1) FAMILY: Malpighiaceae
2) SYNONYMS/COMMON NAMES: Ayahuasca vine; Banisteria quitensis; B. inebrians; B. quitensis.
3) DESCRIPTION: A large vine that forms very long and very woody stems that branch repeatedly. It has large round-ovate shaped leaves and contains flowers that are 12 to 14 mm in size and have 5 white or pale pink sepals. The plant flowers rarely. The vine is easily confused with the B. membranifolia and B. muricata vines (Ratsch, 1998).
4) DISTRIBUTION: Its origins are unknown, but it has been cultivated in Peru, Ecuador, Colombia and Brazil (ie, the entire Amazon region) (Ratsch, 1998).
5) CONSTITUENTS: This plant is known to contain alkaloids of the beta-carboline type (primary alkaloids include: harmine, harmaline and tetrahydroharmine). The vine is a potent MAO inhibitor. If used alone, the vine can produce mood enhancing and sedative qualities. If taken in higher doses (150 to 200 mg), the effects of the harmine may cause nausea and vomiting (Ratsch, 1998).
6) PSYCHOACTIVE ELEMENT: Stems (fresh or dried); bark (fresh or dried); and leaves (dried) (Ratsch, 1998).
7) USES: It has been used in South American for ayahuasca brews to treat various conditions and diseases. These drinks are sometimes referred to as "yage" (Ratsch, 1998).
8) SEE also HALLUCINOGENIC TRYPTAMINES for further information.

1) FAMILY: Desfontainiaceae
2) SYNONYMS/COMMON NAMES: Michay; Chapico ("chili water"); Taique; D. obovata; D. parvifolia; D. hookeri.
3) DESCRIPTION: Small evergreen bush or shrub-like tree; grows up to 2 to 3 meters. The leaves are thick and medium to dark green in color (they appear similar to English ivy). The flowers are funnel-shape that are orange to red with yellow margins (Ratsch, 1998).
4) CONSTITUENTS: At the time of this review, no constituents have been identified (Ratsch, 1998).
5) DISTRIBUTION: The bush grows in Colombia, Ecuador and the higher regions of Argentina. It also grows in southern Chile (Ratsch, 1998).
6) PSYCHOACTIVE ELEMENT: Leaves and fruit (Ratsch, 1998).
7) USES: The leaves can be brewed to produce a hallucinogenic tea. The tea has also been used to treat an upset stomach (Ratsch, 1998).

1) FAMILY: Solanaceae
2) SYNONYMS/COMMON NAMES: Pitchiri; Pitcheri; Pituri Bush; Emu plant; poison bush; Anthoceris hopwoodii.
3) DESCRIPTION: D. hopwoodii is an erect shrub that grows to 3 to 4 meters tall. The plant produces a berry fruit and flowers (Cawte, 1985).
4) DISTRIBUTION: Australia. Found in all the arid regions of the mainland states, except Victoria (Cawte, 1985).
5) PSYCHOACTIVE ELEMENT: Leaves (Ratsch, 1998).
6) CONSTITUENTS: The seeds reportedly have an antidepressant effect and may stimulate the imagination. Chemical variation has been reported with D. hopwoodii. In west Australia, the D. hopwoodii yielded nicotine, nornicotine, hyoscyamine and metanictoine, while the root contained nornicotine, hyoscyamine, myosmine, and N-formylnornicotine (Watson et al, 1983). The primary alkaloid appears to be nicotine (Rothera, 1911).
7) USES: Pituri has been used by Australian aborigines for its hedonistic and magical effects. Historically, it was used as a stimulant and in larger doses as a narcotic (Watson et al, 1983). It may be used as a substitute for tobacco (Ringer & Murrell, 1878). It may also decrease hunger and thirst, and has an inebriating effect and may produce ardent dreams(Cawte, 1985).
8) The addition of ash and possible other constituents may produce variable clinical effects (Cawte, 1985; Ratsch, 1998).
9) SEE also NICOTINE management for further information.

1) FAMILY: Compositate: Asteraceae
2) SYNONYMS/COMMON NAMES: Wild lettuce, opium lettuce; bitter lettuce; great lettuce; lactucarium; laitue vireuse.
3) DESCRIPTION: May grow up to 2 to 4 feet; maximum 6 feet. The stem is smooth and pale green; may be spotted with purple. Leaves can be 6 to 18 inches long. Flowers are pale yellow with large open clusters.
4) CONSTITUENTS: Lactucarium contains the sedative sesquiterpene lactones (bitter); triterpene alcohols and other guaianolides (Ratsch, 1998).
5) PSYCHOACTIVE ELEMENT: Thickened juice (latex); lactucarium, lactucarium germanicum; dried leaves that can be smoked alone or blended with other herbs (Ratsch, 1998).
6) USES: In ancient times it was used as an aphrodisiac and used in rituals. In recent times, it has been used as a sedative and a mild substitute for opium (Ratsch, 1998).
7) See also PLANTS-SESQUITERPENE LACTONES management.

1) FAMILY: Lamiaceae (formerly known as: Labiatae)
2) SYNONYMS/COMMON NAMES: Turkish mint; Intoxicating mint.
3) DESCRIPTION: A bushy mint plant (Ratsch, 1998).
4) DISTRIBUTION: Turkistan and Uzbekistan; difficult to find (Ratsch, 1998).
5) PSYCHOACTIVE ELEMENT: The leaves contain up to 17% lagochiline, a diterpene alkaloid, that has been associated with the plants sedative, hypotensive and hemostatic effects (Ratsch, 1998).
6) USES: The leaves have been dried to make tea. It has also been used in Russian folk medicine to treat allergies and skin conditions, as well as promote blood coagulation (Ratsch, 1998).

1) SYNONYMS/COMMON NAMES: Lion's tail, lion's ear.
2) DESCRIPTION: A perennial that may grow 2 to 3 meters and produces red, orange, yellow, or white tubular flowers.
3) PSYCHOACTIVE ELEMENT: Leaves and flowers (dried) (Ratsch, 1998).
4) USES: The dried flowers when smoked may provide a mild sedative effect, similar to Cannabis. In California, it has been used as a substitute for marijuana. The dried herbage is referred to as "wild dagga" (Ratsch, 1998).

1) SYNONYMS/COMMON NAMES: This plant is closely related to L. leonurus (Ratsch, 1998).
2) USES: It has been used in Caribbean folk medicine. In Mexico, the plant is known as "world flower" or mota (usually known as marijuana). It is likely used as a marijuana substitute (Ratsch, 1998).
3) PSYCHOACTIVE ELEMENT: Leaves and flowers (Ratsch, 1998).

1) FAMILY: Zygophyllaceae
2) SYNONYMS/COMMON NAMES: Turkish rue; Mexican rue; African rue; Harmel.
3) DESCRIPTION: A perennial hemicrytophyte with a strong, offensive odor. It is a glabrous, herbaceous plant that grows up to 50 to 100 cm. The leaves are thong-like with an unpleasant odor. The fruit is a 3 chambered capsule with several angular black seeds (Ratsch, 1998).
4) DISTRIBUTION: The Middle East and South Africa in semi-arid regions (Ratsch, 1998).
5) PSYCHOACTIVE ELEMENT: Seeds (Ratsch, 1998).
6) CONSTITUENTS: The seeds contain beta-carbolines, harmine, harmaline and harmalol and harmidine reportedly have an antidepressant effect and may stimulate the imagination (Ratsch, 1998).
7) USES: In herbal medicine it has been used as an emmenagogue and abortifacient (Ratsch, 1998).
8) SEE also HALLUCINOGENIC TRYPTAMINES for further information.

1) FAMILY: Mesembryanthemaceae (Iced Plant Family)
2) SYNONYMS/COMMON NAMES: Mesembryanthemum tortusoum L.; Canna; Canna-root; Channa; Gunua; Kaugoed; Kougoed.
3) DESCRIPTION: Succulent ground cover that can grow as tall as 30 cm. Fleshy leaves are attached directly to the branches. The flowers are pale yellow (3 to 4 cm) are attached to the ends of the branches. The fruit is angular shaped with small seeds (Ratsch, 1998).
4) DISTRIBUTION: Grown only in South Africa ("kanna" land). It has become a relatively difficult species to find (Ratsch, 1998).
5) PSYCHOACTIVE ELEMENTS: Entire plant with root (Ratsch, 1998).
6) USES: It has purportedly been used since prehistoric times as a mood altering substance (Stafford et al, 2008). It can also reduce anxiety and stress and lessen feelings of inferiority. In contemporary South African society, it has been used as a party drug (Ratsch, 1998).

1) FAMILY: Convolvulaceae
2) SYNONYMS/COMMON NAMES: Badoh (seeds); Ololiuqui Vine (seeds); Coaxihuitl.
3) DESCRIPTION: A large woody vine, that has flowering branches with funnel-shaped flowers. The flowering portion of the plant may contain a significant amount of psychoactive honey. The leaves and stalks (not the roots) contain psychoactive indole alkaloids (Ratsch, 1998).
4) DISTRIBUTION: Indigenous to tropical Mexico (Ratsch, 1998).
5) PSYCHOACTIVE ELEMENTS: Seeds (fresh or dried), leaves, and roots (Ratsch, 1998).
6) USES: Used as a psychedelic ("visionary inebriant"). It has been used in traditional and folk medicine to treat wounds and bruises and as an aid to parturition (Ratsch, 1998).

1) PLANTS-MITRAGYNA
2) PLANTS-MUCUNA SPECIES
3) PLANTS-NICOTINIC
4) PLANTS-PASSIFLORA
5) PLANTS-SALVIA DIVINORUM
6) PLANTS-SOLANINE
7) PLANTS-STIMULANTS
8) PLANTS-THEOBROMA CACAO
9) PLANTS-VERATRUM ALKALOIDS

1) The following GENERA or SPECIES contain a hallucinogenic tryptamine(s):
2) BACKGROUND INFORMATION: Tryptamine and DMT and its derivatives are naturally occurring compounds. All other agents are synthetic. All compounds are available in pure powder forms. DMT (also referred to as the "businessman's high"), AMT, 5-OMe-DMT, beta carbolines, and bufotenine are found in a variety of South American plants including species of Myristicaceae (Virola species), Fabaceae (Anadenanthera or piptadenia peregrina, Mimosa hostilis), Zygophillaceae (Pegonum harmala), Malpighiaceae (Banisteriopsis species, Tetrapteris methystica), Rubiaceae (Psychotria species) Apocyanaceae (Restonia amazonica), and Acanthaceae (Justicia pectoralis) (Halpern, 2004; Long et al, 2003; Lewis & Elvin-Lewis, 1977). They may be smoked or inhaled as snuffs, or used in beverages.
3) Hallucinogenic derivatives of tryptamine and beta-carboline (eg, harmine, harmoline, and tetrahydroharmine) have structures and properties in common with ergotamine, LSD (lysergic acid diethylamide), and serotonin (5-hydroxytryptamine).
4) DMT, alpha MT, 5-OMe-DMT, bufotenine, and beta-carbolines are found in a variety of South American plants which are smoked, ingested (as resin or tea), or used as snuff.
5) Bufotenine, an indole alkaloid, has been obtained from the seeds and leaves of Piptadenia peregrina, from which hallucinogenic snuff cohoba is made, and P. macrocarpa (Mimosaceae).

a) Obtain a baseline ECG in symptomatic patients and perform continuous cardiac monitoring as indicated.

a) If patient is severely agitated, sedate with IV benzodiazepines.

a) ADULT: 5 to 10 mg IV initially, repeat every 5 to 20 minutes as needed (Brophy et al, 2012; Prod Info diazepam IM, IV injection, 2008; Manno, 2003).
b) CHILD: 0.1 to 0.5 mg/kg IV over 2 to 5 minutes; up to a maximum of 10 mg/dose. May repeat dose every 5 to 10 minutes as needed (Loddenkemper & Goodkin, 2011; Hegenbarth & American Academy of Pediatrics Committee on Drugs, 2008).

a) ADULT: 2 to 4 mg IV initially; repeat every 5 to 10 minutes as needed (Manno, 2003).
b) CHILD: 0.05 to 0.1 mg/kg IV over 2 to 5 minutes, up to a maximum of 4 mg/dose; may repeat in 5 to 15 minutes as needed (Brophy et al, 2012; Loddenkemper & Goodkin, 2011; Hegenbarth & American Academy of Pediatrics Committee on Drugs, 2008).

a) Attempt initial control with a benzodiazepine (eg, diazepam, lorazepam). If seizures persist or recur, administer phenobarbital or propofol.
b) Monitor for respiratory depression, hypotension, and dysrhythmias. Endotracheal intubation should be performed in patients with persistent seizures.
c) Evaluate for hypoxia, electrolyte disturbances, and hypoglycemia (or, if immediate bedside glucose testing is not available, treat with intravenous dextrose).

a) ADULT DOSE: Initially 5 to 10 mg IV, OR 0.15 mg/kg IV up to 10 mg per dose up to a rate of 5 mg/minute; may be repeated every 5 to 20 minutes as needed (Brophy et al, 2012; Prod Info diazepam IM, IV injection, 2008; Manno, 2003).
b) PEDIATRIC DOSE: 0.1 to 0.5 mg/kg IV over 2 to 5 minutes; up to a maximum of 10 mg/dose. May repeat dose every 5 to 10 minutes as needed (Loddenkemper & Goodkin, 2011; Hegenbarth & American Academy of Pediatrics Committee on Drugs, 2008).
c) Monitor for hypotension, respiratory depression, and the need for endotracheal intubation. Consider a second agent if seizures persist or recur after repeated doses of diazepam .

a) DIAZEPAM may be given rectally or intramuscularly (Manno, 2003). RECTAL DOSE: CHILD: Greater than 12 years: 0.2 mg/kg; 6 to 11 years: 0.3 mg/kg; 2 to 5 years: 0.5 mg/kg (Brophy et al, 2012).
b) MIDAZOLAM has been used intramuscularly and intranasally, particularly in children when intravenous access has not been established. ADULT DOSE: 0.2 mg/kg IM, up to a maximum dose of 10 mg (Brophy et al, 2012). PEDIATRIC DOSE: INTRAMUSCULAR: 0.2 mg/kg IM, up to a maximum dose of 7 mg (Chamberlain et al, 1997) OR 10 mg IM (weight greater than 40 kg); 5 mg IM (weight 13 to 40 kg); INTRANASAL: 0.2 to 0.5 mg/kg up to a maximum of 10 mg/dose (Loddenkemper & Goodkin, 2011; Brophy et al, 2012). BUCCAL midazolam, 10 mg, has been used in adolescents and older children (5-years-old or more) to control seizures when intravenous access was not established (Scott et al, 1999).

a) MAXIMUM RATE: The rate of intravenous administration of lorazepam should not exceed 2 mg/min (Brophy et al, 2012; Prod Info lorazepam IM, IV injection, 2008).
b) ADULT DOSE: 2 to 4 mg IV initially; repeat every 5 to 10 minutes as needed, if seizures persist (Manno, 2003; Brophy et al, 2012).
c) PEDIATRIC DOSE: 0.05 to 0.1 mg/kg IV over 2 to 5 minutes, up to a maximum of 4 mg/dose; may repeat in 5 to 15 minutes as needed, if seizures continue (Brophy et al, 2012; Loddenkemper & Goodkin, 2011; Hegenbarth & American Academy of Pediatrics Committee on Drugs, 2008; Sreenath et al, 2009; Chin et al, 2008).

a) ADULT LOADING DOSE: 20 mg/kg IV at an infusion rate of 50 to 100 mg/minute IV. An additional 5 to 10 mg/kg dose may be given 10 minutes after loading infusion if seizures persist or recur (Brophy et al, 2012).
b) Patients receiving high doses will require endotracheal intubation and may require vasopressor support (Brophy et al, 2012).
c) PEDIATRIC LOADING DOSE: 20 mg/kg may be given as single or divided application (2 mg/kg/minute in children weighing less than 40 kg up to 100 mg/min in children weighing greater than 40 kg). A plasma concentration of about 20 mg/L will be achieved by this dose (Loddenkemper & Goodkin, 2011).
d) REPEAT PEDIATRIC DOSE: Repeat doses of 5 to 20 mg/kg may be given every 15 to 20 minutes if seizures persist, with cardiorespiratory monitoring (Loddenkemper & Goodkin, 2011).
e) MONITOR: For hypotension, respiratory depression, and the need for endotracheal intubation (Loddenkemper & Goodkin, 2011; Manno, 2003).
f) SERUM CONCENTRATION MONITORING: Monitor serum concentrations over the next 12 to 24 hours. Therapeutic serum concentrations of phenobarbital range from 10 to 40 mcg/mL, although the optimal plasma concentration for some individuals may vary outside this range (Hvidberg & Dam, 1976; Choonara & Rane, 1990; AMA Department of Drugs, 1992).

a) If seizures persist after phenobarbital, propofol or pentobarbital infusion, or neuromuscular paralysis with general anesthesia (isoflurane) and continuous EEG monitoring should be considered (Manno, 2003). Other anticonvulsants can be considered (eg, valproate sodium, levetiracetam, lacosamide, topiramate) if seizures persist or recur; however, there is very little data regarding their use in toxin induced seizures, controlled trials are not available to define the optimal dosage ranges for these agents in status epilepticus (Brophy et al, 2012):