Skip to main content

Advertisement

Log in

Acute toxicity associated with the recreational use of the ketamine derivative methoxetamine

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

Long-term regular use of ketamine has been reported to be associated with severe symptomatic urinary tract problems. Methoxetamine, an arylcyclohexylamine derivative of ketamine, is marketed as a “bladder safe” derivative of ketamine, and no cases of acute toxicity following analytically confirmed methoxetamine use have been reported to date. We report here a case series of three individuals with acute toxicity related to the analytically confirmed use of methoxetamine.

Case series

Three patients aged between 28 and 42 years presented to the Emergency Department (ED) on unrelated occasions having used methoxetamine. Clinical features were suggestive of a “dissociative/catatonic” state similar to that seen with ketamine; in addition, they had clinical features of acute sympathomimetic toxicity with significant tachycardia and hypertension. All were managed with low-dose benzodiazepines and discharged home once their symptoms/signs had settled.

Toxicological screening

Serum collected at the time of presentation to the ED was analysed qualitatively and quantitatively by gas chromatography–mass spectrometry. Serum concentrations ranged from 0.09 to 0.2 mg/L; in addition, detectable levels of 6-APB/5-APB were found in one of the patients.

Conclusions

These three analytically confirmed cases demonstrate that acute methoxetamine-related toxicity is associated with both “dissociative” and “sympathomimetic” clinical features. The information from these three cases is useful to clinical pharmacologists, not only in managing individuals with acute methoxetamine toxicity but also in advising the appropriate legislative authorities on the risk of acute harm related to methoxetamine use. Further work is needed to determine whether methoxetamine is more “bladder friendly” than ketamine, as has been suggested by those marketing methoxetamine.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. European Monitoring Centre for Drugs and Drug Addiction (2010) Annual report 2010: The state of the drugs problem in Europe. Available from: www.emcdda.europa.eu/attachements.cfm/att_120104_EN_EMCDDA_AR2010_EN.pdf. Accessed 25 Oct 2011

  2. United Nations Office on Drugs and Crime (2011) World drug report 2011. Available from: www.unodc.org/documents/data-and-analysis/WDR2011/World_Drug_Report_2011_ebook.pdf. Accessed 25 Oct 2011

  3. Chu PS, Kwok SC, Lam KM, Chu TY, Chan SW, Man CW, Ma WK, Chui KL, Yiu MK, Chan YC, Tse ML, Lau FL (2007) 'Street ketamine'-associated bladder dysfunction: a report of ten cases. Hong Kong Med J 13:311–313

    PubMed  Google Scholar 

  4. Chu PS, Ma WK, Wong SC, Chu RW, Cheng CH, Wong S, Tse JM, Lau FL, Yiu MK, Man CW (2008) The destruction of the lower urinary tract by ketamine abuse: a new syndrome? BJU Int 102:1616–1622

    Article  PubMed  Google Scholar 

  5. Colebunders B, Van Erps P (2008) Cystitis due to the use of ketamine as a recreational drug: a case report. J Med Case Rep 2:219

    Article  Google Scholar 

  6. Shahani R, Streutker C, Dickson B, Stewart RJ (2007) Ketamine-associated ulcerative cystitis: a new clinical entity. Urology 69:810–812

    Article  PubMed  Google Scholar 

  7. Tsai TH, Cha TL, Lin CM, Tsao CW, Tang SH, Chuang FP, Wu ST, Sun GH, Yu DS, Chang SY (2009) Ketamine-associated bladder dysfunction. Int J Urol 16:826–829

    Article  PubMed  CAS  Google Scholar 

  8. Wood D, Cottrell A, Baker SC, Southgate J, Harris M, Fulford S, Woodhouse C, Gillatt D (2011) Recreational ketamine: from pleasure to pain. BJU Int 107:1881–1884

    Article  PubMed  Google Scholar 

  9. Mak SK, Chan MT, Bower WF, Yip SK, Hou SS, Wu BB, Man CY (2011) Lower urinary tract changes in young adults using ketamine. J Urol 186:610–614

    Article  PubMed  CAS  Google Scholar 

  10. Kalsi SS, Wood DM, Dargan PI (2011) The epidemiology and patterns of acute and chronic toxicity associated with recreational ketamine use. Emerg Heal Threat J 4:7107

    Google Scholar 

  11. UK Advisory Council on the Misuse of Drugs (ACMD) (2011) Consideration of the novel psychoactive substances (‘legal highs’). Available from: http://www.homeoffice.gov.uk/publications/agencies-public-bodies/acmd1/acmdnps2011?view=Binary. Last accessed 25 Oct 2011

  12. Morris H (2011). Interview with a ketamine chemist: or to be more precise, an arylcyclohexylamine chemist. Vice Magazine 11 Feb 2011. Available from: www.vice.com/read/interview-with-ketamine-chemist-704-v18n2. Accessed 25 Oct 2011)

  13. Ward J, Rhyee S, Plansky J, Boyer E (2011) Methoxetamine: a novel ketamine analog and growing health-care concern. Clin Toxicol (Phila). doi:10.3109/15563650.2011.617310

  14. Davies S, Wood DM, Smith G, Button J, Ramsey J, Archer R, Holt DW, Dargan PI (2010) Purchasing 'legal highs' on the Internet—is there consistency in what you get? Q J Med 103:489–493

    Article  CAS  Google Scholar 

  15. Ramsey J, Dargan PI, Smyllie M, Davies S, Button J, Holt DW, Wood DM (2010) Buying 'legal' recreational drugs does not mean that you are not breaking the law. Q J Med 103:777–783

    Article  CAS  Google Scholar 

  16. Brandt SD, Sumnall HR, Measham F, Cole J (2010) Analyses of second-generation 'legal highs' in the UK: initial findings. Drug Test Anal 2:377–382

    Article  PubMed  CAS  Google Scholar 

  17. Spiller HA, Ryan ML, Weston RG, Jansen J (2011) Clinical experience with and analytical confirmation of "bath salts" and "legal highs" (synthetic cathinones) in the United States. Clin Toxicol (Phila) 49:499–505

    Article  CAS  Google Scholar 

  18. Yeung LY, Rudd JA, Lam WP, Mak YT, Yew DT (2009) Mice are prone to kidney pathology after prolonged ketamine addiction. Toxicol Lett 191:275–278

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David M. Wood.

Additional information

DW and PD have acted as scientific advisors to the UK Advisory Council on the Misuse of Drugs (ACMD) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wood, D.M., Davies, S., Puchnarewicz, M. et al. Acute toxicity associated with the recreational use of the ketamine derivative methoxetamine. Eur J Clin Pharmacol 68, 853–856 (2012). https://doi.org/10.1007/s00228-011-1199-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-011-1199-9

Keywords

Navigation