Clinical presentation

Novel stimulant drugs with higher serotonin to dopamine ratio produce more ‘ecstasy’-like effects, whereas novel stimulant drugs with higher dopamine to serotonin ratio produce euphoria similar to cocaine or metamfetamine.

Some novel stimulant drugs also have hallucinogenic effects—see here for clinical presentation of novel hallucinogenic drug poisoning. Cathinones are associated with more pronounced neurotoxicity than established recreational stimulant drugs.

Patients usually present with acute sympathomimetic toxidrome or acute serotonergic toxidrome, with cardiovascular effects (eg arrhythmias, myocardial ischaemia), acute behavioural disturbance, hyperthermia and rhabdomyolysis. Presentations and severity vary, so patients must be treated on a case-by-case basis.