The Poison Review

Lethal Serotonin Syndrome After Methylone and Butylone Ingestion. Warrick BJ et al. J Med Toxicol 2011 Dec 9 [Epub ahead of print]

Abstract 

Methylone and butylone are designer phenethylamines sometimes found in products sold as “legal alternatives” to ecstasy (MDMA).

Methylone has a structure almost identical to that of “ecstasy”, differing only by the addition of a ketone group. It inhibits re-uptake of serotonin, dopamine and norepinephrine, and has  psychogenic and physiological properties quite similar to those of ecstasy:

CNS EFFECTS:

• stimulation
• euphoria or dysphoria
• restlessness
• increased sociability
• hallucinations
• psychosis

SYMPATHOMIMETIC EFFECTS:

• tachycardia
• hypertension
• hyperthermia
• diaphoresis
• mydriasis
• nystagmus
• trismus and bruxism

Butylone has not been well studied, but appears to have similar actions.

This well documented and dramatic case report — from the Children’s Hospital of Michigan Poison Control Center in Detroit — describes a previously healthy 24-year-old woman who developed hyperthermia(107.2^o F!) , hypotension, diaphoresis, tremors,  muscle rigidity, clonus, multiorgan failure, and DIC after ingesting two capsules sold as “ecstasy” at a concert.

Despite treatment including  fluids, external cooling, paralysis, and mechanical ventilation, the patient died 2 days after presentation. Specific urine drug tests were positive for methylone and butylone but not for other drugs of abuse. Analysis found in the patient’s belongings revealed the same two substances. The authors note that the patient’s presentation fulfilled the Hunter criteria for serotonin syndrome.

This is an extremely impressive case report especially given the laboratory confirmation of methylone and butylone in the patient’s urine and in the product ingested. Highly recommended.

Related posts:

Toxicity of Synthetic Cathinones

Bath salts: calls to poison centers in Louisiana and Kentucky

Fake “ecstasy”: ethcathinone and methylone