Dark Classics in Chemical Neuroscience: An Evidence-Based Systematic Review of Belladonna

Belladonna has diverse pharmacotherapeutic properties with shadowy history of beauty, life, and death. Alkaloids present in belladonna have anti-inflammatory, anticholinergic, antispasmodic, mydriatic, analgesic, anticonvulsant, antimicrobial, which makes it widely applicable for the treatment of various diseases. However, due to its associated toxicity, the medicinal use of belladonna is debatable. Therefore, an evidence-based systematic review was planned to elucidate the pharmacotherapeutic potential of belladonna. A comprehensive literature search was performed in PubMed, MEDLINE, Cochrane database, Embase, and ClinicalTrial.gov using keywords 'belladonna' or 'belladonna and clinical trials' or 'safety and efficacy of belladonna'. Articles published from 1965 to 2020, showing the efficacy of bel-ladonna in diverse clinical conditions were included. The quality of evidence was generated using GRADE approach and twenty studies involving 2302 patients were included for the systematic review. Our analyses suggest that belladonna treatment appears to be safe and effective in various disease conditions including acute encephalitis syndrome, urethral stent pain, myocardial ischemia injury, airway obstructions during sleep in infants, climacteric complaints, irritable bowel syndrome, and throbbing headache. However, the better understanding of the dosage, toxicity of tropane alkaloids of belladonna could make it efficient remedy for treating diverse medical conditions.