First case-report: designer Quaalude intoxication
January 12, 2013, 2:55 pm
Acute neurotoxicity associated with recreational use of methylmethaqualone confirmed by liquid chromatography tandem mass spectrometry. Ceschi A et al. Clin Toxicol 2013;52:54-7.
Methylmethaqualone (MMQ) is a designer drug made by adding a methyl group to the long-restricted sedative-hypnotic molecule methaqualone (Quaalude). This paper — from the Swiss Toxicological Information Centre — represents the first case report describing a confirmed case of methylmethaqualone toxicity.
A 24-year-old man presented to the emergency department approximately 2-3 hours after washing down several MMQ tablets with wine. Shortly after this, he was found at home somnolent but suddenly became extremely agitated with urinary incontinence and generalized clonic muscle contractions.
When paramedics arrived the patient was agitated and confused, but improved with 10 mg IV midazolam. In the ED, he was confused but not agitated. Vital signs were unremarkable except for a heart rate of 115/min. He had a mild resting tremor but no nystagmus. EKG was normal. Urine drug screen was negative.
A serum sample — analyzed by liquid chromatography tandem mass spectrometry — was positive for MMQ but no other medications or drugs of abuse.
The patient was observed overnight and discharged the next day.
Ten days later the patient again came to the ED with a similar presentation after ingesting MMQ. He responded to midazolam, and was discharged after 2 hours of observation.
The authors note that methaqualone is an addictive quinazolone derivative that acts as a sedative-hypnotic, anticonvulsant, and anxiolytic. It acts on GABA-A receptors.
Methaqualone overdose usually causes ataxia, lethargy, and CNS depression, although limb hyperreflexia, myoclonia, seizures, coma, and other non-neurological symptoms such as respiratory and cardiac failure have been described after severe poisoning. Psychomotor agitation was observed in a life-threatening intoxication, and, at lower doses, recreational users have reported a euphoriant effect.
MMQ users describe similar effects to those of methaqualone, and the symptoms and signs observed in our patient (CNS depression followed by psychomotor agitation, muscle hyperactivity, and tachycardia) are compatible with methaqualone-induced adverse effects.
The authors conclude: “MMQ appears to have a similar acute toxicity profile to methaqualone, with marked psychomotor stimulation. Symptoms of acute toxicity can be expected to resolve within hours with supportive care.” Of course, all expectations may go out the window in cases of massive overdose.
For extra credit, what popular culture figure had a boat named after methaqualone? For the answer, click
In 1971, while living on the French Riviera and recording Exile on Main Street, Keith Richards bought a speedboat that he christened Mandrax, one of the trade names for methaqualone.