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A SAFE COUGH SUPPRESSANT WITH NEWLY DISCOVERED EFFECTS IN TREATING CANCER AND STROKE
SUMMARY : Noscapine is a very safe cough suppressant (antitussive) which has been in use for many decades. In recent years, noscapine’s anti-cancer effect has been demonstrated when taken at doses higher than those used for cough suppression. It is currently in off-label use by a number of physicians in treatment of cancers of the breast, lung, prostate, ovaries and brain, and lymphomas, to name but a few. It is being clinically studied in non-Hodgkin’s lymphoma and chronic lymphocytic leukemia (CLL). Noscapine, a non-addictive derivative of opium, has also demonstrated outstanding clinical effectiveness in reducing death rates from strokes. Its long safety record, widespread availability and ease of administration make it an ideal candidate for fighting several life-threatening conditions.
HISTORY : In 1817, Pierre-Jean Robiquet, a famous French pharmacist and professor at the Paris Ecole de Pharmacie, fellow of the Academie Royale des Sciences, isolated two natural compounds from opium: codeine and noscapine.1 Noscapine, formerly known as narcotine, anarcotine or gnoscopine, was classified as an alkaloid. It forms between four and twelve percent of the opium seed. In the late nineteenth century, opium (Papaver somniferum) was known as an
anti-malarial medicine. It was mainly produced in India, which was at
that time part of the British Empire, and was considered the third pillar
of British India’s economy. The opium trade was not without controversy,
however. This finally prompted the establishment of a Royal Commission on Opium. During the 1893-95 Royal Commission, its medical expert, Sir Robert Williams, concluded that noscapine was responsible for opium’s ability to prevent and treat malaria. This was in contrast to the opinion of renowned chemists, who by 1874 had classified it as an insignificant substance possessing minimal or no therapeutic value. Noscapine’s application as an anti-malarial was revived in 1895 at the suggestion of Sir Robert Williams. It remained in use for many years, until a comprehensive study published in 1930 discredited its use for this purpose. The earliest pharmacological investigations of noscapine attempted to define its analgesic (pain-relieving) properties. It was found that the alkaloid on its own has a very slight analgesic effect.4 However, when taken with morphine, it acts synergistically to potentiate morphine’s sedative effects4,5 by as much as threefold.6 Furthermore, noscapine did not cause constipation, unlike the other opium alkaloids such as morphine, codeine, and papaverine.
USES : As of the time of writing, the only formally approved application for noscapine is as a cough suppressant. Usual doses used for cough suppression vary from 45 to 200 mg per day, usually in three divided doses. Off-label use of noscapine is being made by a number of physicians in treating cancers of the breast, lung, prostate, and ovaries. Clinical trials have yet to be performed to determine optimal dosages. Dosages currently in use for cancer range between 1,000 to 2,250 mg per day, usually n three divided doses. Some physicians are using noscapine for its pain-relief effects by combining it with lower-than-usual doses of morphine. The author is presently unaware of any physicians using noscapine for treatment of stroke. This does, owever, remain a safe and effective potential application.
MODE OF INGESTION : Noscapine can be given orally in tablets, lozenges, capsules, and syrup, and rectally in suppositories. It has also been tested in intravenous form in humans; however, since oral absorption is found to be satisfactory36, being additionally safer and far less expensive than intravenous forms, it remains the route of choice. Due to its low molecular weight, Noscapine can be administered trans-dermally in cream form, provided it is combined with an effective penetrant.
SAFETY AND SIDE EFFECTS : The side effects which have been observed with very high doses of noscapine Hcl have generally been limited to nausea and abdominal discomfort in a small percentage of patients. Extensive toxicology studies carried out in both animals39 and humans3,43 have confirmed its extremely low toxicity,45 with little or no effect on vital organs and blood parameters, and with negligible side effects. In 1961, a toxicity study on terminally ill cancer patients, many with only days left to live, was carried out by the renowned Dr. Louis Lasagna at Johns Hopkins University. It was found that at daily doses of up to 3,000 mg, 80% of patients experienced no side effects.41 The other 20% experienced mild sedation and abdominal discomfort. However, this study had no control group and therefore it could not be determined whether the side effects experienced by the minority of patients were due to noscapine or to their terminal illnesses. Subsequent protocols for animal-based studies on the anti-cancer effect of noscapine (described below) determined what could be considered a “safe” dose according to the results of Dr. Lasagna’s study. Precaution is required before administering noscapine to patients during pregnancy. In 1991, the UK Committee on Safety of Medicines recommended that noscapine should be contraindicated in women of childbearing potential because of potential genotoxicity.42 This decision was criticized, however, because it was based solely on the results of in vitro (laboratory) work. Indeed, subsequent animal studies have shown that such hazards were not found with recommended therapeutic doses of noscapine, requiring megadoses equivalent to 28,000 mg for a bodyweight of 70 kg before observing such effect. An in vitro study performed in 1991 by Smithkline Beecham Pharmaceuticals, UK, also concluded that noscapine does not pose a significant potential hazard for humans.45 The American Academy of Pediatrics considers that noscapine is usually compatible with breast-feeding.