title: Flubromazolam--A new life-threatening designer benzodiazepine.
abstract: BACKGROUND
  In addition to designer benzodiazepines such as etizolam, deschloroetizolam, pyrazolam, diclazepam, nifoxipam, or clonazolam, a new psychoactive substance like flubromazolam, triazole of flubromazepam has become available. Flubromazolam is currently not marketed as a medication but rather as a research chemical and recreational drug. It mostly causes sedative effects but also has moderate anti-anxiety and muscle relaxant effects. A case of a severe intoxication of flubromazolam has been reported.
  
  
  METHODS
  A 27-year-old man, presented with deep coma, bilateral pinpoint unreactive pupils, acute respiratory failure and hypotension, complicated by hypoxic ischemic changes in the central nervous system. A positive result of a urine screening test confirmed the presence of benzodiazepines, which resulted in administration of flumazenil and improved patient consciousness. Quantitative method of liquid chromatography indicated flubromazolam in the patient's serum at 59 ng/mL and urine at 105 ng/mL about 19 h after ingestion of 3 mg dose. On admission, serum creatine kinase was 15,960 U/L. The patient was treated with mechanical ventilation, intravenous fluids, flumazenil and continuous infusion of norepinephrine at a dose of 0.12 µg/kg/min. The patient survived and on the ninth day of hospitalization he was transferred to the Department of Neurology.
  
  
  CONCLUSIONS
  Flubromazolam is a new designer drug. Recreational use may be a cause of prolonged, severe intoxication associated with coma, hypotension, and rhabdomyolysis.
authors.affiliation: a Department of Emergency Medicine , Poznan University of Medical Sciences , Poznan , Poland ;|b Department of Toxicology , Raszeja Hospital , Poznan , Poland ;
authors.forename: Magdalena
authors.initials: M
authors.lastname: Łukasik-Głębocka
authors.affiliation: c Department of Toxicology , Poznan University of Medical Sciences , Poznan , Poland ;
authors.forename: Karina
authors.initials: K
authors.lastname: Sommerfeld
authors.affiliation: d Department of Forensic Sciences , Poznan University of Medical Sciences , Poznan , Poland.
authors.forename: Artur
authors.initials: A
authors.lastname: Teżyk
authors.affiliation: c Department of Toxicology , Poznan University of Medical Sciences , Poznan , Poland ;
authors.forename: Barbara
authors.initials: B
authors.lastname: Zielińska-Psuja
authors.affiliation: a Department of Emergency Medicine , Poznan University of Medical Sciences , Poznan , Poland ;
authors.forename: Paweł
authors.initials: P
authors.lastname: Panieński
authors.affiliation: d Department of Forensic Sciences , Poznan University of Medical Sciences , Poznan , Poland.
authors.forename: Czesław
authors.initials: C
authors.lastname: Żaba
mesh_terms: D000328:Adult; D000931:Antidotes / Q000627:therapeutic use; D001569:Benzodiazepines / Q000097:blood / Q000506:poisoning* / Q000652:urine; D003128:Coma / Q000139:chemically induced; D003131:Combined Modality Therapy; D015198:Designer Drugs / Q000506:poisoning*; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy / Q000652:urine; D005442:Flumazenil / Q000627:therapeutic use; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D008297:Male; D011619:Psychotropic Drugs / Q000097:blood / Q000506:poisoning* / Q000652:urine; D012206:Rhabdomyolysis / Q000139:chemically induced; D015813:Substance Abuse Detection / Q000379:methods; D016896:Treatment Outcome; D016482:Urinalysis
chemical_list: D000931:Antidotes; D015198:Designer Drugs; D011619:Psychotropic Drugs; D001569:Benzodiazepines; D005442:Flumazenil
keywords: CNS; lung; other; psychological; respiratory support