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-Cathinone is a natural stimulant found in the khat plant
-Synthetic cathinones, aka “Bath salts”, refer to a collective group of compounds that are highly potent stimulants and are similar to MDMA, cocaine, and methamphetamine
-The most common compound found in bath salts is MDPV (3,4-methylenedioxypyrovalerone)
-Alpha-PVP is not a “second-generation bath salt”; it was actually first synthesized in the 1960s
-Alpha-PVP has been recently been linked to multiple reported deaths in Florida
-Alpha-PVP was added to the controlled substance list in the USA in 2014Structure:
-Alpha-PVP typically comes in a crystal form
-Formula: C15H21NO
-Alpha-PVP’s mechanism of action is believed to involve inhibition of the reuptake of norepinephrine, dopamine, and serotonin
-Rat studies have shown that alpha-PVP is both an uptake blocker of norepinephrine/dopamine and stimulates dopamine releaseAbsorption/Distribution/Metabolism/Excretion:
Absorption
-Can be taken orally, sublingually, injected, vaporized, or intranasal
-Onset of desired effects (euphoria) in 5-30 minutes and lasts for 1-3 hours. However, the undesired side effects (including psychosis) can last days
Distribution
-Postmortem studies have found alpha-PVP uniformly distributed among multiple tissues (blood, brain, muscle, CSF, lung, kidney, and liver)
Metabolism
-Six phase I metabolites have been identified
-Lactam is the major metabolite
Excretion
-A study of postmortem alpha-PVP levels showed the highest concentrations of Buy Bath Salts Alpha PVP Crystal were found in urine and the lowest concentrations were found in the liver → suggesting the drug is excreted chiefly by the renal systemSignificant Drug/Drug Interactions:
-Co-ingestion of alcohol, other stimulants, and other illicit drugs has been shown to enhance the effects of the drugs
-A large proportion of the fatal cases of alpha-PVP have involved co-ingestions of multiples drugs and alcoholToxicity/Mechanism of Toxicity:
-LD50 has not been determined
-The potency and efficacy of alpha-PVP and MDPV are very similar in rat studies
-Rat studies showed increased locomotor signs with doses ranging from 1mg/kg to 30mg/kg
-A few case reports of drug-related fatalities with serum alpha-PVP and blue solid levels have been reported: 0.1mg/L, 0.29mg/L, 0.52mg/L, 0.901mg/L
-All serum levels are determined by the liquid-mass-mass spectrometry method
-There is a significant overlap between concentrations tolerated by individuals and those reported in drug-related fatalities → alpha-PVP concentration alone does not determine toxicity
Clinical Toxicity/Presentation:
-Increased dopamine causes euphoria, increased activity, and hyperstimulation
-Increased norepinephrine increases heart rate and blood pressure
-Increased serotonin can cause hallucinations, delirium, and Terfamex available in capsule form paranoia
-Severe agitated delirium and aggressive behavior have been reported
-Life-threatening severe toxicity: Serotonin syndrome, hyperthermia, hypotension, rhabdomyolysis, acute renal failure, liver failure, cardiac dysrhythmias, seizures
-Chronic exposure: May lead to physical and psychological dependence with withdrawal symptoms
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