Clenbuterol adulteration

The authors reported that these patients had an unusual neuromuscular syndrome (which has not previously been described), characterized by muscle spasms and hyper-reflexia that lasted between 2 and 8 days. They reported that though clenbuterol toxicity has been reported to cause muscle tremors and myalgia, previous patients did not have tetany, muscle spasms, or hyper-reflexia. None of the drug screens detected strychnine, which is a common contaminant of heroin. They concluded that this novel neuromuscular syndrome was probably due to clenbuterol-adulterated heroin, but acknowledged that there could be other possible expla-nations/contaminations that were not detected. 

A novel neuromuscular syndrome, characterized by muscle spasm, tremor, hyper-refiexia, and raised serum creatine kinase activity, has been described in five heroin users and attributed to clenbuterol adulteration [115. ... 

In all the cases the heroin had been adulterated with veterinary clenbuterol. 

These changes may go unnoticed or can on occasion cause morbidity and/or mortality. From 28 January to 2 February 2005, nine cases of atypical reactions to heroin were reported from a county in New Jersey, USA. The patients had nausea, chest pain, palpitation, agitation, anxiety, tachycardia, hypotension, hyperglycemia, hypokalemia, and metabolic acidosis with increased lactate concentrations. Cyanide poisoning was suspected, but cyanide was not found and specific treatment was ineffective. However, clenbuterol was identified as an adulterant in a sample of heroin obtained by the police. A public health alert was issued usingthe USA Centers for Disease Control and Prevention s EPI-X system... 

Thus, adulteration of heroin by clenbuterol was associated with sympathomimetic effects, metabolic acidosis, and myocardial injury. However, collaborative efforts among the... 

Drug adulteration Adulteration of heroin with clenbuterol is frequently reported [112 ]. In 13 confirmed cases of exposure to clenbuterol in this way, clenbuterol was identified in the blood and or urine of 12 [113 ]. Symptoms included nausea, chest pain, palpitation, dyspnea, and tremor. The physical findings included significant tachycardia and hypotension, and there was laboratory evidence of hyperglycemia, hypokalemia, and increased lactate concentrations six patients had biochemical evidence of myocardial injury. Ten were given beta-adrenoceptor antagonists without adverse effects. 

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