II. Mechanism

  1. Synthetic Hallucinogen (2C) acting at 5-HT2A receptor (potent Serotonin 2A receptor agonists)
  2. Phenethylamine pharmacore increases neurotransmitter levels with Sympathomimetic effects
  3. Originally developed in 2003 as Serotonin 2A receptor agonist as traceable agent for PET Scan

III. Preparations

  1. Formulations
    1. Most common formulation of three produced: 25I-NBOMe
    2. Forms include liquid, powder, capsule, tablet, spray
    3. Used orally most frequently (mixed with solvent on blotting paper)
    4. Also used sublingual, intranasal, rectal, smoked or injected
    5. Typically sold for $7-10 per dose
  2. Street Names
    1. N-Bomb
    2. Smiles

IV. Pharmacokinetics

  1. Minimum effective dose: 50 mcg SL
  2. Onset: 20 minutes
  3. Duration: 3-13 hours

V. Symptoms: Desired Effects

  1. Hallucinations
  2. Dissociation
  3. Euphoria

VI. Labs

  1. Serum Creatinine Kinase
  2. White Blood Cell Count (Leukocytosis)
  3. Serum Glucose (Hyperglycemia)
  4. Serum transaminases (increased)
  5. Serum Creatinine (increased)

VII. Adverse effects

  1. Cardiovascular effects
    1. Tachycardia
    2. Hypertension
  2. Neuropsychiatric effects
    1. Agitation and aggression (85% of patients)
    2. Delirium
    3. Paranoia
    4. Altered Mental Status
    5. Hyperreflexia
    6. Clonus
    7. Seizures (75%)
  3. Miscellaneous
    1. Tongue Paresthesias (related to blotting paper contact reaction)

VIII. Complications

  1. Hyperthermia
  2. Pulmonary edema
  3. Death
  4. Status Epilepticus (with anoxic brain injury)

IX. Management

  1. Benzodiazepines
    1. Agitation or Psychosis
    2. Seizures
  2. IV Fluids
    1. Prevent or treat Rhabdomyolysis
  3. Cooling measures
    1. Manage hyperthermia

X. References

  1. Bersani (2014) Biomed Res Int 2014: 734749
    1. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106087/
  2. Haynes, Meadors and Yuan (2016) Crit Dec Emerg Med 30(2): 3-9
  3. Laskowski (2015) J Med Toxicol 11(2):237-41 +PMID:25387562 [PubMed]

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