Herb/Hallucinogen
pregnancy recommendation: No Human Data—No Relevant Animal Data
BREASTFEEDING RECOMMENDATION: No Human Data—Potential Toxicity
PREGNANCY SUMMARY
No reports describing the use of Salvia divinorum or its active ingredient, salvinorin A, in human pregnancy have been located. The herb is used by some cultures in Mexico and exposure during gestation may have occurred. However, because smoking the herb has caused toxic, persistent psychosis in an 18-year-old female and a 21-year-old male (1–3), it is best avoided in pregnancy.
FETAL RISK SUMMARY
Salvia divinorum is a perennial herb that is a species of sage cultivated in certain regions of Mexico. The hallucinogenic substances from the leaves and juices of the herb have been used by some groups in Mexico for healing and divinatory rituals. In addition, it is thought to have antidiarrheal properties. The hallucinogenic effects are produced by smoking or chewing the leaves or drinking the juices. When taken orally, systemic effects are dependent upon absorption across the oral mucosa, as the active agent is deactivated in the gastrointestinal tract (1,4). The active psychotropic agent is the diterpene salvinorin A, also referred to as divinorin A, a nonalkaloid hallucinogen. It acts as kappa opioid receptor agonist. The major metabolite is salvinorin B (1), but it is not known if it is active. The substance crosses the blood–brain barrier, resulting in a rapid onset of effects but of short duration (1,5). In female monkeys, the elimination half-life of salvinorin A is 80 minutes (6).
Animal reproduction studies have not been conducted with S. divinorum or its active ingredient, salvinorin A.
BREASTFEEDING SUMMARY
No reports describing the use of S. divinorum or its active ingredient, salvinorin A, during human lactation have been located. The herb is used by some cultures in Mexico and exposure during breastfeeding may have occurred. However, because smoking the herb has caused toxic, persistent psychosis in two persons (1–3), it is best avoided.
References
1.Salvia divinorum. In The Review of Natural Products. St. Louis, MO: Wolters Kluwer Health, June 2010.
2.Paulzen M, Grunder G. Toxic psychosis after intake of the hallucinogen salvinorin A. J Clin Psychiatry 2008;69:1501–2.
3.Prezekop P, Lee T. Persistent psychosis associated with Salvia divinorum use. Am J Psychiatry 2009;166:832.
4.Siebert DJ. Salvia divinorum and salvinorin A: a new pharmacologic findings. J Ethnopharmacol 1994;43:53–6.
5.Butelman ER, Prisinzano TE, Deng H, Rus S, Kreek MJ. Unconditioned behavioral effects of the powerful k-opioid hallucinogen salvinorin A in nonhuman primates: fast onset and entry into cerebrospinal fluid. J Pharmacol Exp Ther 2009;328:588–97.
6.Schmidt MD, Schmidt MS, Butelman ER, Harding WW, Tidgewell K, Murry DJ, Kreek MJ, Prisinzano TE. Pharmacokinetics of the plant-derived k-opioid hallucinogen salvinorin A in nonhuman primates. Synapse 2005;58:208–10.