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4-Fluoroamphetamine (4-FA) intoxication results in exaggerated blood pressure effects compared to MDMA and
Femke M J Gresnigt1,2, Anouk Snik1, Eric J F Franssen3
1Department of Emergency Medicine Onze Lieve Vrouwe Gasthuis Hospital AC Amsterdam the Netherlands.
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.
Insights
4-Fluoroamphetamine (4-FA) intoxication presents cardiovascular risks similar to MDMA and amphetamine, with higher rates of headache and hypertension. Severe 4-FA complications, including cardiomyopathy, occurred in 40% of mono-intoxicated patients.
Area of Science:
- Cardiology
- Toxicology
- Emergency Medicine
Background:
- 4-Fluoroamphetamine (4-FA) is a stimulant with effects similar to amphetamine and MDMA.
- Severe cardiovascular complications, including cardiomyopathy and hemorrhage, have been linked to 4-FA use.
- Understanding these risks is crucial for emergency department (ED) management.
Purpose of the Study:
- To investigate cardiovascular symptoms and complications associated with 4-FA intoxication.
- To compare these effects with those of MDMA and amphetamine in ED patients.
Main Methods:
- Retrospective analysis of adult patients presenting to an Amsterdam ED between November 2015 and March 2020.
- Inclusion criteria: self-reported intoxication with 4-FA, MDMA, or amphetamine.
- Data collected: cardiovascular symptoms, vital signs, complications, interventions, admission rates, and Poisoning Severity Score (PSS).
Main Results:
- A total of 582 patients were analyzed: 31 with 4-FA, 406 with MDMA, 100 with amphetamine, and 45 with cross-intoxications.
- 4-FA mono-intoxicated patients reported more headaches (80%) and had higher systolic blood pressure (164 mmHg) compared to MDMA and amphetamine users.
- Severe 4-FA cardiovascular complications included Takotsubo cardiomyopathy (3.2%), subarachnoid hemorrhage (3.2%), and hypertensive urgency (6.5%).
Conclusions:
- 4-FA intoxication shares cardiovascular symptoms with MDMA and amphetamine but is more frequently associated with headache and hypertension.
- Severe cardiovascular complications occurred in 40% of 4-FA mono-intoxication cases.
- These findings highlight the significant cardiovascular risks of 4-FA, necessitating prompt medical attention.
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