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Arillotta D, Totti A, Dimitrova A, Croce EB, Di Milia MG, Gambassi F, Gualco B, Pieraccini G, Mannaioni G, Vaiano F. Clinical manifestations and analytical reports for MDPHP acute intoxication cases. J Pharm Biomed Anal 2024; 241:115974. [PMID: 38277706 DOI: 10.1016/j.jpba.2024.115974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/04/2024] [Accepted: 01/08/2024] [Indexed: 01/28/2024]
Abstract
MDPHP is a synthetic cathinone (SC) belonging to α-pyrrolidinophenone derivatives. It is a central nervous system stimulant and may induce hallucinations, paranoia, tachycardia, hypertension, chest pain, and rhabdomyolysis. In literature, a few cases of intoxication have been reported. In the present study, 17 cases of MDPHP intake were described including the analytical findings and clinical manifestations. MDPHP was quantified by liquid chromatography-tandem mass spectrometry in blood (range 1.26-73.30 ng/mL) and urine (range 19.31-8769.64 ng/mL) samples. In three cases the presence of α-PHP was observed. In one case, MDPHP was the only detected substance. Concomitant use of MDPHP with other substances, particularly psychostimulants, was common and it was difficult to describe the peculiar clinical characteristics of this SC. Most of the symptoms overlapped those expected, some of them were unusual and all of them particularly severe thus inducing the research of NPS in laboratory tests. We demonstrated the presence of psychiatric, neurological, and respiratory symptoms, as well as the possible presence of rhabdomyolysis and cardiotoxicity associated with the use of MDPHP. ED admissions were also more frequent in patients with addiction problems. In some cases, MDPHP intake required intensive supportive care. A multidisciplinary approach, including specialist consultation, is recommended for patients showing challenging features. Moreover, we demonstrated that the adoption of advanced analytical techniques, i.e., liquid chromatography-tandem mass spectrometry, is necessary to detect these molecules. Further studies are needed to understand MDPHP intake patterns and associated symptoms. It is essential to raise awareness in addiction treatment centers and among potential users, especially young people, and chemsex addicted.
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Affiliation(s)
- Davide Arillotta
- Department of Neurosciences, Psychology, Drug Research and Child Health, Section of Pharmacology and Toxicology, University of Florence, Florence, Italy
| | - Arianna Totti
- Toxicology Unit, Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Alexandra Dimitrova
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Emma B Croce
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Maria Grazia Di Milia
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy
| | - Francesco Gambassi
- Toxicology Unit, Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Barbara Gualco
- Department of Health Science, University of Florence, Florence, Italy
| | | | - Guido Mannaioni
- Toxicology Unit, Poison Control Center, Careggi University Hospital, Florence, Italy
| | - Fabio Vaiano
- FT-LAB Forensic Toxicology Laboratory, Department of Health Science, University of Florence, Florence, Italy.
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