Psychoactive “Bath Salts” Intoxication with Methylenedioxypyrovalerone

Ross, Edward A.; Reisfield, Gary M.; Watson, Mary C.; Chronister, Chris W.; Goldberger, Bruce A.

doi:10.1016/j.amjmed.2012.02.019

Cited by 132 publications

(86 citation statements)

References 14 publications

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“…MDPV is reported to have an onset of action of 15 to 30 min, although this is dependent on route of exposure [6]. It is felt to be more potent than mephedrone, and doses of 3 to 5 mg can produce psychoactive effects, although 10 to 15 mg is typically used [10]. Its duration of action is estimated to be 6 to 8 h, although some cite effects lasting 48 h [5,10], Some authors report a compulsion to redose MDPV to avoid the harsh, extremely unpleasant effects associated with resolution of intoxication [10].…”

Section: Mephedrone Is a β-Ketonated Amphetamine And Mdpv I S A P Y mentioning

confidence: 99%

“…It is felt to be more potent than mephedrone, and doses of 3 to 5 mg can produce psychoactive effects, although 10 to 15 mg is typically used [10]. Its duration of action is estimated to be 6 to 8 h, although some cite effects lasting 48 h [5,10], Some authors report a compulsion to redose MDPV to avoid the harsh, extremely unpleasant effects associated with resolution of intoxication [10]. This relative increased potency, delayed onset of action, and compulsion to redose may explain the increased prevalence of rhabdomyolysis seen in patients exposed to MDPV.…”

Section: Mephedrone Is a β-Ketonated Amphetamine And Mdpv I S A P Y mentioning

confidence: 99%

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Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants

et al. 2014

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Synthetic cathinones have emerged as popular drugs of abuse and produce sympathomimetic toxicity. It is unknown if rhabdomyolysis occurs more frequently following the use of synthetic cathinones compared to other stimulants. This retrospective study sought to determine the prevalence of rhabdomyolysis in patients with sympathomimetic toxicity and compare rates among patients using specific agents. Patients greater than 14 years of age with sympathomimetic toxicity and detection of a stimulant agent in urine via gas chromatography-mass spectroscopy (GC-MS) were included. Patients were excluded if clinical sympathomimetic toxicity was not present, a serum creatine kinase (CK) was not measured, or urine GC-MS was not performed. Rhabdomyolysis and severe rhabdomyolysis were defined as CK>1000 and 10,000 IU/L, respectively. Prevalence of rhabdomyolysis and severe rhabdomyolysis were reported. Logistic regression was performed to determine the relative effect in single-agent exposures of a synthetic cathinone compared to other sympathomimetics on rhabdomyolysis. A secondary outcome, a composite endpoint defined as need for mechanical ventilation, renal replacement therapy, development of compartment syndrome, or death, was also analyzed. One hundred two subjects met inclusion criteria; median age (IQR) was 32 (25-42)years with a range of 14-65 years; 74 % were male. Rhabdomyolysis occurred in 42 % (43/102) of subjects. Patients whose sympathomimetic toxicity could be ascribed to a single agent were considered for further statistical analysis and placed into four groups: methamphetamine (n=55), synthetic cathinone (n=19), cocaine (n=9), and other sympathomimetic (n=6). In 89 subjects with single stimulant exposure, the prevalence of rhabdomyolysis was as follows: synthetic cathinone, 12/19 (63 %); methamphetamine, 22/55 (40 %); cocaine, 3/9 (33 %); and other single agent, 0/6 (0 %). The occurrence of severe rhabdomyolysis (CK>10,000 IU/L) for each of the four groups was synthetic cathinone with 5/19 (26 %), methamphetamine with 2/55 (3.6 %), cocaine with 1/9 (11 %), and other with 0/6 (0 %). Median maximal CK (range) by groups was as follows: synthetic cathinone, 2638 (62-350,000+)IU/L; methamphetamine, 665 (61-50,233)IU/L; cocaine, 276 (87-25,614)IU/L; and other, 142 (51-816)IU/ L. A statistically significant difference (p=0.004) was found when comparing maximal CK among the four groups. Exposure to a synthetic cathinone compared with other sympathomimetics was associated with increased risk of developing rhabdomyolysis and severe rhabdomyolysis with odds ratios of 3.09 and 7.98, respectively. In this cohort of patients with sympathomimetic toxicity, 42 % developed rhabdomyolysis. Synthetic cathinones were associated with an increased risk of rhabdomyolysis and severe rhabdomyolysis compared with other stimulants.

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Section: Mephedrone Is a β-Ketonated Amphetamine And Mdpv I S A P Y mentioning

confidence: 99%

Section: Mephedrone Is a β-Ketonated Amphetamine And Mdpv I S A P Y mentioning

confidence: 99%

Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants

et al. 2014

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“…Two very popular synthetic cathinones are 3,4-methylenedioxymethcathinone (methylone) and 3,4-methylenedioxypyrovalerone (MDPV) (Spiller et al, 2011). Although low recreational doses of synthetic cathinones enhance mood and increase energy, high doses or chronic use can cause serious medical complications, including agitation, psychosis, tachycardia, hyperthermia, and even death (Prosser and Nelson, 2012;Ross et al, 2012). Because of these risks, methylone and MDPV have been classified as Schedule I controlled substances in the United States (DEA, 2011).…”

Section: Introductionmentioning

confidence: 99%

Effects of Social Interaction and Warm Ambient Temperature on Brain Hyperthermia Induced by the Designer Drugs Methylone and MDPV

Kiyatkin

Kim

Wakabayashi

et al. 2014

Neuropsychopharmacol

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3,4-Methylenedioxymethcathinone (methylone) and 3,4-methylenedioxypyrovalerone (MDPV) are new drugs of abuse that have gained worldwide popularity. These drugs are structurally similar to 3,4-methylenedioxymethamphetamine (MDMA) and share many of its physiological and behavioral effects in humans, including the development of hyperthermia during acute intoxication. Here, we examined the effects of methylone (1-9 mg/kg, s.c.) or MDPV (0.1-1.0 mg/kg, s.c.) on brain temperature homeostasis in rats maintained in a standard laboratory environment (single-housed in a quiet rest at 22 1C) and under conditions that model human drug use (social interaction and 29 1C ambient temperature). By simultaneously monitoring temperatures in the nucleus accumbens, temporal muscle, and facial skin, we assessed the effects of methylone and MDPV on intra-brain heat production and cutaneous vascular tone, two critical factors that control brain temperature responses. Both methylone and MDPV dose-dependently increased brain temperature, but even at high doses that induced robust locomotor activation, hyperthermia was modest in magnitude (up to B2 1C). Both drugs also induced dose-dependent peripheral vasoconstriction, which appears to be a primary mechanism determining the brain hyperthermic responses. In contrast to the powerful potentiation of MDMA-induced hyperthermia by social interaction and warm ambient temperature, such potentiation was absent for methylone and minimal for MDPV. Taken together, despite structural similarities to MDMA, exposure to methylone or MDPV under conditions commonly associated with human drug use does not lead to profound elevations in brain temperature and sustained vasoconstriction, two critical factors associated with MDMA toxicity.

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“…The desired effects of euphoria, increased energy, expanded consciousness, and increased libido begin rapidly, typically last for 3 to 4 hours, and are associated with considerable adverse effects. 1,4,[7][8][9] The duration of action is typically 2 hours or longer, although the actual half-life is difficult to ascertain due to a lack of pharmacokinetic evidence, the frequent presence of coingestants, and the possibility of undetermined contaminants. 3 Use is often continuous, with another dose taken as soon as the euphoria wanes.…”

Section: Discussionmentioning

confidence: 99%

“Bath salts” intoxication: a new recreational drug that presents with a familiar toxidrome

Hall

Heyd

Butler

et al. 2014

CJEM

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It is important for emergency physicians to be aware of new psychoactive agents being used as recreational drugs. ''Bath salts,'' which include 3,4-methylenedioxypyrovalerone (MDPV), mephedrone, and methylone, are the newest recreational stimulants to appear in Canada. There are currently more than 12 synthetic cathinones marketed as bath salts and used with increasing frequency recreationally. Although these drugs are now illegal in Canada, they are widely available online. We present a case report and discuss bath salts intoxication and its anticipated sympathomimetic toxidrome, treatment strategies, and toxicologic analysis, Treatment should not rely on laboratory confirmation. Since the laboratory identification of such drugs varies by institution and toxicologic assay, physicians should not misconstrue a negative toxicology screen as evidence of no exposure to synthetic cathinones. Illicit bath salts represent an increasing public health concern that involves risk to the user, prehospital personnel, and health care providers. RÉ SUMÉIl est important que les urgentologues connaissent les nouvelles substances psychoactives utilisé es comme drogues à usage ré cré atif. Les «sels de bain», qui contiennent de la 3,4-mé thylè nedioxypyrovalé rone (MDPV), de la mé phé -drone et de la mé thylone, sont les tout derniers stimulants à usage ré cré atif qui ont fait leur entré e au Canada. Il existe actuellement plus d'une douzaine de cathinones synthé -tiques, qui sont vendus comme des sels de bain et qui sont de plus en plus utilisé s à des fins ré cré atives. Bien que ces drogues soient maintenant illicites au Canada, on peut se les procurer facilement en ligne. Il y aura dans l'article un exposé de cas, suivi d'une discussion sur l'intoxication aux «sels de bain», le toxidrome sympathomimé tique pré visible, les straté gies de traitement et les analyses toxicologiques. Le traitement ne devrait pas reposer sur la confirmation des ré sultats des examens de laboratoire. Comme l'identification de ces drogues par les laboratoires varie d'un é tablissement à l'autre et selon les é preuves de dosage toxicologique, les mé decins ne devraient pas interpré ter à tort un test de dé pistage toxicologique né gatif comme un signe d'absence d'exposition à des cathinones synthé tiques. Les sels de bain illicites posent un problè me de santé publique, qui prend de l'ampleur et qui pré sente des risques pour l'utilisateur luimê me, pour le personnel pré hospitalier et pour les fournisseurs de soins de santé .

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Psychoactive “Bath Salts” Intoxication with Methylenedioxypyrovalerone

Cited by 132 publications

References 14 publications

Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants

Prevalence of Rhabdomyolysis in Sympathomimetic Toxicity: a Comparison of Stimulants

Effects of Social Interaction and Warm Ambient Temperature on Brain Hyperthermia Induced by the Designer Drugs Methylone and MDPV

“Bath salts” intoxication: a new recreational drug that presents with a familiar toxidrome

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