Acute toxicity associated with the recreational use of the ketamine derivative methoxetamine.
David M Wood, Susannah Davies, Malgorzata Puchnarewicz, Atholl Johnston, Paul I Dargan
European Journal of Clinical Pharmacology May 1, 2012 DOI: 10.1007/s00228-011-1199-9 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 3 |
| Population | Patients aged 28 to 42 years presenting to an Emergency Department with acute methoxetamine toxicity |
| Intervention | low-dose benzodiazepines |
| Topics | Esketamine Ketamine |
| Key findings | Analytically confirmed methoxetamine use is associated with acute toxicity featuring both dissociative and sympathomimetic clinical features. |
Abstract
Long-term regular use of ketamine has been reported to be associated with severe symptomatic urinary tract problems. Methoxetamine, an arylcyclohexylamine derivative of ketamine, is marketed as a "bladder safe" derivative of ketamine, and no cases of acute toxicity following analytically confirmed methoxetamine use have been reported to date. We report here a case series of three individuals with acute toxicity related to the analytically confirmed use of methoxetamine. Three patients aged between 28 and 42 years presented to the Emergency Department (ED) on unrelated occasions having used methoxetamine. Clinical features were suggestive of a "dissociative/catatonic" state similar to that seen with ketamine; in addition, they had clinical features of acute sympathomimetic toxicity with significant tachycardia and hypertension. All were managed with low-dose benzodiazepines and discharged home once their symptoms/signs had settled. TOXICOLOGICAL SCREENING: Serum collected at the time of presentation to the ED was analysed qualitatively and quantitatively by gas chromatography-mass spectrometry. Serum concentrations ranged from 0.09 to 0.2 mg/L; in addition, detectable levels of 6-APB/5-APB were found in one of the patients. These three analytically confirmed cases demonstrate that acute methoxetamine-related toxicity is associated with both "dissociative" and "sympathomimetic" clinical features. The information from these three cases is useful to clinical pharmacologists, not only in managing individuals with acute methoxetamine toxicity but also in advising the appropriate legislative authorities on the risk of acute harm related to methoxetamine use. Further work is needed to determine whether methoxetamine is more "bladder friendly" than ketamine, as has been suggested by those marketing methoxetamine.
Comparable studies
Other case reports and case series on ketamine, most cited first.
Citations in the library
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- Designer drugs: mechanism of action and adverse effects Archives of Toxicology April 1, 2020
- From PCP to MXE: a comprehensive review of the non-medical use of dissociative drugs. Drug Testing and Analysis 2014
- The ketamine analogue methoxetamine and 3- and 4-methoxy analogues of phencyclidine are high affinity and selective ligands for the glutamate NMDA receptor. PLoS One June 14, 2016
- From “Special K” to “Special M”: The Evolution of the Recreational Use of Ketamine and Methoxetamine CNS Neuroscience & Therapeutics June 1, 2013
- Monitoring new psychoactive substances (NPS) in The Netherlands: data from the drug market and the Poisons Information Centre. Drug and Alcohol Dependence February 1, 2015
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Cites 3
- The destruction of the lower urinary tract by ketamine abuse: a new syndrome? British Journal of Urology August 1, 2008
- The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use. Emerging health threats journal April 15, 2011
- Cystitis due to the use of ketamine as a recreational drug: a case report. Journal of Medical Case Reports June 26, 2008