Salvia toxicity

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Salvia divinorum
  • Historically used by shamans in rituals
  • Active ingredient: Salvinorin A
  • Kappa opioid receptor agonist and D2 agonist
  • Hallucinogen
  • Dissociative effects similar to ketamine
  • Tea: 10 min onset, duration 30-90 min
  • Smoked: 1-2 minute onset, tapers over 10-20 min and may last up to 1-2 hours
  • Does not appear on typical tox screens

Clinical Features

  • Uncontrollable laughter
  • Intense hallucinations
  • Diaphoresis
  • Sensations of motion, lights, visions, overlapping realities
  • Low toxicity, little hangover, low abuse potential
  • Few reports of psychosis and suicide associated with use

Differential Diagnosis


Serotonin-Like Agents


Dissociative Agents

Plant-based Hallucinogenics

  • Marijuana
  • Salvia
  • Absinthe
  • Isoxazole Mushrooms
  • Hawaiian baby woodrose (Argyreia nervosa)
  • Hawaiian woodrose (Merremia tuberosa)
  • Morning glory (Ipomoea violacea)
  • Olili- uqui (Rivea corymbosa)

Organic causes

Other Toxicologic Causes

Psychiatric Causes [1]


  • Supportive
  • Benzodiazepines as needed
  • Most patients will have symptoms resolve prior to ED arrival given short duration of action

See Also


  1. Visual Hallucinations: Differential Diagnosis and Treatment. PMID PMC2660156