Department of Emergency Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon; and
Department of Emergency Medicine, School of Medicine, Oregon Health and Science University, Portland, Oregon; and.
Pediatrics. 2020 Jul;146(1). doi: 10.1542/peds.2019-2953. Epub 2020 Jun 24.
Flualprazolam is a nonregistered drug in the benzodiazepine family and constitutes a new psychoactive substance (NPS). Since 2014, a growing number of designer benzodiazepines have become available over the Internet and on the counterfeit drug market. In June 2019, a cluster of patients intoxicated with flualprazolam was identified by the Oregon Poison Center. As an emerging drug of abuse, the clinical characteristics of flualprazolam have been poorly characterized thus far. Over a one-week period, 6 teenagers presented to local emergency departments after ingesting illegally obtained counterfeit alprazolam, which led to sedation. Other symptoms included slurred speech, confusion, and mild respiratory depression. All 6 patients had resolution of their symptoms within 6 hours of ingestion. Blood and urine samples, as well as a tablet fragment, were obtained from 3 patients. The tablet and biological samples were analyzed by using liquid chromatography-quadrupole time-of-flight mass spectrometry and were found to contain the NPS flualprazolam without other drugs or intoxicants. With this case series, we add to the medical literature a clinical description of an emerging drug of abuse. Flualprazolam appears to share the clinical properties of other benzodiazepines. As flualprazolam and other NPSs become more common, physicians must be aware of their availability and characteristics. Sedation lasting <6 hours was observed in 6 of 6 patients exposed to flualprazolam. No effects that would be unexpected from benzodiazepine intoxication were seen among the patients. Specifically, none developed prolonged symptoms or required intubation and mechanical ventilation, ICU admission, or antidotal therapy.
氟拉䓬仑是苯二氮䓬类家族中的一种未注册药物，构成了一种新的精神活性物质（NPS）。自 2014 年以来，越来越多的苯二氮䓬类设计药物在互联网和假冒药物市场上出现。2019 年 6 月，俄勒冈州毒物中心发现了一组因氟拉䓬仑中毒的患者。作为一种新出现的滥用药物，氟拉䓬仑的临床特征迄今描述甚少。在一周的时间里，6 名青少年因摄入非法获得的假冒阿普唑仑而出现镇静作用，随后前往当地急诊部门就诊。其他症状包括言语不清、意识混乱和轻度呼吸抑制。所有 6 名患者在摄入后 6 小时内症状均得到缓解。从 3 名患者中获得了血液和尿液样本以及一片药渣。使用液相色谱-四极杆飞行时间质谱法对药片和生物样本进行分析，发现含有 NPS 氟拉䓬仑，而无其他药物或毒物。通过本病例系列，我们在医学文献中增加了一种新出现的滥用药物的临床描述。氟拉䓬仑似乎具有其他苯二氮䓬类药物的临床特征。随着氟拉䓬仑和其他 NPS 的出现越来越普遍，医生必须了解其可用性和特征。6 名暴露于氟拉䓬仑的患者中，有 6 名患者的镇静作用持续<6 小时。患者中未出现苯二氮䓬类中毒的异常表现。具体来说，没有患者出现症状持续时间延长或需要插管和机械通气、入住 ICU 或解毒治疗。
