Recreational ketamine use has risen sharply in the Netherlands, especially among young adults in nightlife settings, leading to more first aid incidents often involving combinations with alcohol or MDMA that increase toxicity. Acute intoxication causes agitation, hallucinations, nausea, tachycardia, and hypertension; frequent use can lead to long-term complications like ketamine-induced uropathy. Although ketamine is not currently part of standard toxicological screenings, including it could help diagnose mixed intoxications, rule out other causes, and support referrals to follow-up care, improving diagnostic accuracy and addressing health risks from its growing prevalence.
The novel phenethylamines 4-fluoroamphetamine (4-FA) and 2,5-dimethoxy-4-bromophenethylamine (2C-B) are among the ten most used new psychoactive substances among high-risk users, and their use is also common in people with depression, ADHD, and those engaging in risky sexual behavior. A systematic review of literature on interactions between these phenethylamines and antidepressants, ADHD medications, and antiretrovirals found very limited pharmacokinetic data; only one case report suggested a possible interaction between 4-FA and ADHD medication. Pharmacodynamic profiles indicate potential interactions between both 4-FA and 2C-B with antidepressants and ADHD medications, primarily involving monoamine oxidases for both substances, with monoamine transporters more specific to 4-FA.