25C-NBOMe

25C-NBOMe

Background

• 2-(4-chloro-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine
• Other names: NBOMe-2C-C, Boom, C-Boom, Cimbi-82, Pandora, N-bomb, Holland film, Dime
• Potent partial agonist of 5-HT2A receptor
• Member of new class of toxic phenethylamine derivatives (NBOMe) with similar effects to LSD
• Commonly ingested orally or sublingually; can also be ingested nasally, parenterally, vaginally, rectally
• Dose of 50-200 micrograms causes hallucinogenic effects
• Onset 0-15 mins, peak 30-90 mins, total duration 4-10 hours

Clinical Features

• Metallic chemical taste
• Sense of numbness of tongue and mouth
• Euphoria
• Visual/Auditory hallucinations
• Stimulation +/- tremors, bruxism
• Serotonin Syndrome (AMS, Hyperthermia, rigidity, autonomic instability)
• Confusion
• Agitation
• Vasoconstriction
• Nausea and Vomiting
• Headache
• Palpitations
• Diaphoresis
• Dysuria
• Hypertension
• Generalized Seizure
• Mydriasis
• Acute Renal Failure
• Metabolic Acidosis

Workup

Hallucination workup

• Urine pregnancy
• CBC, Metabolic panel, LFTs, coags, APAP level, ASA level
• Total CK level
• ECG
• UA
• Tox screen, blood alcohol
• Serum osmoles, urine Na (if Hyponatremia present)
• Head CT as indicated
• LP to rule out Meningitis if infectious symptoms and based on history and physical

Treatment

• ABCs
• IV, O2, monitor
• Agitation
  • Benzodiazepines
  • Haldol for acute agitation
• Seizure
  • Benzodiazepines
  • manage airway as indicated
• Hyperthermia:
  • ice packs, cold IVF

Disposition

• Admit pt's with complications of ingestion

See Also

• LSD
• Ecstasy (MDMA)
• Hallucinations
• Hallucinogens

Sources

Bersani FS, Corazza O, Albano G, et al. 25C-NBOMe: preliminary data on pharmacology, psychoactive effects, and toxicity of a new potent and dangerous hallucinogenic drug. Biomed Res Int. 2014;2014:734749.