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ingestion are the most common routes of administration, though inhalation,
IV/IM use, and rectal administration have also been described.
Cathinones are β-ketophenethylamines, structurally similar to amphetamines.
The primarily pharmacologic mechanism of action is via blocking the reuptake of
dopamine, norepinephrine, and serotonin. Onset of action is typically rapid,
though pharmacokinetics vary depending on the particular derivative and route of
administration.
Clinical Considerations
Amphetamine-like sympathomimetic effects predominate. Desired effects include
a sense of euphoria, increased energy, enhanced openness, and empathy. The most
common clinical findings include agitation, aggression, hallucinations,
tachycardia, hypertension, mydriasis, and hyperthermia. Adverse effects reported
by users include palpitations, chest pain, dry mouth, nausea, and vomiting. Severe
sequelae of use include seizures, myocardial infarction, myocarditis,
rhabdomyolysis, excited delirium syndrome, serotonin syndrome, and death. As
with many ingestions, the presence of hyperthermia is typically a poor prognostic
indicator.
Treatment is primarily supportive, with initial attention often directed to
management of agitation, aggression, tachycardia, hypertension, and
hyperthermia with liberal use of IV benzodiazepines. A core temperature should
be obtained. While benzodiazepines may effectively manage hyperthermia,
consider passive or active cooling techniques if hyperthermia persists. Further
testing often includes an EKG, electrolytes, renal function, hepatic transaminases,
and a CK. Standard drug screens for amphetamines are often negative in the
setting of synthetic cathinone use. Administer IV fluids, particularly in the setting
of rhabdomyolysis.
Suggested Readings and Key References
Reference Toxicology Textbooks
Erickson T, Ahrens W, Aks S, et al., eds. Pediatric Toxicology: Diagnosis and
Management of the Poisoned Child. New York: McGraw-Hill; 2005.
Nelson LS, Howland MA, Lewin NA, et al., eds. Goldfrank’s Toxicologic

Emergencies. 11th ed. New York: McGraw-Hill; 2019.
Osterhoudt KC, Perrone J, DeRoos F, et al. Toxicology Pearls. Philadelphia, PA:
Hanley & Belfus; 2004.