Evolution of the NBOMes: 25C- and 25B- Sold as 25I-NBOMe.
BACKGROUND
The NBOMes (N-benzyl-oxy-methyl derivatives of known 2C phenylethylamines) are a new and growing class of potent synthetic stimulants. Case reports provide the bulk of available safety and clinical data for clinicians. We report two cases of NBOMe intoxication with 25C-NBOMe (the first lab-confirmed US case) and 25B-NBOMe, respectively, both confirmed via triple quadrapole mass spectrometry.


METHODS
Case 1: A 16-year-old girl had a generalized seizure after reported use of 25I-NBOMe. She presented with altered mental status, lower extremity rigidity, and elevated CPK (6042 U/L). Despite treatment with benzodiazepines, her lower extremity rigidity persisted and CPK peaked at 47,906 U/L. She was discharged on hospital day 8. Serum and urine specimens confirmed presence of 25C-NBOMe. Case 2: A 15-year-old boy developed bizarre behavior after reported use of 25I-NBOMe. In the ED, he had two generalized seizures and persistent muscle rigidity. CPK peaked at 429 U/L. Seizures were managed with benzodiazepines, and he was discharged within 24 h. Serum specimens revealed 25B-NBOMe.


CONCLUSIONS
NBOMes are amphetamine derivatives and highly potent 5-HT(2A) receptor agonists. Clinical manifestations are a product of enhanced central sympathetic and serotonergic tone. We report two cases of NBOMe intoxication in patients who believed they used 25I-NBOME, while lab confirmation proved otherwise. Whether unique clinical manifestations are specific to the NBOMe variant, dose, route of administration, or other factors is unknown. Laboratory confirmation may play a role in identifying unexpected NBOMe variants, while contributing to the epidemiologic data on these novel substances.
New York University School of Medicine/New York City Poison Control Center, 455 First Avenue Room 123, New York, NY, 10016, USA, larissa.laskowski@nyumc.org.
Larissa K
LK
Laskowski
Faesal
F
Elbakoush
Jessica
J
Calvo
Gina
G
Exantus-Bernard
Jane
J
Fong
Justin L
JL
Poklis
Alphonse
A
Poklis
Lewis S
LS
Nelson
D000293:Adolescent; D000840:Anisoles / Q000737:chemistry* / Q000506:poisoning*; D001569:Benzodiazepines / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000737:chemistry* / Q000506:poisoning; D003402:Creatine Kinase / Q000097:blood; D015198:Designer Drugs / Q000737:chemistry* / Q000506:poisoning*; D004118:Dimethoxyphenylethylamine / Q000031:analogs & derivatives* / Q000737:chemistry / Q000506:poisoning; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D008297:Male; D013058:Mass Spectrometry; D001523:Mental Disorders / Q000139:chemically induced / Q000523:psychology; D009127:Muscle Rigidity / Q000139:chemically induced / Q000188:drug therapy; D010627:Phenethylamines / Q000737:chemistry* / Q000506:poisoning*; D044402:Receptor, Serotonin, 5-HT2A / Q000187:drug effects; D012640:Seizures / Q000139:chemically induced / Q000188:drug therapy; D058826:Serotonin 5-HT2 Receptor Agonists / Q000737:chemistry / Q000506:poisoning; D019966:Substance-Related Disorders
D000840:Anisoles; D000697:Central Nervous System Stimulants; D015198:Designer Drugs; D004118:Dimethoxyphenylethylamine; D006993:Hypnotics and Sedatives; D010627:Phenethylamines; D044402:Receptor, Serotonin, 5-HT2A; D058826:Serotonin 5-HT2 Receptor Agonists; D001569:Benzodiazepines; C554181:2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine; D003402:Creatine Kinase; C000595926:2-(4-bromo-2,5-dimethoxyphenyl)-N-((2-methoxyphenyl)methyl)ethanamine