Benzylpiperizine
OVERVIEW
- hallucinogenic stimulant with similar effects to amphetamines and MDMA
- once studied as an antihelminthic agent but abandoned due to side effects
- taken by oral, intravenous, insufflation routes
- liquid base form is corrosive
- Risk assessment: > 400mg ingestion requires observation
TOXICODYNAMICS
- reuptake inhibitor of serotonin > noradrenaline and dopamine
- alpha2 adrenoceptor antagonist
- serotonin agonist — 5HT2B =hallucinations , 5HT2A = peripheral effects (e.g. GI symptoms), 5HT1 -> headaches
TOXICOKINETICS
- bioavailability uncertain
- hepatic metabolism
- renal elimination with t1/2 = 5.5 hours
CLINICAL FEATURES
Neurological
- euphoria, confusion/agitation, anxiety, tremor, seizures
Cardiovascular
- tachycardia, palpitations, chest pains, dysrhythmias
Other
- GI upset, fever, hepatotoxicity, rhabdomyolysis
INVESTIGATIONS
- screening tests — APAP level, ECG, glucose
- UEC — hyponatremia
- others as indicated (e.g. cardiac markers, CK, CT head if headache, FND or seizure)
MANAGEMENT
- treat as for amphetamine toxicity
- benzodiazepines for agitation, seizures and hypertension
- phentolamine +/- SNP/ GTN infusions for refractory hypertension
- treat cardiovascular emergencies as per usual protocols but avoid beta-blockers (risk of unopposed alpha-agonism)
References and Links
- Gee P, Richardson S, Woltersdorf W, Moore G (2005). Toxic effects of BZP-based herbal party pills in humans: a prospective study in Christchurch, New Zealand (PDF). N Z Med J 118 (1227): U1784. PMID: 16372033
References and Links
CCC Toxicology Series
General
Approach to acute poisoning, ECGs in Tox, Evidenced-based Tox, Toxicology literature summaries, Does anti-venom work?
Toxins / Overdose
Amphetamines, Barbituates, Benzylpiperazine, Beta Blockers, Calcium Channel Blocker, Carbamazepine, Carbon Monoxide, Ciguatera, Citrate, Clenbuterol, Cocaine, Corrosive ingestion, Cyanide, Digoxin, Ethanol, Ethylene Glycol, Iron, Isoniazid, Lithium, Local anaesthetic, Methanol, Monoamine oxidase inhibitor (MAOI), Mushrooms (non-hallucinogenic), Opioids, Organophosphate, Paracetamol, Paraquat, Plants, Polonium, Salicylate, Scombroid, Sodium channel blockers, Sodium valproate, Theophylline, Toxic alcohols, Tricyclic antidepressants (TCA)
Envenomation
Marine, Snakebite, Spider, Tick paralysis
Syndromes
Alcohol withdrawal, Anticholinergic syndrome, Cholinergic syndrome, Drug withdrawals in ICU, Hyperthermia associated toxidromes, Malignant hyperthermia (MH), Neuroleptic malignant syndrome (NMS), Opioid withdrawal, Propofol Infusion Syndrome (PrIS) Sedative toxidrome, Serotonin syndrome, Sympatholytic toxidrome, Sympathomimetic toxidrome
Decontamination
Activated Charcoal, Gastric lavage, GI Decontamination
Enhanced Elimination
Enhanced elimination, Hyperbaric therapy for CO
Antidotes
Antidote summary, Digibind, Glucagon, Flumazenil, HIET – High dose euglycaemic therapy, Intralipid, Methylene Blue, N-Acetylcysteine (NAC), Naloxone
Miscellaneous
Cocaine chest pain, Digoxin and stone heart theory, Hyperbaric oxygen, Hypoxaemia in tox, Liver failure in tox, Liver transplant for paracetamol, Methaemoglobinaemia, Urine drug screen
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
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