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Dornbierer DA, Marten L, Mueller J, Aicher HD, Mueller MJ, Boxler M, Kometer M, Kosanic D, von Rotz R, Puchkov M, Kraemer T, Landolt HP, Seifritz E, Scheidegger M. Overcoming the clinical challenges of traditional ayahuasca: a first-in-human trial exploring novel routes of administration of N,N-Dimethyltryptamine and harmine. Front Pharmacol 2023; 14:1246892. [PMID: 38089057 PMCID: PMC10711279 DOI: 10.3389/fphar.2023.1246892] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/10/2023] [Indexed: 04/19/2024] Open
Abstract
Recently, the Amazonian plant medicine "ayahuasca"-containing the psychedelic compound N,N-dimethyltryptamine (DMT) and numerous β-carboline alkaloids, such as harmine-has been suggested to exhibit beneficial effects in patients with affective and other mental health disorders. Although ayahuasca ingestion is considered safe, its pharmacokinetics/pharmacodynamics and tolerability profile pose some challenges and may limit the clinical applicability in vulnerable patient populations. While overdosing and the admixture of intolerable plant constituents may explain some of the common adverse reactions, the peroral route of administration may represent another relevant source of gastro-intestinal intolerabilities and unpredictable pharmacokinetics across users. To overcome these challenges, the present work aimed at creating ayahuasca-analogue formulations with improved pharmacokinetics and tolerability profiles. To this end, we developed peroral formulas and compared them with parenteral formulas specifically designed to circumvent the gastro-intestinal tract. In more detail, peroral administration of a capsule (containing purified DMT and harmine) was tested against a combined administration of an oromucosal harmine tablet and an intranasal DMT spray at two dose levels in an open-label within-subject study in 10 healthy male subjects. Pharmacokinetic and pharmacodynamic profiles were assessed by means of continuous blood sampling, vital sign monitoring, and psychometric assessments. Common side effects induced by traditional herbal ayahuasca such as nausea, vomiting, and diarrhea were significantly attenuated by our DMT/harmine formulations. While all preparations were well tolerated, the combined buccal/intranasal administration of harmine and DMT yielded substantially improved pharmacokinetic profiles, indicated by significantly reduced variations in systemic exposure. In conclusion, the combined buccal/intranasal administration of harmine and DMT is an innovative approach that may pave the way towards a safe, rapid-acting, and patient-oriented administration of DMT/harmine for the treatment of affective disorders. Clinical Trial Registration: clinicaltrials.gov, identifier NCT04716335.
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Affiliation(s)
- Dario A. Dornbierer
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Laurenz Marten
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Department of Chemistry and Applied Biosciences, Zurich, Switzerland
| | - Jovin Mueller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Helena D. Aicher
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Michael J. Mueller
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
- Department of Health Science & Technology, Zurich, Switzerland
| | - Martina Boxler
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | | | - Robin von Rotz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Maxim Puchkov
- Institute of Pharmaceutical Technology, University of Basel, Basel, Switzerland
| | - Thomas Kraemer
- Department of Forensic Pharmacology and Toxicology, Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | - Hans-Peter Landolt
- Institute of Pharmacology and Toxicology, University of Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
| | - Milan Scheidegger
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland
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Ruffell S, Netzband N, Bird C, Young AH, Juruena MF. The pharmacological interaction of compounds in ayahuasca: a systematic review. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:646-656. [PMID: 32638916 PMCID: PMC7678905 DOI: 10.1590/1516-4446-2020-0884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/06/2020] [Indexed: 02/08/2023]
Abstract
Ayahuasca is a South American psychoactive plant brew used as traditional medicine in spiritual and in cultural rituals. This is a review of the current understanding about the pharmacological mechanisms that may be interacting in ayahuasca. Searches were performed using PubMed, PsycINFO, and Web of Science databases and 16 papers were selected. As hypothesized, the primary narrative in existing research revolved around prevention of deamination of N,N-dimethyltryptamine (N,N-DMT, also referred to as DMT) by monoamine oxidase inhibitors (MAOIs) in ayahuasca. Two of the constituents, DMT and harmine, have been studied more than the secondary harmala alkaloids. At present, it is unclear whether the pharmacological interactions in ayahuasca act synergistically or additively to produce psychoactive drug effects. The included studies suggest that our current understanding of the preparation's synergistic mechanisms is limited and that more complex processes may be involved; there is not yet enough data to determine any potential synergistic interaction between the known compounds in ayahuasca. Our pharmacological understanding of its compounds must be increased to avoid the potential risks of ayahuasca use.
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Affiliation(s)
- Simon Ruffell
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Correspondence: Mario F. Juruena, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Room M3.24, PO72 De Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail:
| | - Nige Netzband
- University of the West of England, Bristol, UK
- Correspondence: Mario F. Juruena, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Room M3.24, PO72 De Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail:
| | - Catherine Bird
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Allan H. Young
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mario F. Juruena
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Correspondence: Mario F. Juruena, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Room M3.24, PO72 De Crespigny Park, Denmark Hill, London SE5 8AF, UK. E-mail:
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Brito-da-Costa AM, Dias-da-Silva D, Gomes NGM, Dinis-Oliveira RJ, Madureira-Carvalho Á. Toxicokinetics and Toxicodynamics of Ayahuasca Alkaloids N, N-Dimethyltryptamine (DMT), Harmine, Harmaline and Tetrahydroharmine: Clinical and Forensic Impact. Pharmaceuticals (Basel) 2020; 13:ph13110334. [PMID: 33114119 PMCID: PMC7690791 DOI: 10.3390/ph13110334] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 12/11/2022] Open
Abstract
Ayahuasca is a hallucinogenic botanical beverage originally used by indigenous Amazonian tribes in religious ceremonies and therapeutic practices. While ethnobotanical surveys still indicate its spiritual and medicinal uses, consumption of ayahuasca has been progressively related with a recreational purpose, particularly in Western societies. The ayahuasca aqueous concoction is typically prepared from the leaves of the N,N-dimethyltryptamine (DMT)-containing Psychotria viridis, and the stem and bark of Banisteriopsis caapi, the plant source of harmala alkaloids. Herein, the toxicokinetics and toxicodynamics of the psychoactive DMT and harmala alkaloids harmine, harmaline and tetrahydroharmine, are comprehensively covered, particularly emphasizing the psychological, physiological, and toxic effects deriving from their concomitant intake. Potential therapeutic utility, particularly in mental and psychiatric disorders, and forensic aspects of DMT and ayahuasca are also reviewed and discussed. Following administration of ayahuasca, DMT is rapidly absorbed and distributed. Harmala alkaloids act as potent inhibitors of monoamine oxidase A (MAO-A), preventing extensive first-pass degradation of DMT into 3-indole-acetic acid (3-IAA), and enabling sufficient amounts of DMT to reach the brain. DMT has affinity for a variety of serotonergic and non-serotonergic receptors, though its psychotropic effects are mainly related with the activation of serotonin receptors type 2A (5-HT2A). Mildly to rarely severe psychedelic adverse effects are reported for ayahuasca or its alkaloids individually, but abuse does not lead to dependence or tolerance. For a long time, the evidence has pointed to potential psychotherapeutic benefits in the treatment of depression, anxiety, and substance abuse disorders; and although misuse of ayahuasca has been diverting attention away from such clinical potential, research onto its therapeutic effects has now strongly resurged.
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Affiliation(s)
- Andreia Machado Brito-da-Costa
- Department of Sciences, IINFACTS-Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (A.M.B.-d.-C.); (N.G.M.G.); (Á.M.-C.)
| | - Diana Dias-da-Silva
- Department of Sciences, IINFACTS-Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (A.M.B.-d.-C.); (N.G.M.G.); (Á.M.-C.)
- UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Correspondence: (D.D.-d.-S.); (R.J.D.-O.); Tel.: +351-224-157-216 (R.J.D.-O.)
| | - Nelson G. M. Gomes
- Department of Sciences, IINFACTS-Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (A.M.B.-d.-C.); (N.G.M.G.); (Á.M.-C.)
- LAQV-REQUIMTE, Laboratory of Pharmacognosy, Department of Chemistry, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- Department of Sciences, IINFACTS-Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (A.M.B.-d.-C.); (N.G.M.G.); (Á.M.-C.)
- UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
- Correspondence: (D.D.-d.-S.); (R.J.D.-O.); Tel.: +351-224-157-216 (R.J.D.-O.)
| | - Áurea Madureira-Carvalho
- Department of Sciences, IINFACTS-Institute of Research and Advanced Training in Health Sciences and Technologies, University Institute of Health Sciences (IUCS), CESPU, CRL, 4585-116 Gandra, Portugal; (A.M.B.-d.-C.); (N.G.M.G.); (Á.M.-C.)
- LAQV-REQUIMTE, Laboratory of Pharmacognosy, Department of Chemistry, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
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Tavares L, Monedeiro F, Bordin DM, De Martinis BS. Investigation of Ayahuasca β-Carboline Alkaloids and Tryptamine in Sweat Samples from Religious Community Participants by GC-MS. J Anal Toxicol 2020; 44:601-609. [PMID: 32103256 DOI: 10.1093/jat/bkz116] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/05/2019] [Accepted: 11/20/2019] [Indexed: 11/14/2022] Open
Abstract
Ayahuasca, a hallucinogenic beverage used in religious rituals in South America, has become a global phenomenon. Its main active components are the β-carbolines alkaloids, harmine (HRM) and harmaline (HRL), as well as the potent hallucinogen N,N-dimethyltryptamine (DMT). Despite its rising consumption, information regarding possible clinical applications and toxicological effects of ayahuasca is still limited. This study presents the first investigation of the use of sweat for the determination of DMT, HRM and HRL in ayahuasca users during a religious ritual. Sweat is an alternative matrix with advantages over many conventional biological samples, mainly because the collection procedure is non-invasive, easy and simple and samples can be collected without disturbing the religious ritual. In the study, solid-phase extraction was performed under basic conditions. Linearity was observed ranging from 20 to 1500 ng/patch with coefficients of determination (R2) higher than 0.99 for all analytes. The results indicated high selectivity for all investigated analytes, with extraction efficiency exceeding 70%, accuracy ranging from 87.5 to 102.4%, intra-assay precision of 1.85-9.44% and inter-assay precision between 3.34 and 9.85%. The limits of detection were 15 ng/patch for HRM and HRL and 10 ng/patch for DMT. The sweat proved to be a viable option to monitor ayahuasca use.
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Affiliation(s)
- Lidiane Tavares
- Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, 3900 Av. Bandeirantes, SP 14050-140, Ribeirão Preto, Brazil
| | - Fernanda Monedeiro
- Department of Chemistry, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, 3900 Av. Bandeirantes, SP 14050-140, Ribeirão Preto, Brazil
| | - Dayanne Mozaner Bordin
- Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, 3900 Av. Bandeirantes, SP 14050-140, Ribeirão Preto, Brazil.,School of Mathematical and Physical Sciences, University of Technology Sydney, 15 Broadway, NSW 2007, Ultimo, Australia
| | - Bruno Spinosa De Martinis
- Department of Chemistry, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto, University of São Paulo, 3900 Av. Bandeirantes, SP 14050-140, Ribeirão Preto, Brazil
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Kaasik H, Souza RCZ, Zandonadi FS, Tófoli LF, Sussulini A. Chemical Composition of Traditional and Analog Ayahuasca. J Psychoactive Drugs 2020; 53:65-75. [PMID: 32896230 DOI: 10.1080/02791072.2020.1815911] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Traditional ayahuasca can be defined as a brew made from Amazonian vine Banisteriopsis caapi and Amazonian admixture plants. Ayahuasca is used by indigenous groups in Amazonia, as a sacrament in syncretic Brazilian religions, and in healing and spiritual ceremonies internationally. The study aimed to determine concentrations of the main bio- and psychoactive components of ayahuasca used in different locations and traditions. We collected 102 samples of brews from ayahuasca-using communities. Concentrations of N,N-dimethyltryptamine (DMT), tetrahydroharmine, harmine, and harmaline were determined by ultra-high performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). Qualitative analyses for non-traditional additives (moclobemide, psilocin, yuremamine) were performed by high resolution mass spectrometry. Higher and more variable concentrations of DMT in neoshamanic ayahuasca samples compared to indigenous samples may indicate use of higher and more variable proportions of DMT-containing admixture plants. From European samples, we found two related samples of analog ayahuasca containing moclobemide, psilocin, DMT, yuremamine, and very low concentrations of B. caapi alkaloids. Some analogs of ayahuasca (Peganum harmala, Mimosa tenuiflora) were used in Europe. No analogs were found from Brazil or Santo Daime ceremonies in Europe. We recommend awareness about the constituents of the brew and ethical self-regulation among practitioners of ayahuasca ceremonies.
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Affiliation(s)
- Helle Kaasik
- School of Theology and Religious Studies; and Institute of Physics, University of Tartu, Tartu, Estonia
| | - Rita C Z Souza
- Laboratory of Bioanalytics and Integrated Omics (LaBIOmics), Institute of Chemistry, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Flávia S Zandonadi
- Laboratory of Bioanalytics and Integrated Omics (LaBIOmics), Institute of Chemistry, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luís Fernando Tófoli
- Interdisciplinary Cooperation for Ayahuasca Research and Outreach (ICARO), School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Alessandra Sussulini
- Laboratory of Bioanalytics and Integrated Omics (LaBIOmics), Institute of Chemistry, University of Campinas (UNICAMP), Campinas, SP, Brazil
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Kaasik H, Kreegipuu K. Ayahuasca Users in Estonia: Ceremonial Practices, Subjective Long-Term Effects, Mental Health, and Quality of Life. J Psychoactive Drugs 2020; 52:255-263. [PMID: 32299306 DOI: 10.1080/02791072.2020.1748773] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study aims to describe ayahuasca users in Estonia and compare their mental health and quality of life to those of nonusers. Ceremonial practices, motivation for ayahuasca use, use-related experiences, and subjective consequences of use are described. We conducted a cross-sectional case-controlled study of thirty ayahuasca users and thirty nonusers matched by gender, age, and education. The participants completed questionnaires, standardized psychometric tests, and neuropsychiatric interviews. Ayahuasca use in Estonia occurred mainly in (neo)shamanic group ceremonies. The main motives for ayahuasca use were spiritual development, self-knowledge, and spiritual experiences. The users reported mostly positive subjective consequences of ayahuasca use for their health and life. However, some difficult experiences and adverse effects were reported. No abuse of ayahuasca or addiction to it was found. Screening test indicators of depression and anxiety were lower in the ayahuasca-using group. No deterioration of the mental health of ayahuasca users in comparison to nonusers was found. The participants perceive their use of ayahuasca as a spiritual practice with mostly favorable outcomes for their health and life. They also perceive ayahuasca use in Estonia as a reasonably safe and self-limiting form of spiritual practice.
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Affiliation(s)
- Helle Kaasik
- School of Theology and Religious Studies, University of Tartu , Tartu, Estonia
| | - Kairi Kreegipuu
- Institute of Psychology, University of Tartu , Tartu, Estonia
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Estrella-Parra EA, Almanza-Pérez JC, Alarcón-Aguilar FJ. Ayahuasca: Uses, Phytochemical and Biological Activities. NATURAL PRODUCTS AND BIOPROSPECTING 2019; 9:251-265. [PMID: 31134518 PMCID: PMC6646606 DOI: 10.1007/s13659-019-0210-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 05/12/2019] [Indexed: 05/14/2023]
Abstract
Ayahuasca (caapi, yajé), is a psychoactive brew from the Amazon Basin region of South America traditionally considered a "master plant." It is prepared as a decoction from Banisteriopsis caapi and Psychotria viridis, which it is thought that it stimulates creative thinking and visual creativity. Native healers of the Orinoco and Amazon basins have used traditionally ayahuasca as a healing tool for multiple purposes, particularly to treat psychological disorders in the patients, with some beneficial effects experimentally and clinically validated. Recently, several syncretic religions, as the "União de Vegetal" (UDV) group in Brazil, have been spread around the world. The use of ayahuasca has been popularized by internet and smart-shops, bringing the psychoactive substance to new highs, emerging new "ayahuasqueros." Ayahuasca has alkaloids as β-carbolines and dimethyltryptamines, which inhibit the monoamine oxidase and active the 5-HT2A (5-hydroxytryptamine) receptor, respectively, resulting in hallucinations in the users. Ayahuasca induces a psychedelic change in the anteroposterior coupling of the electrophysiological brain oscillations in humans. Traditional ayahuasca beverage is generating pharmacological, commercial and spiritual interest among the scientific community, government people, and different populations worldwide. The goal of this article is to report about the uses, chemistry and biological activities of ayahuasca.
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Affiliation(s)
- Edgar Antonio Estrella-Parra
- Laboratorio de Farmacología. Dpto. Ciencias de la Salud. Div. C.B.S. Universidad Autónoma Metropolitana, Unidad Iztapalapa. Av. San Rafael Atlixco No. 186, Col. Vicentina, 09340, Mexico CDMX, Mexico
- Laboratorio de Fitoquímica, Laboratorio de Farmacognosia, Laboratorio de Fisiología Vegetal, Unidad UBIPRO, FES-Iztacala, UNAM, Tlalnepantla de Baz, 54090, Mexico CDMX, Mexico
| | - Julio Cesar Almanza-Pérez
- Laboratorio de Farmacología. Dpto. Ciencias de la Salud. Div. C.B.S. Universidad Autónoma Metropolitana, Unidad Iztapalapa. Av. San Rafael Atlixco No. 186, Col. Vicentina, 09340, Mexico CDMX, Mexico
| | - Francisco Javier Alarcón-Aguilar
- Laboratorio de Farmacología. Dpto. Ciencias de la Salud. Div. C.B.S. Universidad Autónoma Metropolitana, Unidad Iztapalapa. Av. San Rafael Atlixco No. 186, Col. Vicentina, 09340, Mexico CDMX, Mexico.
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Hamill J, Hallak J, Dursun SM, Baker G. Ayahuasca: Psychological and Physiologic Effects, Pharmacology and Potential Uses in Addiction and Mental Illness. Curr Neuropharmacol 2019; 17:108-128. [PMID: 29366418 PMCID: PMC6343205 DOI: 10.2174/1570159x16666180125095902] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 11/07/2017] [Accepted: 01/24/2018] [Indexed: 01/07/2023] Open
Abstract
Background: Ayahuasca, a traditional Amazonian decoction with psychoactive properties, is made from bark of the Banisteriopsis caapi vine (containing beta-carboline alkaloids) and leaves of the Psychotria viridis bush (supplying the hallucinogen N,N-dimethyltryptamine, DMT). Originally used by indigenous shamans for the purposes of spirit communi-cation, magical experiences, healing, and religious rituals across several South American countries, ayahuasca has been in-corporated into folk medicine and spiritual healing, and several Brazilian churches use it routinely to foster a spiritual experi-ence. More recently, it is being used in Europe and North America, not only for religious or healing reasons, but also for rec-reation. Objective: To review ayahuasca’s behavioral effects, possible adverse effects, proposed mechanisms of action and potential clinical uses in mental illness. Method: We searched Medline, in English, using the terms ayahuasca, dimethyltryptamine, Banisteriopsis caapi, and Psy-chotria viridis and reviewed the relevant publications. Results: The following aspects of ayahuasca are summarized: Political and legal factors; acute and chronic psychological ef-fects; electrophysiological studies and imaging; physiological effects; safety and adverse effects; pharmacology; potential psychiatric uses. Conclusion: Many years of shamanic wisdom have indicated potential therapeutic uses for ayahuasca, and several present day studies suggest that it may be useful for treating various psychiatric disorders and addictions. The side effect profile ap-pears to be relatively mild, but more detailed studies need to be done. Several prominent researchers believe that government regulations with regard to ayahuasca should be relaxed so that it could be provided more readily to recognized, credible re-searchers to conduct comprehensive clinical trials.
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Affiliation(s)
- Jonathan Hamill
- Department of Psychiatry (Neurochemical Research Unit) and Neuroscience & Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jaime Hallak
- Department of Psychiatry (Neurochemical Research Unit) and Neuroscience & Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada.,Department of Neurosciences and Behavior and National Institute of Science and Technology (Translational Medicine), Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Serdar M Dursun
- Department of Psychiatry (Neurochemical Research Unit) and Neuroscience & Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Glen Baker
- Department of Psychiatry (Neurochemical Research Unit) and Neuroscience & Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
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Pires JM, Mendes FR, Pires APS, Yonamine M, Amaral JLGD, Carlini EA. Pre-clinical interaction of ayahuasca, a brew used in spiritual movements, with morphine and propofol. BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000117174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Malcolm BJ, Lee KC. Ayahuasca: An ancient sacrament for treatment of contemporary psychiatric illness? Ment Health Clin 2018; 7:39-45. [PMID: 29955496 DOI: 10.9740/mhc.2017.01.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ayahuasca is a traditional psychoactive sacrament that's been used in Amazonian shamanic rituals for hundreds of years. Ayahuasca is notorious for its psychedelic properties produced from the combination of monoamine oxidase inhibitors (MAOIs) found in the Banisteriopsis caapi vine and N-N-dimethyltryptamine from Psychotria viridis or Diplopterys cabrerana. Recently, ritual use of ayahuasca has increased and garnered attention for its potential in treating mental illnesses, such as substance use and depressive disorders. Due to its MAOI properties, there are serious drug interactions that may be of concern among patients who participate in ayahuasca use. The objectives of this paper are to describe ayahuasca's pharmacology, potential drug interactions, and clinical data for its treatment potential in psychiatric illness.
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Affiliation(s)
- Benjamin J Malcolm
- Assistant Professor of Pharmacy Practice, Western University of Health Sciences College of Pharmacy, Pomona, California,
| | - Kelly C Lee
- Associate Professor of Clinical Pharmacy and Associate Dean for Assessment and Accreditation, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California at San Diego, San Diego, California; Residency Program Director, PGY2 Psychiatric Pharmacy Residency, University of California at San Diego Health, San Diego, California
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Morales-García JA, de la Fuente Revenga M, Alonso-Gil S, Rodríguez-Franco MI, Feilding A, Perez-Castillo A, Riba J. The alkaloids of Banisteriopsis caapi, the plant source of the Amazonian hallucinogen Ayahuasca, stimulate adult neurogenesis in vitro. Sci Rep 2017; 7:5309. [PMID: 28706205 PMCID: PMC5509699 DOI: 10.1038/s41598-017-05407-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/07/2017] [Indexed: 11/10/2022] Open
Abstract
Banisteriopsis caapi is the basic ingredient of ayahuasca, a psychotropic plant tea used in the Amazon for ritual and medicinal purposes, and by interested individuals worldwide. Animal studies and recent clinical research suggests that B. caapi preparations show antidepressant activity, a therapeutic effect that has been linked to hippocampal neurogenesis. Here we report that harmine, tetrahydroharmine and harmaline, the three main alkaloids present in B. caapi, and the harmine metabolite harmol, stimulate adult neurogenesis in vitro. In neurospheres prepared from progenitor cells obtained from the subventricular and the subgranular zones of adult mice brains, all compounds stimulated neural stem cell proliferation, migration, and differentiation into adult neurons. These findings suggest that modulation of brain plasticity could be a major contribution to the antidepressant effects of ayahuasca. They also expand the potential application of B. caapi alkaloids to other brain disorders that may benefit from stimulation of endogenous neural precursor niches.
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Affiliation(s)
- Jose A Morales-García
- Instituto de Investigaciones Biomédicas (CSIC-UAM), Arturo Duperier 4, 28029, Madrid, Spain.,Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), 28031, Madrid, Spain.,Departamento de Biología Celular, Facultad de Medicina, UCM, Plaza Ramón y Cajal s/n, 28040, Madrid, Spain
| | - Mario de la Fuente Revenga
- Human Neuropsychopharmacology Research Group. Sant Pau Institute of Biomedical Research (IIB-Sant Pau). Sant Antoni María Claret, 167. 08025, Barcelona, Spain.,Instituto de Química Médica (IQM-CSIC), Juan de la Cierva 3, 28006, Madrid, Spain.,MFR currently at: Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA, 23298, USA
| | - Sandra Alonso-Gil
- Instituto de Investigaciones Biomédicas (CSIC-UAM), Arturo Duperier 4, 28029, Madrid, Spain.,Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), 28031, Madrid, Spain
| | | | - Amanda Feilding
- The Beckley Foundation, Beckley Park, Oxford, OX3 9SY, United Kingdom
| | - Ana Perez-Castillo
- Instituto de Investigaciones Biomédicas (CSIC-UAM), Arturo Duperier 4, 28029, Madrid, Spain. .,Center for Networked Biomedical Research on Neurodegenerative Diseases (CIBERNED), 28031, Madrid, Spain.
| | - Jordi Riba
- Human Neuropsychopharmacology Research Group. Sant Pau Institute of Biomedical Research (IIB-Sant Pau). Sant Antoni María Claret, 167. 08025, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Planta, 028029, Madrid, Spain.
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Ray RR, Lassiter KS. Ayahuasca Treatment Center Safety for the Western Seeker. ANTHROPOLOGY OF CONSCIOUSNESS 2016. [DOI: 10.1111/anoc.12060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schenberg EE, Alexandre JFM, Filev R, Cravo AM, Sato JR, Muthukumaraswamy SD, Yonamine M, Waguespack M, Lomnicka I, Barker SA, da Silveira DX. Acute Biphasic Effects of Ayahuasca. PLoS One 2015; 10:e0137202. [PMID: 26421727 PMCID: PMC4589238 DOI: 10.1371/journal.pone.0137202] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/13/2015] [Indexed: 12/14/2022] Open
Abstract
Ritual use of ayahuasca, an amazonian Amerindian medicine turned sacrament in syncretic religions in Brazil, is rapidly growing around the world. Because of this internationalization, a comprehensive understanding of the pharmacological mechanisms of action of the brew and the neural correlates of the modified states of consciousness it induces is important. Employing a combination of electroencephalogram (EEG) recordings and quantification of ayahuasca's compounds and their metabolites in the systemic circulation we found ayahuasca to induce a biphasic effect in the brain. This effect was composed of reduced power in the alpha band (8-13 Hz) after 50 minutes from ingestion of the brew and increased slow- and fast-gamma power (30-50 and 50-100 Hz, respectively) between 75 and 125 minutes. Alpha power reductions were mostly located at left parieto-occipital cortex, slow-gamma power increase was observed at left centro-parieto-occipital, left fronto-temporal and right frontal cortices while fast-gamma increases were significant at left centro-parieto-occipital, left fronto-temporal, right frontal and right parieto-occipital cortices. These effects were significantly associated with circulating levels of ayahuasca's chemical compounds, mostly N,N-dimethyltryptamine (DMT), harmine, harmaline and tetrahydroharmine and some of their metabolites. An interpretation based on a cognitive and emotional framework relevant to the ritual use of ayahuasca, as well as it's potential therapeutic effects is offered.
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Affiliation(s)
| | | | - Renato Filev
- Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Andre Mascioli Cravo
- Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Santo André, Brazil
| | - João Ricardo Sato
- Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Santo André, Brazil
| | | | - Maurício Yonamine
- Departamento de Análises Clinicas e Toxicológicas, Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil
| | - Marian Waguespack
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Izabela Lomnicka
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
| | - Steven A. Barker
- Department of Comparative Biomedical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, United States of America
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dos Santos RG. A Critical Evaluation of Reports Associating Ayahuasca with Life-Threatening Adverse Reactions. J Psychoactive Drugs 2013; 45:179-88. [DOI: 10.1080/02791072.2013.785846] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Guimarães dos Santos R. Safety and Side Effects of Ayahuasca in Humans—An Overview Focusing on Developmental Toxicology. J Psychoactive Drugs 2013; 45:68-78. [DOI: 10.1080/02791072.2013.763564] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Brierley DI, Davidson C. Developments in harmine pharmacology--implications for ayahuasca use and drug-dependence treatment. Prog Neuropsychopharmacol Biol Psychiatry 2012; 39:263-72. [PMID: 22691716 DOI: 10.1016/j.pnpbp.2012.06.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/16/2012] [Accepted: 06/03/2012] [Indexed: 12/14/2022]
Abstract
Ayahuasca is a hallucinogenic botanical mixture originating in the Amazon area where it is used ritually, but is now being taken globally. The 2 main constituents of ayahuasca are N,N-dimethyltryptamine (DMT), a hallucinogen, and harmine, a monoamine oxidase inhibitor (MAOI) which attenuates the breakdown of DMT, which would otherwise be broken down very quickly after oral consumption. Recent developments in ayahuasca use include the sale of these compounds on the internet and the substitution of related botanical (anahuasca) or synthetic (pharmahuasca) compounds to achieve the same desired hallucinogenic effects. One intriguing result of ayahuasca use appears to be improved mental health and a reduction in recidivism to alternate (alcohol, cocaine) drug use. In this review we discuss the pharmacology of ayahuasca, with a focus on harmine, and suggest pharmacological mechanisms for the putative reduction in recidivism to alcohol and cocaine misuse. These pharmacological mechanisms include MAOI, effects at 5-HT(2A) and imidazoline receptors and inhibition of dual-specificity tyrosine-phosphorylation regulated kinase 1A (DYRK1A) and the dopamine transporter. We also speculate on the therapeutic potential of harmine in other CNS conditions.
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Affiliation(s)
- Daniel I Brierley
- Pharmacology & Cell Physiology, Division of Biomedical Science, St George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
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Determination of dimethyltryptamine and β-carbolines (ayahuasca alkaloids) in plasma samples by LC-MS/MS. Bioanalysis 2012; 4:1731-8. [PMID: 22877219 DOI: 10.4155/bio.12.124] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Ayahuasca is a psychoactive plant beverage originally used by indigenous people throughout the Amazon Basin, long before its modern use by syncretic religious groups established in Brazil, the USA and European countries. The objective of this study was to develop a method for quantification of dimethyltryptamine and β-carbolines in human plasma samples. RESULTS The analytes were extracted by means of C18 cartridges and injected into LC-MS/MS, operated in positive ion mode and multiple reaction monitoring. The LOQs obtained for all analytes were below 0.5 ng/ml. By using the weighted least squares linear regression, the accuracy of the analytical method was improved at the lower end of the calibration curve (from 0.5 to 100 ng/ml; r(2)> 0.98). CONCLUSION The method proved to be simple, rapid and useful to estimate administered doses for further pharmacological and toxicological investigations of ayahuasca exposure.
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dos Santos RG. Toxicity of chronic ayahuasca administration to the pregnant rat: how relevant it is regarding the human, ritual use of ayahuasca? ACTA ACUST UNITED AC 2010; 89:533-5; author reply 531-2.. [DOI: 10.1002/bdrb.20272] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Oliveira CDR, Moreira CQ, de Sá LRM, de Souza Spinosa H, Yonamine M. Maternal and developmental toxicity of ayahuasca in Wistar rats. ACTA ACUST UNITED AC 2010; 89:207-12. [DOI: 10.1002/bdrb.20244] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wu C, Jiang XL, Shen HW, Yu AM. Effects of CYP2D6 status on harmaline metabolism, pharmacokinetics and pharmacodynamics, and a pharmacogenetics-based pharmacokinetic model. Biochem Pharmacol 2009; 78:617-24. [PMID: 19445902 DOI: 10.1016/j.bcp.2009.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Revised: 05/06/2009] [Accepted: 05/07/2009] [Indexed: 12/31/2022]
Abstract
Harmaline is a beta-carboline alkaloid showing neuroprotective and neurotoxic properties. Our recent studies have revealed an important role for cytochrome P450 2D6 (CYP2D6) in harmaline O-demethylation. This study, therefore, aimed to delineate the effects of CYP2D6 phenotype/genotype on harmaline metabolism, pharmacokinetics (PK) and pharmacodynamics (PD), and to develop a pharmacogenetics mechanism-based compartmental PK model. In vitro kinetic studies on metabolite formation in human CYP2D6 extensive metabolizer (EM) and poor metabolizer (PM) hepatocytes indicated that harmaline O-demethylase activity (V(max)/K(m)) was about 9-fold higher in EM hepatocytes. Substrate depletion showed mono-exponential decay trait, and estimated in vitro harmaline clearance (CL(int), microL/min/10(6)cells) was significantly lower in PM hepatocytes (28.5) than EM hepatocytes (71.1). In vivo studies in CYP2D6-humanized and wild-type mouse models showed that wild-type mice were subjected to higher and longer exposure to harmaline (5 and 15mg/kg; i.v. and i.p.), and more severe hypothermic responses. The PK/PD data were nicely described by our pharmacogenetics-based PK model involving the clearance of drug by CYP2D6 (CL(CYP2D6)) and other mechanisms (CL(other)), and an indirect response PD model, respectively. Wild-type mice were also more sensitive to harmaline in marble-burying tests, as manifested by significantly lower ED(50) and steeper Hill slope. These findings suggest that distinct CYP2D6 status may cause considerable variations in harmaline metabolism, PK and PD. In addition, the pharmacogenetics-based PK model may be extended to define PK difference caused by other polymorphic drug-metabolizing enzyme in different populations.
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Affiliation(s)
- Chao Wu
- Department of Pharmaceutical Sciences, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, Buffalo, NY 14260-1200, USA
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Pires APS, De Oliveira CDR, Moura S, Dörr FA, Silva WAE, Yonamine M. Gas chromatographic analysis of dimethyltryptamine and beta-carboline alkaloids in ayahuasca, an Amazonian psychoactive plant beverage. PHYTOCHEMICAL ANALYSIS : PCA 2009; 20:149-53. [PMID: 19140116 DOI: 10.1002/pca.1110] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
INTRODUCTION Ayahuasca is obtained by infusing the pounded stems of Banisteriopsis caapi in combination with the leaves of Psychotria viridis. P. viridis is rich in the psychedelic indole N,N-dimethyltryptamine, whereas B. caapi contains substantial amounts of beta-carboline alkaloids, mainly harmine, harmaline and tetrahydroharmine, which are monoamine-oxidase inhibitors. Because of differences in composition in ayahuasca preparations, a method to measure their main active constituents is needed. OBJECTIVE To develop a gas chromatographic method for the simultaneous determination of dimethyltryptamine and the main beta-carbolines found in ayahuasca preparations. METHODOLOGY The alkaloids were extracted by means of solid phase extraction (C(18)) and detected by gas chromatography with nitrogen/phosphorous detector. RESULTS The lower limit of quantification (LLOQ) was 0.02 mg/mL for all analytes. The calibration curves were linear over a concentration range of 0.02-4.0 mg/mL (r(2 )> 0.99). The method was also precise (RSD < 10%). CONCLUSION A simple gas chromatographic method to determine the main alkaloids found in ayahuasca was developed and validated. The method can be useful to estimate administered doses in animals and humans for further pharmacological and toxicological investigations of ayahuasca.
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Affiliation(s)
- Ana Paula Salum Pires
- Department of Clinical and Toxicological Analysis, Faculty of Pharmaceutical Sciences, University of São Paulo, Av. Prof. Lineu Prestes 580 B13B, São Paulo, SP, Brazil
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Yu AM. Indolealkylamines: biotransformations and potential drug-drug interactions. AAPS JOURNAL 2008; 10:242-53. [PMID: 18454322 DOI: 10.1208/s12248-008-9028-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Accepted: 03/21/2008] [Indexed: 11/30/2022]
Abstract
Indolealkylamine (IAA) drugs are 5-hydroxytryptamine (5-HT or serotonin) analogs that mainly act on the serotonin system. Some IAAs are clinically utilized for antimigraine therapy, whereas other substances are notable as drugs of abuse. In the clinical evaluation of antimigraine triptan drugs, studies on their biotransformations and pharmacokinetics would facilitate the understanding and prevention of unwanted drug-drug interactions (DDIs). A stable, principal metabolite of an IAA drug of abuse could serve as a useful biomarker in assessing intoxication of the IAA substance. Studies on the metabolism of IAA drugs of abuse including lysergic acid amides, tryptamine derivatives and beta-carbolines are therefore emerging. An important role for polymorphic cytochrome P450 2D6 (CYP2D6) in the metabolism of IAA drugs of abuse has been revealed by recent studies, suggesting that variations in IAA metabolism, pharmaco- or toxicokinetics and dynamics can arise from distinct CYP2D6 status, and CYP2D6 polymorphism may represent an additional risk factor in the use of these IAA drugs. Furthermore, DDIs with IAA agents could occur additively at the pharmaco/toxicokinetic and dynamic levels, leading to severe or even fatal serotonin toxicity. In this review, the metabolism and potential DDIs of these therapeutic and abused IAA drugs are described.
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Affiliation(s)
- Ai-Ming Yu
- Department of Pharmaceutical Sciences, University at Buffalo, The State University of New York, 541 Cooke Hall, Buffalo, New York, 14260-1200, USA.
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Wink M. Molecular modes of action of cytotoxic alkaloids: from DNA intercalation, spindle poisoning, topoisomerase inhibition to apoptosis and multiple drug resistance. THE ALKALOIDS. CHEMISTRY AND BIOLOGY 2007; 64:1-47. [PMID: 18085328 DOI: 10.1016/s1099-4831(07)64001-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michael Wink
- Institute of Pharmacy and Molecular Biotechnology, University of Heidelberg, 69120 Heidelberg, Germany.
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