura stramonium, poisoning, abuse, anticholinergic, laboratory ndings, liver function tests, rhabdomyolysis. Language: en

Possible role for anisodamine in organophosphate poisoning.

In cases of organophosphate poisoning, patients are treated with a combination of antidotes. In addition to these poison-directed antidotes, patients may require extra oxygen and artificial ventilation; other modalities may also be needed due to the wide range of toxic effects. Anisodamine is a belladonna alkaloid, and like other drugs from this family is non subtype-selective muscarinic, and a nicotinic cholinoceptor antagonist, which has been employed in traditional Chinese medicine. As a muscarinic antagonist, it displays similar pharmacological effects to atropine and scopolamine. However, anisodamine is not only less potent than atropine and scopolamine but also less toxic. Current in vitro and animal model studies have demonstrated that anisodamine has protective effects in a variety of diseases. Organophosphate poisoning involves not only the central and peripheral nervous systems, but also the cardiac and respiratory systems, as well as activation of inflammatory processes and oxidative stress. Therefore, the anticholinergic and additional activities of anisodamine appear to be relevant and justify its consideration as an addition to the existing remedies. However, more research is needed, as at present data on the role of anisodamine in the management of organophosphate poisoning are limited. Here, we review the beneficial effects of anisodamine on processes relevant to organophosphate poisoning.

Belladonna Alkaloid Intoxication

The belladonna alkaloids can be isolated from a number of plants, which contain hallucinogens that represent a serious danger to infants, children, and adolescents. Roots, leaves, and fruits of the plant contain the alkaloids atropine, hyoscyamine, and scopolamine, which can lead to an anticholinergic toxidrome; however, not all characteristics of the toxidrome are necessarily present in each case of poisoning. A retrospective chart review of all children seen following anticholinergic ingestions, between April 2001 and November 2010, at the Hospital for Sick Children in Toronto. Ten children, with a mean age of 15.5 years (range, 15-18 years), were identified; 5 had used jimsonweed and the others had a variety of tablets containing atropine. All 10 presented with severe anticholinergic symptoms and 2 with suicide attempts. Treatments included charcoal, benzodiazepines, haloperidol, and physostigmine, and 2 patients were intubated. Ingestion and subsequent severe anticholinergic toxidrome occurred exclusively in adolescents. It is important to educate this age group regarding the toxicity and potential risks associated with the recreational use of these plants and substances. Physostigmine can help in both the diagnosis and management of patients intoxicated with these substances.

Cardioprotective Effect of Anisodamine Against Myocardial Ischemia Injury and its Influence on Cardiomyocytes Apoptosis.

Anisodamine is an ancient Chinese medicine derived from Tibet as a belladonna alkaloid, which is usually used for improvement of blood circulation in patients with organ phosphorus poisoning or shock. In this study, for the first time, we report its cardioprotective effects on preventing ischemia/reperfusion (I/R) injury of patients with acute myocardial infarction (AMI), and decreasing the myocardial infarction area and severity in heart of Sprague-Dawley (SD) rats. Our results suggest a potential molecular mechanism of anisodamine against the I/R injury in cardiomyocytes is associated with its anti-apoptotic effect. Anisodamine treatment decreases the expression of caspase-3 and caspase-8, and increases Bcl-2/Bax ratio in cardiomyocytes. Our data suggest that anisodamine can provide significant cardioprotection against I/R injury, potentially through the suppression of cardiomyocytes apoptosis.

Anticholinergic Syndrome Due to Suicidal Intake of Datura Stramonium: A Case Report

Introduction: Datura stramonium is a member of the Belladonna alkaloid family. It contains atropine and can cause anticholinergic symptoms. Datura stramonium intoxications in the literature often occur as side effects of an alternative medicine method. In our case, the patient researched and used it with the aim of suicide.Case Report: A 38-year-old patient was brought to the emergency department with confusion, muscle contractions, and hallucinations. The patient’s relatives informed us he had eaten seeds of a plant 8 hours before he arrived to the hospital, and his complaints had started 5 to 6 hours after he had eaten the seeds. He was an old boxer and he looked like he was fighting against an imaginary opponent with the face off with both arms. His pupils were mydriatic, the mucosal membranes and his tongue were dry, his bowel sounds were decreased, and his eyes were red. We had learned that the seeds were datura stramonium seeds. We administered physostigmine. Patient consciousness recovered after physostigmine. Patient was discharged after follow-up.Conclusion: Patients who are admitted to emergency services with anticholinergic toxidrome should be kept in mind about plants like datura stramonium which is commonly used for alternative medicine and emergent appropriate therapy should started early

The effect of transdermal scopolamine for the prevention of postoperative nausea and vomiting.

Postoperative nausea and vomiting (PONV) is one of the most common and undesirable complaints recorded in as many as 70–80% of high-risk surgical patients. The current prophylactic therapy recommendations for PONV management stated in the Society of Ambulatory Anesthesia (SAMBA) guidelines should start with monotherapy and patients at moderate to high risk, a combination of antiemetic medication should be considered. Consequently, if rescue medication is required, the antiemetic drug chosen should be from a different therapeutic class and administration mode than the drug used for prophylaxis. The guidelines restrict the use of dexamethasone, transdermal scopolamine, aprepitant, and palonosetron as rescue medication 6 h after surgery. In an effort to find a safer and reliable therapy for PONV, new drugs with antiemetic properties and minimal side effects are needed, and scopolamine may be considered an effective alternative. Scopolamine is a belladonna alkaloid, α-(hydroxymethyl) benzene acetic acid 9-methyl-3-oxa-9-azatricyclo non-7-yl ester, acting as a non-selective muscarinic antagonist and producing both peripheral antimuscarinic and central sedative, antiemetic, and amnestic effects. The empirical formula is C17H21NO4 and its structural formula is a tertiary amine L-(2)-scopolamine (tropic acid ester with scopine; MW = 303.4). Scopolamine became the first drug commercially available as a transdermal therapeutic system used for extended continuous drug delivery during 72 h. Clinical trials with transdermal scopolamine have consistently demonstrated its safety and efficacy in PONV. Thus, scopolamine is a promising candidate for the management of PONV in adults as a first line monotherapy or in combination with other drugs. In addition, transdermal scopolamine might be helpful in preventing postoperative discharge nausea and vomiting owing to its long-lasting clinical effects.

Delirium Due to Datura stramoniun Ingestion: A Case Report

Introduction: Datura stramonium, known as devils apple or tatula by Turkish people. It is a plant known as a member of belladonna alkaloid family contains atropine, hyoscyamine and scopolamine that are having hallucinogenic and anticholinergic effects. In our study we described a case presented by delirium to our emergency department with later diagnosed as Datura stramonium poisoning. Presentation of Case: 19 years old male patient admitted to our emergency department by his relatives with the complaints of altered mental status, yelling, and meaningless speech. He was conscious at the time of admission but place, time and person orientation was altered with no cooperation. Ten mg midazolam was administrated intravenously to the patient because he was further harm caused by him to himself and environment. After further monitorisation for 8 hours patient were discharged safely. Discussion and Conclusion: Herbal wealth of Turkey is widespread. Turkish people are traditionally more prone to usage of herbal medicine. Also drug abuse is a growing problem in the country. Case Study Yilmaz et al.; AIR, Article no. AIR.2014.10.001 524

Effects of Atropa belladonna as an Anti-Cholinergic

Atropa belladonna, commonly known as ‘deadly nightshade’ or ‘Belladonna’ is known to be extremely toxic. The toxicity is caused by the alkaloids atropine, scopolamine and hyoscyamine which are produced in the plant. The alkaloids present in Atropa belladonna have toxic anti-cholinergic effects on the body. The anti-cholinergic toxidrome affects both central and peripheral nervous system, causing acute delirium, hallucination, tachycardia, dry mouth, flushed skin, vomiting and blurry vision. Both medicinal and toxic anti-cholinergic effects produced by Atropa belladonna alkaloids atropine, scopolamine and hyoscyamine on central and peripheral nervous system are discussed in this study.

Temporary diplopia upon hyoscine-N-butyl bromide administration: case report

Hyoscine-N-butyl bromide is a widely used antispasmodic belonging to the belladonna alkaloid class of semisynthetic quaternary ammonium compounds. These compounds exert a spasmolytic action on the smooth muscles of the bile-gastrointestinal tract, genitourinary tract, salivary glands (xerostomia), and also on the visual apparatus - in particular, the irido-ciliary complex. As a consequence, they provoke collateral effects such as mydriasis and accommodation disturbances. We report the case of a 23-year-old woman who complained of not only “dry mouth” but also “cloudy vision” and a “diplopia”, both of temporary type, 2 hours after oral administration of hyoscine-N-butyl bromide.

Rational formulation design

To be efficacious and to satisfy the requirements for claim substantiation, a cosmetic formulation must achieve effective targeting of an active in the skin. Although the basic principles governing the skin permeation and disposition of molecules have been known for many years, attention has been far less focused on the role of the vehicle, particularly at cosmetically relevant doses. In this article, we discuss the necessity to understand the fate of the formulation components as well as the active once applied onto skin. Recent data confirm that the residence time of the formulation constituents can have a profound impact on the fate of the active. Approaches to identify the ideal vehicle for skin delivery are considered critically, specifically the recent work on 'formulating for efficacy' (FFE) by the late Johann Wiechers. Essentially, FFE aims to match the active with the optimal vehicle for skin delivery based on matching polarity/solubility values of the trinity of skin, active and vehicle. The emerging importance of techniques that provide insight to how the vehicle distributes in and on skin is highlighted.

Studying the Effectiveness of Triple Therapy with Scopolamine, Ondansetron and Dexamethasone for Prevention of Post Operative Nausea and Vomiting in High Risk Patients Undergoing Neurological Surgery and General Anesthesia

Post operative nausea and vomiting (PONV) are common complications and occurs in as many as 70%- 80% of high risk surgical patients. The latest prophylactic treatment recommended in the Society of Ambulatory Anesthesia Guidelines (SAMBA) for the management of Post operative Nausea and Vomiting for high risk patients is a combination of 2 or more interventions (multimodal therapy). A combination of a 5-HT3 receptor antagonist with Dexamethasone and/or Droperidol, or a 5-HT3 receptor antagonist with Droperidol alone, or Dexamethasone with Droperidol, have been the pharmacologic combination therapies suggested in these guidelines. Scopolamine “Transdermal Scop” is a belladonna alkaloid with anticholinergic properties. It acts as a nonselective muscarinic antagonist, approved by the FDA for PONV prophylaxis. The use of this novel drug in a triple therapy combination with Dexamethasone and/or Droperidol could be an effective treatment for the prevention of PONV. However, since the FDA issued a warning stating that Droperidol may cause life – threatening arrhythmias as well as a prolongation of the QTc interval, the need to discover new combination therapies for PONV prevention in high risk patients is still in demand. Therefore, we hypothesize that the use of a triple prophylactic therapy consisting of Scopolamine, Dexamethasone, and Ondansetron will be an effective treatment for the prevention of PONV in patients at a high risk for developing PONV during the first 120 hours after neurosurgery.