Acute dilated cardiomyopathy and myocardial injury after combined 4‐fluoroamphetamine and modafinil ingestion

4‐Fluoroamphetamine (4‐FA) intoxication results in exaggerated blood pressure effects compared to MDMA and amphetamine: A retrospective analysis

“…The cardiovascular complications observed in 4-FA-intoxicated patients were in line with the complications reported by earlier studies 15,16,20,22,23 and comparable to the nature of complications observed in MDMA-intoxicated patients. Although the overall prevalence of complications was low, 4-FA intoxications (4/31, 12.9%) seemed to have a higher complication rate then MDMA (6/406, 1.5%) and amphetamine intoxications (2/100, 2.0%).…”

“…The popularity of 4‐FA might be due to the described effect as intermediate between MDMA and amphetamine 20,21 . In case reports and small case studies, serious complications, such as heart failure, cardiomyopathy, myocardial infarction, cerebral hemorrhage, seizures, hyperpyrexia, and fatalities, have been described, 6,14–16,22–25 which are comparable to previously described MDMA‐ and amphetamine‐related complications 5 . Due to these similarities, emergency department (ED) management of 4‐FA intoxications is mostly similar to MDMA and amphetamine, although specific management may be indicated based on specific clinical effects of 4‐FA 1 …”

“…7,8 Its prevalence of use among Dutch party-goers (15-35 years) increased rapidly from 9% in 2013 to 25% in 2016 9,10 and it showed a global presence on the drug market. 8,[11][12][13][14][15][16][17][18] Although 4-FA is an illicit drug in the Netherlands since 2017, 4-FA continued to be the most prominent novel psychoactive substance in the Netherlands in 2018, with 0.9% of all Dutch adults having used 4-FA in that year, compared to 2.8% MDMA and 1.1% amphetamine use. 19…”

Non-ST elevation myocardial ischemia in a patient on modafinil

“…Wolf and colleagues, for example, reported myocardial injury after ingestion of modafi nil 800 mg along with an amphetamine. 11 However, the patient in the present case study reported taking only modafi nil on the day of presentation to the ED with chest pain.…”