Methcathinone: a Russian designer amphetamine infiltrates the rural midwest

Four cases of methcathinone toxicity in the United States are presented and discussed. This drug is the latest in a series of "designer" amphetamines. Prominent findings of acute toxicity include hallucinations, fever, and tachycardia followed by periods of bradycardia and moderate hypotension as acute symptoms resolve. Chronic binge use may result in development of paranoid psychosis and brief periods of withdrawal tremors. Our current understanding of methcathinone effects and the Russian experience with it are discussed. Our recommendations for treatment of acute toxicity are based on well established guidelines for managing the toxicity of similar amphetamine-like drugs.