REVIEW Arecoline is a natural product, an alkaloid found in the areca nut, the fruit of the areca palm (Areca catechu). In many Asian cultures, the areca nut is chewed along with betel leaf to obtain a stimulating effect. Betel quid chewing is an ancient practice common in many countries of Asia and among migrated communities in Africa, Europe and North America. It enjoys complete social acceptance in many societies and is also popular among women. In its most basic form, betel quid consists of betel leaf (Piper betel), areca nut, the main psychoactive ingredient, and slaked lime (calcium hydroxide). Areca nut is said to be the fourth most commonly used psychoactive substance in the world, after caffeine, nicotine and alcohol.
Arecoline has been shown to be the primary active ingredient in areca nut responsible for the central nervous system effects of the areca nut. Arecoline is a partial agonist of muscarinic acetylcholine M1, M2, M3 receptors and M4,which is believed to be the primary cause of its parasympathetic effects (such as pupillary constriction, bronchial constriction, etc.). Owing to its muscarinic and nicotinic agonist properties, arecoline has shown improvement in the learning ability of healthy volunteers. Since one of the hallmarks of Alzheimer's disease is a cognitive decline, arecoline was suggested as a treatment to slow down this process and arecoline administered intravenously did indeed show modest verbal and spatial memory improvement in Alzheimer's patients However, due to arecoline's possible carcinogenic properties, it is not the first drug of choice for this degenerative disease. Efforts have been undertaken to improve on arecoline drug properties through modification of the core structure, and in particular use of biosteres to replace the labile methyl ester. Arecoline has also been used medicinally as an antihelmintic (a drug against parasitic worms).
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