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Targeting the Nervous System
Published in Nathan Keighley, Miraculous Medicines and the Chemistry of Drug Design, 2020
A compound called 3,4-Methyl enedioxymethamphetamine (MDMA), widely known as ecstasy, acts as a releasing agent of neurotransmitters, namely serotonin, norepinephrine, and dopamine, which control mood and behaviour. These compounds are associated with release of the hormone oxytocin, which is implicated in the experiential qualities of the drug. Para-methoxyamphetamine (PMA), like ecstasy, is serotonergic but takes longer to achieve the same effects. It may be sold instead of, or mixed with, MDMA because it is synthesised from more readily available starting materials (anisole) rather than the natural plant extract safrole, as with MDMA. What are the consequences of this? PMA is slower acting than MDMA; it takes much longer than 30 min for any effect and 3 hrs to reach maximum plasma levels; MDMA takes half this time, but the half-lives of the two are similar. Consequently, multiple dosing is common when the expected effects fail to occur quickly. Furthermore, the potency of PMA is 5–10 times that of MDMA; acting to both release serotonin and inhibit breakdown of the neurotransmitter, so low doses (plasma levels of 0.5 mg L−1) cause serious elevated body temperature, resulting in overdose death. To put this in perspective, a typical 100 mg tablet of ‘ecstasy’ comprising 50 mg PMA will give a plasma PMA concentration of ca. 0.25 mg L−1 in other words two doses are likely to be fatal. Given that the user expects the rapid results of MDMA, when this fails to happen, multiple dosing will be a temptation.
Licit and illicit drugs
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
In recent years, these distinctions have become blurred, as both dissociative anaesthetics and designer amphetamines such as MDMA (3,4-methylenedioxymethamphetamine, commonly known as ecstasy) (Figure 24.16), share some properties with the hallucinogens. The most important distinction appears to be that, at worst, use of hallucinogens leads only to behavioural toxicity. However, the hallucinatory ‘designer’ amphetamines have been responsible for many deaths, often a result of hyperthermia and multiorgan failure. PMA (paramethoxyamphetamine) appears to be the most dangerous member of this latter group.
Medical Consequences of the Use of Hallucinogens: LSD, Mescaline, PCP, and MDMA (“Ecstasy”)
Published in John Brick, Handbook of the Medical Consequences of Alcohol and Drug Abuse, 2012
Timothy Wiegand, Dung Thai, Neal Benowitz
MDMA often contains adulterants or is misrepresented and replaced with another substance entirely. Common adulterants include: methamphetamine, amphetamine, caffeine, dextromethorphan, ketamine, ephedrine, pseudoephedrine, and prior to the FDA banning of its sale, phenylpropanolamine. PMA (paramethoxyamphetamine) has been sold as MDMA and several deaths due to hyperthermia and subsequent multiorgan system failure after ingestion of PMA have been reported (Dams et al., 2003; Martin, 2001).
Deaths related to MDMA (ecstasy/molly): Prevalence, root causes, and harm reduction interventions
Published in Journal of Substance Use, 2018
On the other hand, some underground manufacturers of ecstasy and molly use chemicals that are cheaper and more readily available than MDMA to turn a higher profit (Henry, Jeffreys, & Dawling, 1992). Although some of these other substances (e.g., 3,4-methylenedioxyamphetamine [MDA], Pentylone, and N-Ethyl-Pentylone) can resemble MDMA in their effects, studies point to many of these substitutes being more toxic than MDMA (Felgate, Felgate, James, Sims, & Vozzo, 1998; Winstock et al. 2002). PMA (paramethoxyamphetamine), a common adulterant, is sometimes used in lieu of MDMA because it causes the stimulation of the central nervous system and provides hallucinogenic effects (Bryson, 1996). But not much is known about PMA’s effects on humans (Kraner et al., 2001). Since PMA was placed into the schedule I list of the Controlled Substances Act, human research has been conducted only sparingly. However, PMA is considered to be more toxic and a more potent stimulant than MDMA (Byard, James, Gilbert, & Felgate, 1999; Felgate et al., 1998). In fact, some findings suggest that dosages of PMA above 0.5 mg can be toxic and cause death (Kraner et al., 2001). In some cases, drugs purported to be ecstasy or molly may have no MDMA content whatsoever (Center for Substance Abuse Research, 2002). The unpredictable purity of ecstasy and molly contribute to MRDs because users are not able to accurately gauge MDMA content or the presence of other potentially harmful adulterants.
Supraventricular tachycardia with the use of phentermine: case report and review of literature
Published in Postgraduate Medicine, 2021
Sundeep Kumar, Akhil Mogalapalli, Ruthvik Srinivasamurthy, Sayed T. Hussain, Philip L. Mar
The cardiac toxicity of phentermine has not been thoroughly studied. Most of the purported cardiotoxic effects of phentermine are derived from methamphetamine abuse or amphetamine derivatives such as 3,4-methylenedioxymethamphetamine (‘ecstasy’). Reported cardiac toxic effects of these drugs include various arrhythmias, heart failure, myocardial infarction, and cardiomyopathy [7,8]. There have been some case reports documenting significant arrhythmias related to amphetamine use. One case series looked at 22 patients that presented with paramethoxyamphetamine toxicity, a recreational stimulant, and five out of 22 patients were found to have various arrhythmias (supraventricular tachycardia, atrial fibrillation, and multifocal ventricular ectopic beats) [8].
Prevalence of Stimulant, Hallucinogen, and Dissociative Substances Detected in Biological Samples of NPS-Intoxicated Patients in Italy
Published in Journal of Psychoactive Drugs, 2021
Pietro Papa, Antonella Valli, Marcello Di Tuccio, Eleonora Buscaglia, Elena Brambilla, Giulia Scaravaggi, Mariapina Gallo, Carlo Alessandro Locatelli
Phenylethylamines. PMMA, aminopropyl-benzofuran isomers (APB-isomers) and methylphenidate/analogues were identified in 10 patients (0.69% of total cases, 4.06% of positives). PMMA and its metabolite paramethoxyamphetamine (PMA) were detected in five cases, during the period 2012–2014. One case tested positive for PMMA only, another for PMMA and ketamine, and 3 for PMMA and 3,4 methylendioxy-methamphetamine (MDMA). In four cases, immunoenzymatic urine test resulted positive also to amphetamine and ecstasy screening, but the second level analysis (LC-MS-MS) confirmed the presence of MDMA in three cases only. Being PMMA and PMA the 4-methoxy analogue of methamphetamine and amphetamine, respectively, their cross-reactivity to the immunoassay kits for amphetamine/ecstasy is a matter of fact (Regester et al. 2015) . Moreover, “ecstasy” tablets could contain PMMA/PMA instead of, or with, MDMA, and clinical manifestation of PMMA and PMA are similar to those of MDMA, but are usually more severe and even lethal (Johansen et al. 2003; Nicol et al. 2015). In our casuistry, the patients were unable to report the substance taken or they generically referred to ecstasy consumption. Consequently, the use of a chromatographic method coupled to MS detector has been mandatory for a correct diagnosis of intoxication. One case refers to a lethal intoxication (Locatelli et al. 2016) involving PMMA (blood concentration: 615 ng/ml PMMA and 91 ng/ml PMA). In this case the blood sample was also positive for MDMA (192 ng/ml), cocaine (21 ng/ml), and tramadol (88 ng/ml), and the analysis (GC-MS) of a residue of the tablet consumed by the patient revealed the presence of PMMA (25 mg) and MDMA (11 mg).