Narcissus and Daffodil

Pharmacology of Narcissus compounds 343
in muscle tone and isometric contractions) and at an early, rather than late, phase
of treatment (5–15 days of the first course). No improvement was seen where the
muscle showed zero power from the onset or in chronic cases. Very little improvement
was seen in four of the seven cases of pseudo-hypertrophic muscular
dystrophy and none in the remaining patients. Some improvement in the two
children with facial paralysis was noted. Galanthamine was described as being well
tolerated; mild reactions included salivation, nausea and abdominal pain that
resolved on decreasing the dose.
Improvement in motor function was observed when galanthamine was used as
part of a programme of therapies used to treat polyneuropathy-associated Guillain-
Barre syndrome (Kuyumdzhieva et al., 1996).
Use in poisoning
Reports in animal, and later in human, studies, of the reversal of respiratory
depression caused by opiate analgesics are tempered by observations that cholinergic
side effects are likely at the doses required and that only temporary reversal
is achieved (Tassonyi et al., 1976). However, galanthamine has been used to
reverse CNS effects in several cases of drug overdose, including scopolamine
(Cozanitis, 1977), Mandrax (a combination of diphenhydramine, a drug with
marked anticholinergic properties and methaqualone, an hypnotic), and dextromoramide
(a narcotic analgesic related to methadone, which caused marked
respiratory depression) (Cozanitis and Toivakka, 1974).
Analgesia
Poultices of the leaves and bulbs of the Amaryllidaceae have been reported in
herbal lore for hundreds of years as being used to treat painful neurological
conditions such as facial neuralgia; this treatment was said to provide analgesic
and curative effects (Rainer, 1997).
Despite its apparent ability to reverse the respiratory depression seen with
morphine-like analgesics, galanthamine does not appear to antagonise opiateinduced
analgesia. Indeed, the drug is structurally related to morphine (see
Figure 13.1). Evidence from standard laboratory tests suggests that the drug may
have mild analgesic properties (Cozanitis et al., 1983). Suggestions that galanthamine
may stimulate opioid receptors directly needs substantiation by direct,
radioligand binding studies.
Migraine
Ikonomoff (1968) was the first to report the use of galanthamine in the management
of migraine patients. Of 140 cases involving galanthamine (in the form of the
commercially available product ‘Nivalin’), 25 (18%) were headache free for 6
years, and a further 64 (46%) had shown some improvement. In 42 patients, spontaneous
epistaxis resolved and in 56 patients, subcutaneous ecchymosis ceased
when galanthamine was used. Twenty-two of 59 female patients with dysmenorrhoea
accompanying their migraine experienced resolution of period pains.
Neostigmine was found to be superior in a similar range of patients. The author