LETTERS TO THE EDITORS
Mephentermine: rediscovering its biology and use, misuse and their implications
Mefentermina: redescobrindo sua biologia, uso, abuso e suas implicações
Dear Editor,
Mephentermine is an amphetamine-derived phenethylamine which shares a strong chemical similarity with both methamphetamine and the resulting stimulant actions of the alpha and beta adrenoceptors. It has been proposed that phentermine, which is a main metabolite of mephentermine, acts by inhibiting monoaminoxidases A and B.1
Mephentermine is less powerful compared to methamphetamine, and was traditionally used as a vasoconstrictor to maintain blood pressure in cases of hypotension during spinal anesthesia in patients undergoing elective Caesarean section procedures and pregnancy.2 It has also been used as a nasal decongestant.3
Nowadays, it is mainly used as a stimulant administered to disease-recovering competition animals. Its misuse by humans to achieve better physical performance has been described, however little data is available on the dependence and misuse of mephentermine.4
Both mephentermine and phentermine are stimulants whose use is prohibited by the World Anti-Doping Agency (WADA).1
Only five case reports on the misuse and or dependence of mephentermine were found in the literature. The first two cases involved the misuse of mephentermine without dependence secondary to the use of inhalers. This misuse induced acute paranoid-hallucinatory symptoms that were identical to those seen in amphetamine-caused psychosis or acute paranoid schizophrenia. The third case involved a patient who became dependent although this patient had already presented psychotic symptoms on prior occasions. The fourth case involved an associated dependence of mephentermine, buprenorphine and promethazine.3,4
In Brazil, the use of mephentermine is restricted to veterinary use. It is used for fatigue, anemia, malnutrition and recovery from infectious and parasitic diseases. Its commercial names are Potenay® and Potemax®, which are administered orally or injected intramuscularly. The recommended dose for horses, cattle, swine, goats, dogs and cats is 6 to 12mg for each 5kg twice or three times a day.
Our group has recently described the sixth case of misuse and the second case of mephentermine dependence without the presence of psychotic symptoms in a 22-year-old Brazilian man. The same case is the first described in Brazil. Although our initial experience with this patient revealed that this substance is widely available for sale in the black market, the medical literature has not yet fully investigated enough cases on the misuse of mephentermine and its derivates.4
Our aim is to highlight the relevance of a theme that is certainly more frequent than what is shown by the data currently available and is associated with social issues. The misuse of mephentermine can bring about major clinical implications, which may include secondary hypertension and a myriad of cardiovascular diseases such as arrhythmias and sudden death syndrome.
The extensive use of these substances may warrant testing for these drugs on a more routine basis by drug monitoring programs. The healthcare community should, by all means, conduct surveys to identify new kinds of stimulants that are used to generate intellectual and physical doping.5
Furthermore, we support the establishment of a public health program whose goal would be to disseminate information about the risks involved to both users and non-users, as well as to provide specific treatment to already dependent patients and appropriate training to human resources so as to better prepare them to deal with these cases.
Matheus Fernandes de Oliveira
Department of Neuropsychiatry, Universidade Federal de
Pernambuco (UFPE), Recife, PE, Brazil
Hospital do Servidor Público Estadual de São Paulo (FMO),
São Paulo, SP, Brazil
Henrique Faria de Sousa, Murilo Costa Duarte Lima,
João Ricardo Mendes de Oliveira
Department of Neuropsychiatry, Universidade Federal de
Pernambuco (UFPE), Recife, PE, Brazil
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- 1. Docherty JR. Pharmacology of stimulants phohibited by the World Anti-Doping Agency (WADA). Br J Pharmacol. 2008;154(3):606-22.
- 2. Kansal A, Mohta M, Sethi AK, Tyagi A, Kumar P. Randomised trial of intravenous infusion of ephedrine or mephentermine for management of hypotension during spinal anaesthesia for Caesarean section. Anaesthesia. 2005;60(1):28-34.
- 3. Basu D, Nebhinani N. Mephentermine dependence without psychosis. Indian J Med Sci. 2009;63(3):117-9.
- 4. Sousa HF, Oliveira MF, Costa Lima MD, Oliveira JR. Mephentermine dependence without psychosis: a Brazilian case report. Addiction 2010;105(6):1129-30.
- 5. Oliveira JR. Much ado about cognitive enhancement. Nature 2009;457(7229):532.
Publication Dates
-
Publication in this collection
26 Apr 2011 -
Date of issue
Mar 2011
