New psychoactive substances (NPS) and serotonin syndrome onset: A systematic review.
Fabrizio Schifano, Stefania Chiappini, Andrea Miuli, John Martin Corkery, Norbert Scherbaum, Flavia Napoletano, Davide Arillotta, Caroline Zangani, Valeria Catalani, Alessandro Vento, Mauro Pettorruso, Giovanni Martinotti, Di Giannantonio Massimo, Amira Guirguis
Experimental Neurology May 1, 2021 DOI: 10.1016/j.expneurol.2021.113638 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Case report Peer reviewed |
|---|---|
| Population | Human subjects from three retrospective studies, two case series, and five case reports |
| Topics | Serotonin |
| Keywords | Bupropion New psychoactive substances Phenethylamines Serotonin syndrome Synthetic cathinones Severe serotonin over-activation Dangerous condition Various nps |
| Citations | 49 |
| Key findings | Several NPS, including psychedelic phenethylamines, synthetic cathinones, and bupropion, are associated with serotonin syndrome. |
Abstract
The use of several new psychoactive substances (NPS) has become very popular and is posing global health risks. Chemically and pharmacologically diverse molecules are constantly emerging and are presenting with a wide range of clinical implications. Serotonin toxicity, and specifically Serotonin Syndrome (SS), might develop as a result of an over-activation of the serotoninergic system caused by several mechanisms resulting in a classic triad of altered mental status, neuromuscular effects, and autonomic hyperactivity. In the present systematic review, we have investigated and summarized the available evidence related to the association between SS and NPS intake. Three retrospective studies, two case series and five case reports were included in this systematic review; several NPS were found to be implicated in SS occurrence These include psychedelic phenethylamines, e.g. 2, 5-dimethoxy-4-iodophenethylamine (2C-I); 2-(4-Iodo-2,5-dimethoxyphenyl)- N-I[(2-methyoxyphenyl)methyl]ethanamine (25I-NBOMe); and 5-(2-aminopropyl)indole (5-IT); and synthetic cathinones, e.g. mephedrone; 3,4-methylenedioxypyrovalerone (MDPV); methylone; butylone; NRG3; alpha-methyltryptamine (AMT); methoxphenidine (MXP); and the antidepressant bupropion. Bupropion was here misused at high dosages and/or in combination with other licit/illicit serotonergic drugs. Whilst most substances were ingested orally, nasal insufflation (with both 5-IT and 2C-I) and sublingual administration of blotter paper (with 25I-NBOMe) were reported as well. Interestingly, the psychiatric history was negative for most subjects, apart from two cases. Clinicians should be aware of NPS potential risks and the severe consequences of their recreational use, including SS. Also, due to their undetectability in routine and common drug screenings, the diagnostic challenges posed by NPS should not be underestimated during the treatment of such patients.
Comparable studies
Other systematic reviews and meta-analyses on serotonin, most cited first.
Citations in the library
Cited by 15
- The promises and perils of psychedelic pharmacology for psychiatry. Nature Reviews Drug Discovery June 1, 2022
- The effects of psilocybin on cognitive and emotional functions in healthy participants: Results from a phase 1, randomised, placebo-controlled trial involving simultaneous psilocybin administration and preparation Journal of Psychopharmacology 2022
- Seeking the Psilocybiome: Psychedelics meet the microbiota-gut-brain axis. International journal of clinical and health psychology : IJCHP 2023
- Ibogaine/Noribogaine in the Treatment of Substance Use Disorders: ASystematic Review of the Current Literature Current Neuropharmacology October 20, 2022
- Drugs Used in "Chemsex"/Sexualized Drug Behaviour-Overview of the Related Clinical Psychopharmacological Issues. Brain Sciences April 22, 2025
and 10 more in the library
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and 13 more in the library