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Adrian Stoller, Patrick C. Rentsch, Aristomenis K. Exadaktylos, Matthias E. These compounds can differ ificantly in receptor affinity, potency and duration of action, and an important structural difference is the ligand in the 4 position of the phenyl ring, such as propyl in 2C-P or bromine in 2,5-dimethoxybromophenethylamine 2C-B.
The 2C drugs are known for their hallucinogenic properties. We present a case of a year-old male admitted to the emergency department with severe hallucinations, mydriasis, tachycardia, agitation and confusion following the use of a substance sold as 2C-B. By using liquid chromatography—mass spectrometry, the more potent substance 2C-P was detected and quantified. On the basis of two blood sample concentrations, the estimated elimination half-life was 19 h. This case report illustrates and discusses the differences in potency and duration of action of 2C drugs.
Many novel psychoactive substances NPS have emerged in recent years in response to market trends and legislative control 1. In total, 81 NPS were detected for the first time in a single year in Europe in and in 2.
NPS are typically not detectable with the usual drug of abuse immunoassays. They may therefore contribute to acute toxicities and medical complications, or even deaths, but escape detection. Small modifications in the chemical structure can dramatically change the pharmacological, psychoactive and toxicological properties, thus making it difficult to predict the s and symptoms of acute intoxication with NPS 3 — 5.
The 2C drugs are a subgroup of the phenethylamines, with primarily hallucinogenic properties, while the better-known alpha-methyl-phenethylamines or short: amphetamines include related substances such as amphetamine, methamphetamine and 3,4-methylenedioxymethamphetamie MDMA 3.
We now present a case of intoxication with analytical confirmation of 2C-P 2,5-dimethoxy n -propylphenethylaminesold and thus mistaken as the less potent 2C-B 2,5-dimethoxybromophenethylamine. The patient was not violently aggressive on presentation but was shouting wildly and was using an aerosol can erratically.
Due to his confusion, it was not possible Buy 2c t 7 online obtain a medical history. The patient was clearly hallucinating, repeated a sentence stereotypically, expressed fear, and was unable to follow instructions. The rest of the cardiopulmonary, abdominal and neurological examination was unremarkable, with normal deep tendon reflexes and blood pressure and no diaphoresis.
Routine laboratory tests—including liver and renal parameters as well as a complete blood count on presentation—showed marked leucocytosis Following administration of benzodiazepines and haloperidol i. The latter was attributed to iatrogenic administration of midazolam and diazepam. An additional analysis of serum samples using multi-dimensional liquid chromatography coupled with mass spectrometry LC—MS revealed 2C-P, while 2C-B, the compound initially thought to have been taken, was not detected.
The concentrations of 2C-P in two samples taken at and AM, were MDMA-like entactogenic effects, including increases in well-being, have also been reported 7. Typical reported doses of 2C-B are 12—24 mg 15. In clinical studies exploring the emotional effects of 2C-B, doses of 20 mg were used 7. Doses between 5 and 10 mg reportedly induce MDMA- and amphetamine-like stimulating effects, while doses between 10 and 20 mg lead to additional hallucinogenic effects 89.
Higher doses are known to cause unpleasant hallucinations and sympathomimetic effects, such as tachycardia, hypertension and hyperthermia 9 The dose-response curve is reported to be steep for all the compounds of the 2C series 1thus leading to a great risk of overdosing.
The usual oral doses of 2C-P are reportedly lower and vary between 6 and 10 mg, with a reported duration of action of up to 10—16 h 5. In a case series of five presentations following 2C-P use 11the dose was not known in any of the cases but all patients presented with hallucinations, mydriasis and agitation, similarly to our case.
However, 2C-P was detected in the urine of all five patients.
It is not clear why 2C-P is more potent than 2C-B. The in vitro pharmacological receptor interactions profiles of the two compounds are quite similar, with similar binding and activation potencies at the main target, the serotonin 5-HT 2A receptor 6. Differences in blood-brain barrier BBB permeation and, in consequence, in concentrations in the central nervous system and access to the pharmacological target, could for the difference in potency. While the addition of a propyl residue to the 2C scaffold instead of bromide does not influence PSA, it does make 2C-P more lipophilic than 2C-B by a factor of about 4.
Table I. Calculated physicochemical properties of 2C-B and 2C-P. A possible explanation for the difference in the duration of action may lie in differences in metabolism. While metabolism of several 2C drugs has been extensively studied in rats 13 — 16less is known about human metabolism. An in vitro study revealed ificant interspecies differences in formation of metabolites with 2C-B Reported phase I activities for 2C drugs include oxidative demethylation, N -acetylation and deamination, the latter by monoamine oxidases MAO 1014Buy 2c t 7 online The size of the C4-ligand has been associated with altered MAO isoenzyme affinity 17which could be a possible explanation for the prolonged effect, as well as the polymorphic phenotype in acetylation in humans Similarly to other immunoassays, the test can be performed without special knowledge or equipment and rapidly delivers.
However, it has limitations, e. This is a possible explanation for the positive result for opiates in our case, as there was neither clinical evidence nor report of opiate use nor confirmation in the LC—MS, and cross reactivity e. Thus, the immunoassay provides only a preliminary result and other methods e. In our case, the LC—MS not only revealed the presence of 2C-P and excluded 2C-B in blood samples, but also allowed quantification of the concentrations and an estimate of the elimination half-life.
To our knowledge, this is the first published estimation of the elimination half-life of 2C-P. However, this estimation only represents an apparent serum half-life in one individual and should not be used as an estimated half-life in other contexts.
Treatment of intoxications with NPS is mainly supportive 3 Recommendations include fluid replacement, as well as benzodiazepines or antipsychotic agents, such as haloperidol, though the latter should not be used as a single agent. In case of hypertension, the use of beta-blockers without alpha-blocking agents is also discouraged, because unopposed alpha-adrenergic stimulation can result in further increases in blood pressure.
In cases of severe hyperthermia, physical cooling and relaxation may be needed 3. In summary, our patient presented with hallucinations and acute sympathomimetic toxidrome after consuming 25 mg of 2C-P usual doses 6—10 mg, duration of action 10—16 h, longer at higher dosesmistaken for the better-known and shorter-acting 2C-B usual doses 10—20 mg, duration of action 2—8 h. Our case presents the clinical findings of an analytically confirmed intoxication with 2C-P and is the first reported case with documentation of the elimination half-life of this compound.
Furthermore, our case illustrates some of the risks in connection with NPS, as use of apparently similar but more potent substances can lead to more severe intoxication. Moreover, our case highlights the importance of the use of specialized analytical methods in cases of suspected NPS use.
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KanamoriT. Journal of Analytical Toxicology2661 — Biochemical Pharmacology73— GrantD. Mutation Research, 61 — Alere TM. Alere TM Toxicology. Nugteren-van LonkhuyzenJ. Drug and Alcohol Dependence, 18 — Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. In. Advanced Search. Search Menu. Article. Close mobile search Article .
Volume Article Contents Abstract. Case Report. Adrian StollerAdrian Stoller. Oxford Academic. Patrick C. Michael Bodmer. Felix Hammann.
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