title: A novel neuromuscular syndrome associated with clenbuterol-tainted heroin.
abstract: BACKGROUND
  Clenbuterol is a potent, long-acting beta-adrenergic agonist that has been reported as an adulterant of heroin. We describe an atypical syndrome in five users of clenbuterol-tainted heroin.
  
  
  METHODS
  All cases were referred to a regional Poison Control Center. Urine and blood were analyzed using gas and liquid chromatography as well as mass spectrometry.
  
  
  METHODS
  Five heroin users presented with a syndrome characterized by muscular spasm, tremor, hyperreflexia, and elevated serum creatine phosphokinase concentrations. All patients lacked findings of acute clenbuterol toxicity but tested positive for clenbuterol and negative for strychnine and a battery of common potential adulterants.
  
  
  CONCLUSIONS
  We report five cases of a novel neuromuscular syndrome in users of clenbuterol-adulterated heroin. It is unclear whether these reactions represent an atypical response to clenbuterol or another unidentified contaminant.
authors.affiliation: Department of Medical Toxicology, New York City Poison Center, New York, USA. alex.manini@mssm.edu
authors.forename: Alex
authors.initials: A
authors.lastname: Manini
authors.forename: Robert M
authors.initials: RM
authors.lastname: Labinson
authors.forename: Barbara
authors.initials: B
authors.lastname: Kirrane
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hoffman
authors.forename: Rama
authors.initials: R
authors.lastname: Rao
authors.forename: Marina
authors.initials: M
authors.lastname: Stajic
authors.forename: Lewis S
authors.initials: LS
authors.lastname: Nelson
mesh_terms: D000328:Adult; D002976:Clenbuterol / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry / Q000652:urine; D005260:Female; D003932:Heroin / Q000008:administration & dosage / Q000009:adverse effects* / Q000737:chemistry; D006556:Heroin Dependence / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D009468:Neuromuscular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000652:urine
chemical_list: D003932:Heroin; D002976:Clenbuterol