Acute toxicity associated with the recreational use of the novel dissociative psychoactive substance methoxphenidine

Abstract

INTRODUCTION:Methoxphenidine is a novel dissociative designer drug of the diarylethylamine class which shares structural features with phencyclidine (PCP), and is not at present subject to restrictive regulations. There is very limited information about the acute toxicity profile of methoxphenidine and the only sources are anonymous internet sites and a 1989 patent of the Searle Company. We report a case of analytically confirmed oral methoxphenidine toxicity. CASE DETAILS: A 53-year-old man was found on the street in a somnolent and confusional state. Observed signs and symptoms such as tachycardia (112 bpm), hypertension (220/125 mmHg), echolalia, confusion, agitation, opisthotonus, nystagmus and amnesia were consistent with phencyclidine-induced adverse effects. Temperature (99.1°F (37.3°C)) and peripheral oxygen saturation while breathing room air (99%) were normal. Laboratory analysis revealed an increase of creatine kinase (max 865 U/L), alanine aminotransferase (72 U/L) and gamma-glutamyl transpeptidase (123 U/L). Methoxphenidine was identified by a liquid chromatography tandem mass spectrometry toxicological screening method using turbulent flow online extraction in plasma and urine samples collected on admission. The clinical course was favourable and signs and symptoms resolved with symptomatic treatment. CONCLUSION: Based on this case report and users' web reports, and compatible with the chemical structure, methoxphenidine produces effects similar to those of the arylcyclohexylamines, as PCP. Running headAcute toxicity associated with the recreational use of methoxphenidine.The paper is written in UK English. Word count (excluding references, figures, and abstract): 1536References: 15 diarylethylamine, drug of abuse, NMDA receptor, designer drug, phencyclidine, ketamine, psychedelic, 2-MeO-diphenidine Declarations of interestNone of the authors has conflicts of interest concerning commercial or financial involvements. No author is affiliated with an organization whose financial interests may be affected by material in the manuscript.2 AbstractIntroduction: Methoxphenidine is a novel dissociative designer drug of the

A Case of Nonfatal Intoxication Associated with the Recreational use of Diphenidine

“…The commonly recorded clinical features were hypertension, tachycardia, anxiety, and altered mental status including confusion, disorientation, dissociation, and/or hallucinations. The same symptoms were reported by Hofer et al in an intoxication case associated with the use of methoxphenidine. A case of acute and lethal intoxication related to the simultaneous consumption of the synthetic cannabinoids AB‐CHMINACA, 5‐fluoro‐AMB, and diphenidine was also reported in the literature .…”

Severe rhabdomyolysis and acute kidney injury associated with methoxphenidine

“…Patient's clinical presentation, including somnolence, hypertension, amnesia and slurred speech, was consistent with its exposure. [2,3] Mild rhabdomyolysis has been reported in a case of methoxphenidine abuse with opisthotonus, [2] but it was not seen in our patient. Arguably, the other drugs detected in the patient's urine might also be contributory, but only small peaks were found.…”

“…Little is known about its pharmacology and only a few cases of toxicity have been reported. [2][3][4] We report a case of severe rhabdomyolysis and acute kidney injury (AKI) associated with its exposure.…”

Ephenidine, diphenidine, and methoxphenidine complications reported to the French Addictovigilance Network

“…The clinical cases reported in the literature concerned mainly methoxphenidine and diphenidine intoxications, with fatal outcome (death) related to methoxphenidine and diphenidine abuse in six cases [13][14][15][16][17][18][19][20]. These patients were always polysubstance consumers with associated intake of multiple NPS (synthetic cathinones, synthetic cannabinoids), with the exception of three cases of methoxphenidine intoxication, with high femoral blood concentrations of the drug (case 1: 24 mg/L, case 2: 2 mg/L, case 3: 1.36 mg/L) [17].…”