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Ann Emerg Med. 2018 Mar;71(3):294-305. doi: 10.1016/j.annemergmed.2017.07.482. Epub 2017 Sep 29.

Fatalities, Cerebral Hemorrhage, and Severe Cardiovascular Toxicity After Exposure to the New Psychoactive Substance 4-Fluoroamphetamine: A Prospective Cohort Study.

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Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address:
Dutch Poisons Information Center, University Medical Center Utrecht, Utrecht, the Netherlands.
Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Department of Drug Monitoring, Utrecht, the Netherlands, and the Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
National Institute for Public Health and the Environment, Center for Health Protection, Bilthoven, the Netherlands.
Division of Specialist Services and Expertise, Forensic Toxicology and Pathology, Netherlands Forensic Institute, The Hague, the Netherlands.



We study adverse health effects after use of the new psychoactive substance 4-fluoroamphetamine.


All patients who reported 4-fluoroamphetamine exposure and for whom the Dutch Poisons Information Center was consulted by their physician in 2016 were included in a prospective cohort study. The clinical course was investigated through telephone interviews with the physician and/or patient, using standardized questionnaires. 4-Fluoroamphetamine was analyzed in remaining drug material and biological samples with liquid and gas chromatography-mass spectrometry techniques.


We included 45 patients, and follow-up with the physician and/or patient was performed in 33 cases. All patients experienced adverse effects after 4-fluoroamphetamine use. Severe toxicity was reported in 8 patients. In 5 of these patients, 4-fluoroamphetamine exposure was confirmed in biological specimens. Severe toxicity that was reported included 2 fatalities, 4 patients with cerebral hemorrhage (1 fatal), 2 patients with inverted Takotsubo's cardiomyopathy, 1 patient with myocardial infarction, 1 patient with acute heart failure, and an overall high prevalence of pronounced hypertension and tachycardia.


Since the introduction of 4-fluoroamphetamine to the Dutch drug market in 2007, its use continues to increase, possibly because users perceive it as "ecstasy light" and thus relatively safe. However, the proportion of patients with severe toxicity after 4-fluoroamphetamine use is relatively large in our study population. Therefore, users should be warned about the risks of 4-fluoroamphetamine.

[Indexed for MEDLINE]

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