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Medicines > classes : Research material or [[:Category:Crystalloid_IV_fluids|Crystalloid IV fluid]] or dissociative

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generic:
brand:
None (137) · (none, never marketed) (1) · DXM (1) · DXO (1) · Lactated Ringer's Injection (Baxter, B. Braun, ICU Medical); Hartmann's solution (intl.) (1) · Normal saline, NaCl injection, many; nebulized: HyperSal, PulmoSal (1) · O-DSMT (1) · Spravato (1)
classes: (Click arrow to add another value)
mechanism:
5-HT2A agonist (26) · Monoamine releasing agent (9) · GABAA positive allosteric modulator (8) · CB1/CB2 agonist (7) · Dopamine/norepinephrine reuptake inhibitor (5) · Potent 5-HT2A agonist (5) · LSD analogue; 5-HT2A agonist (4) · Prodrug of LSD; 5-HT2A agonist (4) · NMDA antagonist (3) · Serotonin/norepinephrine/dopamine releasing agent (3) · Cathinone analogue; monoamine reuptake inhibitor (2) · Dopamine and norepinephrine reuptake inhibitor (2) · NMDA antagonist; sigma receptor agonist (2) · Prodrug of GHB (2)
uses:
None (140) · No approved medical problem. Encountered as a designer/research benzodiazepine and, increasingly, as an adulterant in illicit opioid supplies. (1) · Treatment-resistant depression (TRD) in adults, as adjunct to oral antidepressant (FDA-approved March 2019). Depressive symptoms in adults with MDD with acute suicidal ideation or behavior (FDA-approved Aug 2020). (1) · '"`UNIQ--vote-00000039-QINU`"', '"`UNIQ--vote-0000003A-QINU`"', '"`UNIQ--vote-0000003B-QINU`"', '"`UNIQ--vote-0000003C-QINU`"', '"`UNIQ--vote-0000003D-QINU`"' (1) · '"`UNIQ--vote-00000088-QINU`"', '"`UNIQ--vote-00000089-QINU`"', '"`UNIQ--vote-0000008A-QINU`"', '"`UNIQ--vote-0000008B-QINU`"' (1)
starting dose:
None (140) · Induction (TRD): 56 mg intranasal twice weekly × 4 weeks. Maintenance: 56-84 mg once weekly × 4 weeks, then 56-84 mg every 1-2 weeks. For acute suicidality: 84 mg twice weekly × 4 weeks. Administered under medical supervision in REMS-certified site. (1) · No medical dose. Active recreational doses reported in the 0.5–1.5 mg range (similar potency to alprazolam). (1) · Volume and concentration titrated to clinical status; symptomatic hyponatremia: 3% NaCl 100-150 mL bolus, reassess (1) · Volume titrated to clinical status; typical adult bolus 500-1000 mL, then reassess (1)
preparations:
None (140) · 0.225%, 0.45%, 0.9%, 3%, 5% IV solutions; 0.9% nasal spray; 3% and 7% nebulizer solutions; oral tablets (1 g) (1) · 250, 500, 1000 mL IV bags. Composition per liter: Na+ 130 mEq, K+ 4 mEq, Ca2+ 3 mEq, Cl- 109 mEq, lactate 28 mEq (1) · 28 mg/device (each dose uses 2 devices) (1) · Illicit tablets ("bars"), powders, blotter, occasionally solutions. No pharmaceutical product exists. (1)
fda max:
None (140) · 84 mg per session (1) · N/A (never approved) (1) · No fixed maximum; titrated to clinical endpoints (1) · No fixed maximum; titrated; sodium correction rate in chronic hyponatremia must not exceed 8-10 mEq/L per 24 hours to avoid osmotic demyelination (1)
routes:
None (140) · intranasal (1) · Intranasal (under direct medical supervision) (1) · intranasal; rectal and IV reported. (1) · IV (2) · nebulized (1) · ophthalmic (1) · oral (2) · sublingual (1)
onset:
None (140) · Immediate (IV) (1) · Immediate intravascular expansion (1) · Within hours of first administration (1) · ~20–40 min PO; faster sublingual/intranasal. (1)
duration:
None (140) · 6–10 h subjective; full pharmacologic effect considerably longer. (1) · Acute effect ~24 hours; cumulative effect builds with repeated dosing (1) · Roughly 20-25% of an IV bolus remains intravascular at 1 hour (1) · Roughly 20-30% remains intravascular at 1 hour (1)
halflife:
None (140) · Estimated ~12–17 h (some sources cite up to ~21 h); active metabolites prolong effect. (1) · Not applicable (electrolyte solution) (1) · Not applicable (electrolyte) (1) · ~7-12 hours (1)
bioavailability:
None (140) · 100% (IV) (1) · 100% (IV); essentially complete (oral) (1) · Not formally characterized in humans. (1) · ~48% intranasal (1)
pregnancy:
None (140) · Avoid. Benzodiazepines are associated with neonatal sedation, floppy-infant syndrome, and withdrawal; teratogenic signal weak but non-zero. Designer benzo with no safety data, assume worst-case. (1) · Avoid; may cause fetal harm (1) · Standard fluid and electrolyte management (1) · Standard resuscitation fluid in pregnancy (1)
legal:
None (141) · Rx, Schedule III (US). REMS program required. (1) · [[USLegal:Prescription only|Rx-only]] for parenteral formulations; OTC for oral, nasal, and many nebulizer products (1) · [[USLegal:Prescription only|Rx-only]] in US (1)

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