title: Severe poisoning after self-reported use of 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine, a novel substituted amphetamine: a case series.
abstract: Significant toxicity from amphetamine and cathinone derivatives is being increasingly reported. We describe a series of self-reported exposures to 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25-I-NBOME or 25-I), a novel amphetamine derivative. Ten patients with an average age of 17 years presented to local emergency departments (EDs) in our community after ingestion and/or insufflation of a drug referred to as "25-I." Of 10 patients, 6 reported taking 25-I alone; other substances included ethanol; 2,5-dimethoxy-4-ethylphenethylamine; marijuana; and ketamine. Most common effects included tachycardia (90%), hypertension (70%), agitation (60%), and hallucinations (50%). The average heart rate was 123 beats per minute. Two patients were found in status epilepticus, and another was found unresponsive. One patient who had a seizure had multiple, discrete intraparenchymal hemorrhages and acute kidney injury. Six patients were admitted to the intensive care unit, two were treated in the ED and released, and 1 each was admitted to psychiatry or managed in a clinical decision unit and subsequently discharged. Three patients required emergent intubation, and all admitted patients (7/10) were given intravenous benzodiazepines for sedation. Urine and blood specimens were obtained from 1 patient, which showed analytic confirmation of 25-I. In addition to sympathomimetic effects, methoxy and other substituent groups impart serotonergic effects, resulting in hallucinogenic properties. 2-(4-iodo-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine appears to be extremely potent with a reported "dose" of 500 μg resulting in increased potential for inadvertent overdose. This case series describes significant morbidity in a local cluster of young patients after self-reported use of 25-I, a newly identified drug of abuse.
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA. Electronic address: mhieger@mcvh-vcu.edu.
authors.forename: M A
authors.initials: MA
authors.lastname: Hieger
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: S R
authors.initials: SR
authors.lastname: Rose
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: K L
authors.initials: KL
authors.lastname: Cumpston
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: P E
authors.initials: PE
authors.lastname: Stromberg
authors.affiliation: Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: S
authors.initials: S
authors.lastname: Miller
authors.affiliation: Division of Clinical Toxicology, Department of Emergency Medicine, VCU Medical Center, Richmond, VA; Virginia Poison Center, Richmond, VA; Department of Emergency Medicine, VCU Medical Center, Richmond, VA.
authors.forename: B K
authors.initials: BK
authors.lastname: Wills
mesh_terms: D000293:Adolescent; D002851:Chromatography, High Pressure Liquid; D015198:Designer Drugs / Q000506:poisoning*; D004118:Dimethoxyphenylethylamine / Q000031:analogs & derivatives* / Q000506:poisoning; D005260:Female; D006801:Humans; D008297:Male; D011041:Poisoning / Q000628:therapy*; D053719:Tandem Mass Spectrometry; D055815:Young Adult
chemical_list: D015198:Designer Drugs; D004118:Dimethoxyphenylethylamine; C554181:2-(4-iodo-2,5-dimethoxyphenyl)-N-(2-methoxybenzyl)ethanamine