Severe tremors induced by tiletamine e-cigarette and alcohol use: a case report
Background and objectivesPolydrug use has caused serious harm to public health, especially involving novel psychoactive substances. Tiletamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist commonly used as a veterinary anesthetic, has recently emerged in China as an additive in e-cigarettes....
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Frontiers Media S.A.
2025-04-01
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| Series: | Frontiers in Psychiatry |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1537822/full |
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| author | Bojie Zhou Bojie Zhou Shanghao Yang Shanghao Yang Xiafeng Zhou Xiafeng Zhou Qian Chen Qian Chen Ewen Tu Ewen Tu Bo Zhang Bo Zhang Li Shi Li Shi Xuhui Zhou Xuhui Zhou |
| author_facet | Bojie Zhou Bojie Zhou Shanghao Yang Shanghao Yang Xiafeng Zhou Xiafeng Zhou Qian Chen Qian Chen Ewen Tu Ewen Tu Bo Zhang Bo Zhang Li Shi Li Shi Xuhui Zhou Xuhui Zhou |
| author_sort | Bojie Zhou |
| collection | DOAJ |
| description | Background and objectivesPolydrug use has caused serious harm to public health, especially involving novel psychoactive substances. Tiletamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist commonly used as a veterinary anesthetic, has recently emerged in China as an additive in e-cigarettes. However, the long-term impacts of tiletamine and its combined use with other substances remain poorly understood. This case report aims to provide further insight into the clinical manifestations and treatment of tiletamine abuse, particularly focusing on the tremors induced by polydrug use.Case presentationThe patient had five years of intermittent alcohol use and five months of etomidate abuse. After combining tiletamine for two months, he was repeatedly hospitalized due to coarse tremors, poor sleep and appetite. Based on his substance use pattern and related outcomes, he was diagnosed with phencyclidine use disorder. Initially, intravenous diazepam (20 mg/day) effectively alleviated the tremors. During the second hospitalization, the same dose took longer to take effect, and by the third hospitalization, the dose was increased to 30 mg/day without reducing the tremors. Therefore, primidone was added and gradually titrated to 50 mg/day. The patient’s tremors began to improve by the eighth day and significantly diminished by the tenth day. As we gradually replaced diazepam with lorazepam, the patient insisted on discharge.ConclusionsPolydrug users, particularly those using NMDAR antagonists and gamma-aminobutyric acid type A receptor (GABA-AR) agonists, may be at increased risk of developing tiletamine dependence, with more severe consequences due to cross-addiction. The combination of alcohol and tiletamine could exacerbate neuroexcitotoxicity during withdrawal, potentially contributing to severe tremors. The successful management of tremors with a combination of neuroinhibitory therapies suggested an effective strategy for complex cases. Further studies are needed to better understand the long-term impacts and risks of tiletamine dependence. |
| format | Article |
| id | doaj-art-684b7f931d7e4832be4e1fb00513ea22 |
| institution | DOAJ |
| issn | 1664-0640 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Psychiatry |
| spelling | doaj-art-684b7f931d7e4832be4e1fb00513ea222025-08-20T03:16:50ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402025-04-011610.3389/fpsyt.2025.15378221537822Severe tremors induced by tiletamine e-cigarette and alcohol use: a case reportBojie Zhou0Bojie Zhou1Shanghao Yang2Shanghao Yang3Xiafeng Zhou4Xiafeng Zhou5Qian Chen6Qian Chen7Ewen Tu8Ewen Tu9Bo Zhang10Bo Zhang11Li Shi12Li Shi13Xuhui Zhou14Xuhui Zhou15The School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Addiction Medicine, Hunan Institute of Mental Health, The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province), Changsha, ChinaThe School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Addiction Medicine, Hunan Institute of Mental Health, The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province), Changsha, ChinaThe School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Addiction Medicine, Hunan Institute of Mental Health, The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province), Changsha, ChinaThe School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Psychiatry, Dongguan Seventh People’s Hospital, Dongguan, ChinaThe School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Neurology, The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province), Changsha, ChinaThe School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaHunan Society of Traditional Chinese Medicine and Integrated Traditional Chinese and Western Medicine, Changsha, ChinaThe School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Addiction Medicine, Hunan Institute of Mental Health, The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province), Changsha, ChinaThe School of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, ChinaDepartment of Addiction Medicine, Hunan Institute of Mental Health, The Second People’s Hospital of Hunan Province (Brain Hospital of Hunan Province), Changsha, ChinaBackground and objectivesPolydrug use has caused serious harm to public health, especially involving novel psychoactive substances. Tiletamine, an N-methyl-D-aspartate receptor (NMDAR) antagonist commonly used as a veterinary anesthetic, has recently emerged in China as an additive in e-cigarettes. However, the long-term impacts of tiletamine and its combined use with other substances remain poorly understood. This case report aims to provide further insight into the clinical manifestations and treatment of tiletamine abuse, particularly focusing on the tremors induced by polydrug use.Case presentationThe patient had five years of intermittent alcohol use and five months of etomidate abuse. After combining tiletamine for two months, he was repeatedly hospitalized due to coarse tremors, poor sleep and appetite. Based on his substance use pattern and related outcomes, he was diagnosed with phencyclidine use disorder. Initially, intravenous diazepam (20 mg/day) effectively alleviated the tremors. During the second hospitalization, the same dose took longer to take effect, and by the third hospitalization, the dose was increased to 30 mg/day without reducing the tremors. Therefore, primidone was added and gradually titrated to 50 mg/day. The patient’s tremors began to improve by the eighth day and significantly diminished by the tenth day. As we gradually replaced diazepam with lorazepam, the patient insisted on discharge.ConclusionsPolydrug users, particularly those using NMDAR antagonists and gamma-aminobutyric acid type A receptor (GABA-AR) agonists, may be at increased risk of developing tiletamine dependence, with more severe consequences due to cross-addiction. The combination of alcohol and tiletamine could exacerbate neuroexcitotoxicity during withdrawal, potentially contributing to severe tremors. The successful management of tremors with a combination of neuroinhibitory therapies suggested an effective strategy for complex cases. Further studies are needed to better understand the long-term impacts and risks of tiletamine dependence.https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1537822/fulltiletaminealcoholprimidonephencyclidine use disorderpolydrug usewithdrawal |
| spellingShingle | Bojie Zhou Bojie Zhou Shanghao Yang Shanghao Yang Xiafeng Zhou Xiafeng Zhou Qian Chen Qian Chen Ewen Tu Ewen Tu Bo Zhang Bo Zhang Li Shi Li Shi Xuhui Zhou Xuhui Zhou Severe tremors induced by tiletamine e-cigarette and alcohol use: a case report Frontiers in Psychiatry tiletamine alcohol primidone phencyclidine use disorder polydrug use withdrawal |
| title | Severe tremors induced by tiletamine e-cigarette and alcohol use: a case report |
| title_full | Severe tremors induced by tiletamine e-cigarette and alcohol use: a case report |
| title_fullStr | Severe tremors induced by tiletamine e-cigarette and alcohol use: a case report |
| title_full_unstemmed | Severe tremors induced by tiletamine e-cigarette and alcohol use: a case report |
| title_short | Severe tremors induced by tiletamine e-cigarette and alcohol use: a case report |
| title_sort | severe tremors induced by tiletamine e cigarette and alcohol use a case report |
| topic | tiletamine alcohol primidone phencyclidine use disorder polydrug use withdrawal |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2025.1537822/full |
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