Clinical toxicology (Philadelphia, Pa.)
January 1, 2016
Ruud P. W. Litjens, Tibor M. Brunt
74 citations
Ibogaine, a psychoactive alkaloid from the African shrub Tabernanthe iboga, is unlicensed but used to treat addiction. It is metabolized mainly by CYP2D6 to noribogaine, which persists for days. Both compounds interact with multiple neurotransmitter systems. In rats, neurotoxicity occurs at doses above 25 mg/kg intraperitoneal, likely via excitotoxic effects on cerebellar Purkinje cells. Cardiotoxicity arises from blockade of hERG potassium channels, prolonging the QT interval and causing arrhythmias and sudden cardiac arrest. Twenty-seven fatalities have been reported; eight case studies show ventricular tachyarrhythmias in individuals without pre-existing heart conditions. Noribogaine appears at least as cardiotoxic as ibogaine. CYP2D6 polymorphism and concurrent medications increase risks. Without medical supervision, further deaths are likely.
Clinical toxicology (Philadelphia, Pa.)
February 1, 2019
Michael J Moss, Robert G Hendrickson
41 citations
Ingestion of mushrooms containing ibotenic acid and muscimol often causes gastrointestinal upset, central nervous system excitation, and central nervous system depression, alone or in combination. In a review of 34 cases reported to a US regional poison center from 2002-2016, Amanita pantherina ingestion led to more symptoms than Amanita muscaria: gastrointestinal symptoms in 80% vs. 35%, central nervous system depression in 70% vs. 35%, and central nervous system excitation in 70% vs. 35%. Five patients required intubation; no deaths, seizures, or organ injuries occurred. Among accidental pediatric ingestions, 25% were symptomatic.
Clinical toxicology (Philadelphia, Pa.)
July 1, 2009
Kristian Björnstad, Peter Hultén, Olof Beck et al.
35 citations
Over a 4-year period, 103 urine samples from mainly young people (age range 13-52 years, median 19) were collected at emergency wards in Sweden from patients who admitted or were suspected of ingesting psychoactive plant materials. Among 53 cases where ingestion of any of 11 plant-derived substances was admitted or suspected, 41 (77%) were confirmed by bioanalytical methods. Psilocin from hallucinogenic mushrooms was the most frequent drug, accounting for 54% of cases. The most common means of drug acquisition (56%) was purchase over the Internet. Having bioanalytical methods for detection of plant-derived psychoactives is important for clinical toxicology services.
Clinical toxicology (Philadelphia, Pa.)
January 1, 2022
Romain Pelletier, Brendan Le Daré, Loic Grandin et al.
22 citations
A 37-year-old man with a history of drug abuse was found unconscious with bags of powder labeled as research chemicals and traces of powder on his nose. He was rehydrated, intubated, and admitted to the intensive care unit. Urine analysis identified several new psychoactive substances, including high concentrations of 3-OH-PCP (12,085 mg/L) and 3-MeO-PCP (1,100 mg/L), along with 2F-DCK, N-ethylhexedrone, and CMC. Molecular networking, a bioinformatic approach, confirmed that the powders in the bags matched the substances found in the patient's urine. This case demonstrates how molecular networking can aid in sample comparison, target quantification methods, and support treatment decisions for intoxications involving arylcyclohexylamine compounds.
Clinical toxicology (Philadelphia, Pa.)
September 1, 2017
Maren Hermanns-Clausen, Verena Angerer, Josephine Kithinji et al.
22 citations
A 42-year-old man accidentally ingested 25I-NBOMe, a potent hallucinogenic drug, after taking a sip of pediatric analgesic syrup that had been refilled with a self-made solution of the drug in ethanol. Within 30 minutes he became restless, and in the emergency department he showed dilated pupils, heavy sweating, disorientation, agitation, and later severe agitation, coenesthesia, and complex hallucinations. Blood tests at admission detected 25I-NBOMe (34 ng/mL), its metabolite 2C-I (12 ng/mL), and 25I-NBOH (<1 ng/mL). The syrup contained 2800 μg/mL of 25I-NBOMe. Symptoms resolved after six hours without complications. The presence of 2C-I 50 minutes after intake suggests rapid metabolic breakdown of 25I-NBOMe via first-pass metabolism.
Clinical toxicology (Philadelphia, Pa.)
July 1, 2017
Marieke Henstra, Liza Wong, Abdel Chahbouni et al.
13 citations
A single patient who took ibogaine, an unapproved anti-addictive agent, developed a severely prolonged QTc interval of 647 milliseconds and multiple cardiac arrhythmias, including atrial tachycardia, ventricular tachycardia, and Torsades de Pointes. The QTc prolongation persisted for 12 days after ingestion, even after ibogaine plasma levels had become low. A newly developed LC-MS/MS method measured ibogaine and noribogaine concentrations, revealing that noribogaine, the metabolite, remained at clinically relevant levels long after ibogaine cleared. A linear relationship was found between noribogaine concentration and the prolonged cardiac effects, implicating the metabolite rather than the parent drug in the extended duration of cardiac arrhythmia risk.
Clinical toxicology (Philadelphia, Pa.)
October 1, 2019
Chuan-Huai Liu, Wei-Lan Chu, Shu-Chen Liao et al.
10 citations
Two patients developed N,N-dimethyltryptamine (DMT) poisoning after consuming an herbal stew made from Syrian rue seeds (containing monoamine oxidase inhibitors) and Acacia tree bark (containing DMT). Laboratory analysis confirmed DMT and harmaline in their blood and urine. One patient had detectable DMT in serum (25 ng/mL) and more severe symptoms, including altered consciousness, rhabdomyolysis, and elevated liver enzymes, while the other had undetectable serum DMT and milder effects. The combination mimics taking DMT with a monoamine oxidase inhibitor, producing sympathomimetic toxicity. Physicians should consider unusual herbal preparations as potential causes of drug-drug interactions and poisoning.
Clinical toxicology (Philadelphia, Pa.)
August 1, 2024
Richard C Dart
9 citations
Ketamine and esketamine, though pharmacologically similar, differ sharply in misuse patterns due to their regulation and availability. Ketamine, with few restrictions and wide availability including as an illicit drug, shows increasing misuse and abuse. Esketamine, despite rising use, has rigorous prescribing restrictions and is difficult to detect in postmarket surveillance, with no increase in misuse. This natural experiment suggests that regulatory controls, not pharmacology, limit misuse. The findings call for reevaluating ketamine's regulation and offer lessons for introducing new psychedelics.
Clinical toxicology (Philadelphia, Pa.)
April 1, 2024
Rachael Wilkes, Darren M Roberts, Paul Liknaitzky et al.
8 citations
Calls to the New South Wales Poisons Information Centre about classical psychedelics more than doubled from 45 in 2014 to 105 in 2022, with 737 total calls over nine years. Most calls involved LSD (48%) or psilocybin (47%); 85% came from or were referred to a hospital. Co-ingestion with other substances occurred in 34% of calls. Among single-substance exposures, common clinical features were hallucinations (28%), gastrointestinal symptoms (22%), and tachycardia (18%); seizures occurred in 3%. The increase likely reflects growing community use, possibly driven by interest in psychedelic-assisted therapy trials. Toxicity was relatively high compared to clinical trial safety, which may be due to uncontrolled community use.
Clinical toxicology (Philadelphia, Pa.)
January 1, 2013
M Mutseura, D Tagwireyi, L L Gadaga
7 citations
Pre-treatment with the serotonin antagonist cyproheptadine dose-dependently reduced mortality and toxicity from Boophone disticha poisoning in mice. Mortality dropped from 80% in untreated mice to 30% in groups given 15 or 20 mg/kg cyproheptadine, and median survival times increased significantly. The drug also lessened other toxic symptoms. These findings support the hypothesis that central nervous system serotonin overdrive underlies B. disticha toxicity, which is used in traditional Southern African medicine but can cause poisoning and death.
Clinical toxicology (Philadelphia, Pa.)
March 1, 2023
Daniel L Sudakin
6 citations
Oregon's 2023 laws regulating psilocybine services require licensed facilities and trained facilitators for supervised sessions. A clinical toxicologist's commentary reviews the final rules, highlighting issues such as non-clinical facilitators' scope of practice, prevention and management of adverse drug reactions, and toxicological uncertainties about dosing for people with mental health or other medical conditions. The commentary also addresses common misperceptions about the program and outlines challenges clinical toxicologists may face as psilocybine legislative reform advances across the United States.
Clinical toxicology (Philadelphia, Pa.)
June 17, 2025
Antoinette J H P van Riel, Wouter M H van der Sanden, Laetitia M O de Kort
4 citations
Recreational ketamine use in the Netherlands has risen sharply from 2018 to 2024, with poison center calls about ketamine intoxication increasing from 33 to 139 per year. A dedicated urology clinic saw patients with ketamine-induced bladder damage grow from zero to 137 over the same period. Long-term, high-dose use (over 1 gram daily for a median of 35 months, median 18 grams per week) was linked to urological complaints. Most affected users were men in their twenties, and the majority also used other drugs or alcohol. Severe cases required surgery, including bladder removal in three patients. The findings highlight a growing public health concern requiring awareness among users and healthcare providers.
Clinical toxicology (Philadelphia, Pa.)
March 1, 2025
Ella P Edwards, Laurence A Gray, Muhammad E M O Elamin et al.
2 citations
Ibogaine, a psychoactive alkaloid from the West African shrub Tabernanthe iboga, is not licensed in the UK but is used by individuals to self-treat drug or alcohol use. A retrospective analysis of telephone enquiries to the UK National Poisons Information Service from 2012 to 2022 identified eleven enquiries about seven patients, all symptomatic and using ibogaine recreationally. Doses ranged from 5g to 34g. Seven patients had neurological symptoms and six had cardiotoxicity, including cardiac arrest, hypoxia, torsade de pointes, and QT prolongation. The findings indicate that ibogaine can cause severe cardiotoxicity and neurological harm, especially when used in variable, unregulated doses.
Clinical toxicology (Philadelphia, Pa.)
March 1, 2025
1 citation
When 3,4-methylenedioxymetamfetamine (MDMA) is taken with alcohol, emergency department visits show higher odds of agitation, drowsiness, and vomiting compared to MDMA alone. Co-intoxication with other substances increases odds of bradycardia, psychosis, and coma. Mortality rates remain low across all groups. Female patients report less chest pain but more vomiting, headache, and hypotension than males. These variations suggest that physicians should consider both the type of co-intoxication and patient sex to optimize treatment.
Clinical toxicology (Philadelphia, Pa.)
March 1, 2025
Mirte J Zuidema, Elles Reimerink, Dena Akhoundzadeh et al.
1 citation
Among critically ill patients with MDMA intoxication admitted to an intensive care unit in Amsterdam between 2010 and 2020, the most common reason for admission was a threatened airway due to trismus (jaw clenching), occurring in 47% of cases, which often led to respiratory acidosis. Hyponatraemia occurred in 39% of patients, and hyperthermia in 11%. Patients with hyperthermia frequently developed severe complications such as rhabdomyolysis, acute kidney injury, and liver failure. The median correction of serum sodium was greater than European guidelines recommend, but no osmotic demyelination was reported. Overall, 4% of the 74 patients died, though most recovered fully.