Journal of Medical Toxicology

, Volume 11, Issue 2, pp 237–241 | Cite as

Evolution of the NBOMes: 25C- and 25B- Sold as 25I-NBOMe

  • Larissa K. LaskowskiEmail author
  • Faesal Elbakoush
  • Jessica Calvo
  • Gina Exantus-Bernard
  • Jane Fong
  • Justin L. Poklis
  • Alphonse Poklis
  • Lewis S. Nelson
Toxicology Observation



The NBOMes (N-benzyl-oxy-methyl derivatives of known 2C phenylethylamines) are a new and growing class of potent synthetic stimulants. Case reports provide the bulk of available safety and clinical data for clinicians. We report two cases of NBOMe intoxication with 25C-NBOMe (the first lab-confirmed US case) and 25B-NBOMe, respectively, both confirmed via triple quadrapole mass spectrometry.

Case Reports

Case 1: A 16-year-old girl had a generalized seizure after reported use of 25I-NBOMe. She presented with altered mental status, lower extremity rigidity, and elevated CPK (6042 U/L). Despite treatment with benzodiazepines, her lower extremity rigidity persisted and CPK peaked at 47,906 U/L. She was discharged on hospital day 8. Serum and urine specimens confirmed presence of 25C-NBOMe. Case 2: A 15-year-old boy developed bizarre behavior after reported use of 25I-NBOMe. In the ED, he had two generalized seizures and persistent muscle rigidity. CPK peaked at 429 U/L. Seizures were managed with benzodiazepines, and he was discharged within 24 h. Serum specimens revealed 25B-NBOMe.


NBOMes are amphetamine derivatives and highly potent 5-HT2A receptor agonists. Clinical manifestations are a product of enhanced central sympathetic and serotonergic tone. We report two cases of NBOMe intoxication in patients who believed they used 25I-NBOME, while lab confirmation proved otherwise. Whether unique clinical manifestations are specific to the NBOMe variant, dose, route of administration, or other factors is unknown. Laboratory confirmation may play a role in identifying unexpected NBOMe variants, while contributing to the epidemiologic data on these novel substances.


NBOMe Substituted phenylethylamines Serotonin toxicity New psychoactive substances Drugs of abuse 


Sources of Funding

Laboratory analysis was supported in part by the National Institutes of Health (NIH) Center grant P30DA033934.

Conflict of Interest

The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.

Previous Presentation of Data

Laskowski LK, Calvo J, Exantus-Bernard G, Fong J, Poklis JL, Poklis A, Nelson L. NBOMes Lost in Translation: What You See is Not What You Get [abstract.] NACCT 2014.


  1. 1.
    Zuba D, Sekuła K, Buczek A (2013) 25C-NBOMe–new potent hallucinogenic substance identified on the drug market. Forensic Sci Int 227:7–14PubMedCrossRefGoogle Scholar
  2. 2.
    Nikolaou P, Papoutsis I, Stefanidou M, Spiliopoulou C, Athanaselis S (2014) 2C-I-NBOMe, an “N-bomb” that kills with “Smiles.” toxicological and legislative aspects. Drug Chem Toxicol. doi: 10.3109/01480545.2014.911882 PubMedGoogle Scholar
  3. 3.
    Nichols DE, Frescas SP, Chemel BR, Rehder KS, Zhong D, Lewin AH (2008) High specific activity tritium-labeled N-(2-methoxybenzyl)-2,5-dimethoxy-4-iodophenethylamine (INBMeO): a high-affinity 5-HT2A receptor-selective agonist radioligand. Bioorg Med Chem 16:6116–6123PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Earth & Fire Erowid. Spotlight on NBOMes – Potent Erowid Extracts. 2013;24:1–8.Google Scholar
  5. 5.
    Braden MR, Parrish JC, Naylor JC, Nichols DE (2006) Molecular interaction of serotonin 5-HT2A receptor residues Phe339(6.51) and Phe340(6.52) with superpotent N-benzyl phenethylamine agonists. Mol Pharmacol 70:1956–1964PubMedCrossRefGoogle Scholar
  6. 6.
    Poklis JL, Clay DJ, Poklis A (2014) High-performance liquid chromatography with tandem mass spectrometry for the determination of nine hallucinogenic 25-NBOMe designer drugs in urine specimens. J Anal Toxicol 38:113–21PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Kelly A, Eisenga B, Riley B, Judge B (2012) 2012 annual meeting of the North American congress of clinical toxicology (NACCT) October 1–6, 2012 Las Vegas, NV, USA. Case series of 25I-NBOMe exposures with laboratory confirmation. Clin Toxicol 50:702, Abstract nr 284Google Scholar
  8. 8.
    Rose SR, Cumpston KL, Stromberg PE, Wills BK (2012) 2012 annual meeting of the North American congress of clinical toxicology (NACCT) October 1–6, 2012 Las Vegas, NV, USA. Severe poisoning following self-reported use of 25-I, a novel substituted amphetamine. Clin Toxicol 50:707–708, Abstract nr 296Google Scholar
  9. 9.
    Mowry JB, Spyker DA, Cantilena LR, Bailey JE, Ford M (2013) 2012 annual report of the American association of poison control centers’ national poison data system (NPDS): 30th annual report. Clin Toxicol 51:949–1229CrossRefGoogle Scholar
  10. 10.
    Poklis JL, Charles J, Wolf CE, Poklis A (2013) High-performance liquid chromatography tandem mass spectrometry method for the determination of 2CC-NBOMe and 25I-NBOMe in human serum. Biomed Chromatogr 27:1794–1800PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© American College of Medical Toxicology 2014

Authors and Affiliations

  • Larissa K. Laskowski
    • 1
    Email author
  • Faesal Elbakoush
    • 2
  • Jessica Calvo
    • 3
  • Gina Exantus-Bernard
    • 3
  • Jane Fong
    • 3
  • Justin L. Poklis
    • 4
  • Alphonse Poklis
    • 4
    • 5
  • Lewis S. Nelson
    • 1
  1. 1.New York University School of Medicine/New York City Poison Control CenterNew YorkUSA
  2. 2.Woodhull Medical CenterBrooklynUSA
  3. 3.Bronx-Lebanon Hospital CenterNew YorkUSA
  4. 4.Department of Pharmacology and ToxicologyVirginia Commonwealth UniversityRichmondUSA
  5. 5.Department of PathologyVirginia Commonwealth UniversityRichmondUSA

Personalised recommendations