Altered Mental Status and End Organ Damage Associated with the use of Gacyclidine: A Case Series

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• 作者：J. A. Chenoweth (1)
  R. R. Gerona (4)
  J. B. Ford (1)
  M. E. Sutter (1)
  J. S. Rose (2)
  T. E. Albertson (3)
  S. O. Clarke (2)
  K. P. Owen (1)
  
  1. Department of Emergency Medicine ; University of California ; Davis Medical Center and VA Northern California Health Care System ; 4150 V Street ; Suite 2100 ; Sacramento ; CA ; 95817 ; USA
  4. Department of Laboratory Medicine ; University of California ; San Francisco ; 513 Parnauss Ave ; San Francisco ; CA ; 94143 ; USA
  2. Department of Emergency Medicine ; University of California ; Davis Medical Center ; 4150 V Street ; Suite 2100 ; Sacramento ; CA ; 95817 ; USA
  3. Division of Pulmonary ; Critical Care ; and Sleep Medicine ; University of California ; Davis Medical Center and VA Northern California Health Care System ; 4150 V Street Suite 2400 ; Sacramento ; CA ; 95817 ; USA
  
• 关键词：Gacyclidine ; Dissociative toxicity ; Phencyclidine derivative
• 刊名：Journal of Medical Toxicology
• 出版年：2015
• 出版时间：March 2015
• 年：2015
• 卷：11
• 期：1
• 页码：115-120
• 全文大小：199 KB
• 参考文献：1. European Monitoring Centre for Drugs and Addiction-Europol New psychoactive substances notified in 2012. In: 2012 Annual Report on the Implementation of Council Decision 2005/387/JHA. 2012. http://www.emcdda.europa.eu/attachements.cfm/att_212366_EN_EMCDDA-Europol%202012%20Annual%20Report_final.pdf. Accessed 4 Dec 2013.
  2. Govtrack.us. S.3190 (112th): Synthetic Drug Abuse Prevention Act of 2012. ofcongress" class="a-plus-plus">http://www.govtrack.us/congress/bills/112/s3190#summary/libraryofcongress. Accessed 4 Dec 2013.
  3. deRoux, SJ, Sgarlato, A, Marker, E (2011) Phencyclidine: a 5-year retrospective review from the New York City Medical Examiner's Office. J Forensic Sci 56: pp. 656-659 CrossRef
  4. Pestaner, JP, Southall, PE (2003) Sudden death during arrest and phencyclidine intoxication. Am J Forensic Med Pathol 24: pp. 119-122
  5. McCarron, MM, Schulze, BW, Thompson, GA, Conder, MC, Goetz, WA (1981) Acute phencyclidine intoxication: clinical patterns, complications, and treatment. Ann Emerg Med 10: pp. 290-297 CrossRef
  6. Bey, T, Patel, A (2007) Phencyclidine intoxication and adverse effects: a clinical and pharmacological review of an illicit drug. Cal J Emerg Med 8: pp. 9-14
  7. Demaria, S, Weinkauf, JL (2011) Cocaine and the club drugs. Int Anesthesiol Clin 49: pp. 79-101 CrossRef
  8. Gaviria, M, Privat, A, d'Arbigny, P, Kamenka, JM, Haton, H, Ohanna, F (2000) Neuroprotective effects of gacyclidine after experimental photochemical spinal cord lesion in adult rats: dose-window and time-window effects. J Neurotrauma 17: pp. 19-30 CrossRef
  9. Drian, MJ, Kamenka, JM, Privat, A (1999) In vitro neuroprotection against glutamate toxicity provided by novel non-competitive N-methyl-d-aspartate antagonists. J Neurosci Res 57: pp. 927-934 CrossRef
  10. Hirbec, H, Teilhac, J, Kamenka, J, Privat, A, Vignon, J (2000) Binding properties of [3H]gacyclidine (cis(pip/me)-1-[1-(2-thienyl)-2-methylcyclohexyl]piperidine) enantiomers in the rat central nervous system. Brain Res 859: pp. 177-192 CrossRef
  11. Kamenka, JM, Chiche, B, Goudal, R, Geneste, P, Vignon, J, Vincent, JP (1982) Chemical synthesis and molecular pharmacology of hydroxylated 1-(1-phenylcyclohexyl-piperidine derivatives. J Med Chem 25: pp. 431-435 CrossRef
  12. Drian, MJ, Kamenka, JM, Pirat, JL, Privat, A (1991) Non-competitive antagonists of N-methyl-d-aspartate prevent spontaneous neuronal death in primary cultures of embryonic rat cortex. J Neurosci Res 29: pp. 133-138 CrossRef
  13. Lepeintre, JF, D'Arbigny, P, Mathe, JF, Vigue, B, Loubert, G, Delcour, J (2004) Neuroprotective effect of gacyclidine. A multicenter double-blind pilot trial in patients with acute traumatic brain injury. Neurochirurgie 50: pp. 83-95
  14. Steeves, J, Fawcett, J, Tuszynski, M (2004) Report of international clinical trials workshop on spinal cord injury February 20鈥?1, 2004, Vancouver, Canada. Spinal Cord 42: pp. 591-597 CrossRef
  15. Lonjon, N, Kouyoumdjian, P, Prieto, M, Bauchet, L, Haton, H, Gaviria, M (2010) Early functional outcomes and histological analysis after spinal cord compression injury in rats. J Neurosurg Spine 12: pp. 106-113 CrossRef
  16. Gaviria, M, Privat, A, d'Arbigny, P, Kamenka, J, Haton, H, Ohanna, F (2000) Neuroprotective effects of a novel NMDA antagonist, Gacyclidine, after experimental contusive spinal cord injury in adult rats. Brain Res 874: pp. 200-209 CrossRef
  17. Smith, JS, Fulop, ZL, Levinsohn, SA, Darrell, RS, Stein, DG (2000) Effects of the novel NMDA receptor antagonist gacyclidine on recovery from medial frontal cortex contusion injury in rats. Neural Plast 7: pp. 73-91 CrossRef
  18. Bhagat, YA, Obenaus, A, Hamilton, MG, Mikler, J, Kendall, EJ (2005) Neuroprotection from soman-induced seizures in the rodent: evaluation with diffusion- and T2-weighted magnetic resonance imaging. Neurotoxicology 26: pp. 1001-1013 CrossRef
  19. Lallement, G, Clarencon, D, Galonnier, M, Baubichon, D, Burckhart, MF, Peoc'h, M (1999) Acute soman poisoning in primates neither pretreated nor receiving immediate therapy: value of gacyclidine (GK-11) in delayed medical support. Arch Toxicol 73: pp. 115-122 CrossRef
  20. Hirbec, H, Kamenka, JM, Privat, A, Vignon, J (2001) Interaction of gacyclidine enantiomers with 鈥榥on-NMDA鈥?binding sites in the rat central nervous system. Brain Res 894: pp. 189-192 CrossRef
  21. Vandame, D, Desmadryl, G, Becerril Ortega, J, Teigell, M, Crouzin, N, Buisson, A (2007) Comparison of the pharmacological properties of GK11 and MK801, two NMDA receptor antagonists: towards an explanation for the lack of intrinsic neurotoxicity of GK11. J Neurochem 103: pp. 1682-1696 CrossRef
  22. Ring, A, Tanso, R, Noraberg, J (2010) The use of organotypic hippocampal slice cultures to evaluate protection by non-competitive NMDA receptor antagonists against excitotoxicity. Altern Lab Anim 38: pp. 71-82
  23. Wenzel, GI, Warnecke, A, Stover, T, Lenarz, T (2010) Effects of extracochlear gacyclidine perfusion on tinnitus in humans: a case series. Eur Arch Otorhinolaryngol 267: pp. 691-699 CrossRef
  24. Gill, JR (2014) The syndrome of excited delirium. Forensic Sci Med Pathol 10: pp. 223-228 CrossRef
  
• 刊物主题：Pharmacology/Toxicology; Biomedicine general;
• 出版者：Springer US
• ISSN：1937-6995

文摘

Introduction Over the past decade, there has been a sharp increase in the number of newly identified synthetic drugs. These new drugs are often derivatives of previously abused substances but have unpredictable toxicity. One of these drugs is gacyclidine, a derivative of phencyclidine (PCP). Gacyclidine has been studied as a neuroprotective agent in trauma and as a therapy of soman toxicity. There are no previous reports of its use as a drug of abuse. Case Reports During a two-month period in the summer of 2013, a series of patients with severe agitation and end-organ injury were identified in an urban academic Emergency Department (ED). A urine drug of abuse screen was performed on all patients, and serum samples were sent for comprehensive toxicology analysis. A total of five patients were identified as having agitation, rhabdomyolysis, and elevated troponin (Table 1). Three of the five patients reported use of methamphetamine, and all five patients had urine drug screens positive for amphetamine. Comprehensive serum analysis identified methamphetamine in three cases, cocaine metabolites in one case, and a potential untargeted match for gacyclidine in all five cases. No other drugs of abuse were identified. Discussion This is the first series of cases describing possible gacyclidine intoxication. The possible source of the gacyclidine is unknown but it may have been an adulterant in methamphetamine as all patients who were questioned reported methamphetamine use. These cases highlight the importance of screening for new drugs of abuse when patients present with atypical or severe symptoms. Gacyclidine has the potential to become a drug of abuse both by itself and in conjunction with other agents and toxicity from gacyclidine can be severe. It is the role of the medical toxicology field to identify new agents such as gacyclidine early and to attempt to educate the community on the dangers of these new drugs of abuse.