4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis
Abstract Objective 4‐Fluoroamphetamine (4‐FA) is an amphetamine‐type stimulant, with effects comparable to amphetamine and 3,4‐methylenedioxymethamphetamine (MDMA). Severe 4‐FA‐related complications, such as cardiomyopathy, myocardial infarction, and cerebral hemorrhage, have been described. The aim...
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| Format: | Article |
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Elsevier
2022-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
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| Online Access: | https://doi.org/10.1002/emp2.12813 |
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| author | Femke M. J. Gresnigt Anouk Snik Eric J. F. Franssen Joost W. Vanhommerig Dylan W. deLange Robert K. Riezebos |
| author_facet | Femke M. J. Gresnigt Anouk Snik Eric J. F. Franssen Joost W. Vanhommerig Dylan W. deLange Robert K. Riezebos |
| author_sort | Femke M. J. Gresnigt |
| collection | DOAJ |
| description | Abstract Objective 4‐Fluoroamphetamine (4‐FA) is an amphetamine‐type stimulant, with effects comparable to amphetamine and 3,4‐methylenedioxymethamphetamine (MDMA). Severe 4‐FA‐related complications, such as cardiomyopathy, myocardial infarction, and cerebral hemorrhage, have been described. The aim of this study was to explore the cardiovascular symptoms and complications in 4‐FA and compare them to MDMA and amphetamine in intoxicated patients who presented to the emergency department (ED). Methods Between November 2015 and March 2020, all self‐reported 4‐FA, MDMA, and amphetamine‐intoxicated adult patients that presented at the ED of an inner‐city hospital in Amsterdam, were retrospectively analyzed for cardiovascular symptoms, vital parameters, cardiovascular complications, interventions, admission rate, and Poisoning Severity Score (PSS). Results A total of 582 patients were included, of which 31 (5.3%) with 4‐FA intoxication (10/31 mono‐intoxications, 32.3%), 406 (69.8%) with MDMA (59/406 mono‐intoxications, 14.5%), 100 (17.2%) with amphetamine (10/100 mono‐intoxications, 10.0%), and 45 (7.7%) with a cross intoxication of these drugs. 4‐FA mono‐intoxicated patients experienced more headache (n = 8; 80.0%) compared to MDMA (n = 2; 3.3%; P < 0.001) and amphetamine mono‐intoxicated patients (n = 0; 0.0%; P < 0.001) and their systolic blood pressure was higher (164 mm Hg ± 31 vs 139 mm Hg ± 19; P = 0.031 vs 135 mm Hg ± 22; P = 0.033, respectively). Severe 4‐FA‐related cardiovascular complications included Takotsubo cardiomyopathy (n = 1; 3.2%), subarachnoid hemorrhage (n = 1; 3.2%), and hypertensive urgency (n = 2; 6.5%). Conclusions 4‐FA intoxication‐related ED symptoms resemble MDMA and amphetamine complications, although patients presented more often with headache and hypertension. Severe 4‐FA‐related cardiovascular complications occurred in 40% of mono‐intoxications. |
| format | Article |
| id | doaj-art-ac993029344e427da3ff0c3a9559da9f |
| institution | DOAJ |
| issn | 2688-1152 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj-art-ac993029344e427da3ff0c3a9559da9f2025-08-20T02:54:46ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522022-10-0135n/an/a10.1002/emp2.128134‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysisFemke M. J. Gresnigt0Anouk Snik1Eric J. F. Franssen2Joost W. Vanhommerig3Dylan W. deLange4Robert K. Riezebos5Department of Emergency Medicine Onze Lieve Vrouwe Gasthuis Hospital AC Amsterdam the NetherlandsDepartment of Emergency Medicine Onze Lieve Vrouwe Gasthuis Hospital AC Amsterdam the NetherlandsDepartment of Clinical Pharmacy Onze Lieve Vrouwe Gasthuis Hospital AC Amsterdam the NetherlandsDepartment of Research and Epidemiology Onze Lieve Vrouwe Gasthuis Hospital AC Amsterdam the NetherlandsDutch Poison Information Center UMC Utrecht, University Utrecht Utrecht the NetherlandsHeart Center, OLVG Hospital AC Amsterdam the NetherlandsAbstract Objective 4‐Fluoroamphetamine (4‐FA) is an amphetamine‐type stimulant, with effects comparable to amphetamine and 3,4‐methylenedioxymethamphetamine (MDMA). Severe 4‐FA‐related complications, such as cardiomyopathy, myocardial infarction, and cerebral hemorrhage, have been described. The aim of this study was to explore the cardiovascular symptoms and complications in 4‐FA and compare them to MDMA and amphetamine in intoxicated patients who presented to the emergency department (ED). Methods Between November 2015 and March 2020, all self‐reported 4‐FA, MDMA, and amphetamine‐intoxicated adult patients that presented at the ED of an inner‐city hospital in Amsterdam, were retrospectively analyzed for cardiovascular symptoms, vital parameters, cardiovascular complications, interventions, admission rate, and Poisoning Severity Score (PSS). Results A total of 582 patients were included, of which 31 (5.3%) with 4‐FA intoxication (10/31 mono‐intoxications, 32.3%), 406 (69.8%) with MDMA (59/406 mono‐intoxications, 14.5%), 100 (17.2%) with amphetamine (10/100 mono‐intoxications, 10.0%), and 45 (7.7%) with a cross intoxication of these drugs. 4‐FA mono‐intoxicated patients experienced more headache (n = 8; 80.0%) compared to MDMA (n = 2; 3.3%; P < 0.001) and amphetamine mono‐intoxicated patients (n = 0; 0.0%; P < 0.001) and their systolic blood pressure was higher (164 mm Hg ± 31 vs 139 mm Hg ± 19; P = 0.031 vs 135 mm Hg ± 22; P = 0.033, respectively). Severe 4‐FA‐related cardiovascular complications included Takotsubo cardiomyopathy (n = 1; 3.2%), subarachnoid hemorrhage (n = 1; 3.2%), and hypertensive urgency (n = 2; 6.5%). Conclusions 4‐FA intoxication‐related ED symptoms resemble MDMA and amphetamine complications, although patients presented more often with headache and hypertension. Severe 4‐FA‐related cardiovascular complications occurred in 40% of mono‐intoxications.https://doi.org/10.1002/emp2.12813amphetaminecardiovascular complicationsemergency department4‐fluoramphetamine4‐FA3,4‐methylenedioxymethamphetamine |
| spellingShingle | Femke M. J. Gresnigt Anouk Snik Eric J. F. Franssen Joost W. Vanhommerig Dylan W. deLange Robert K. Riezebos 4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis Journal of the American College of Emergency Physicians Open amphetamine cardiovascular complications emergency department 4‐fluoramphetamine 4‐FA 3,4‐methylenedioxymethamphetamine |
| title | 4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis |
| title_full | 4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis |
| title_fullStr | 4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis |
| title_full_unstemmed | 4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis |
| title_short | 4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis |
| title_sort | 4 fluoroamphetamine 4 fa intoxication results in exaggerated blood pressure effects compared to mdma and amphetamine a retrospective analysis |
| topic | amphetamine cardiovascular complications emergency department 4‐fluoramphetamine 4‐FA 3,4‐methylenedioxymethamphetamine |
| url | https://doi.org/10.1002/emp2.12813 |
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