Protonitazene | The JHI

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Protonitazene

Found in:  

Fentanyl, BZD

Type/Reason added:  

Nitazene

Relative Potency:  

200 times stronger than morphine (18), similar potency to fentanyl (6)

Overview

The Effects

Treatment Options

Supportive Care:

Oxygen therapy, artificial ventilation, and intensive care monitoring. In severe cases, mechanical ventilation may be necessary to sustain breathing.

Antidote:

Rapid administration of naloxone (Narcan), though protonitazene overdoses often require higher and repeated doses due to its potency.

Pharmacokinetics and Dynamics

Metabolism:

Protonitazene is metabolized in the liver, likely by CYP3A4 enzymes, similar to fentanyl and other synthetic opioids. It is broken down into inactive metabolites and eliminated primarily through the urine. Its duration of action is slightly longer than fentanyl, meaning overdose symptoms may persist for extended periods.

Drug-Drug Interactions:

Protonitazene has dangerous interactions with other central nervous system depressants, including benzodiazepines (e.g., alprazolam, diazepam), alcohol, barbiturates, and other opioids. These combinations dramatically increase the risk of fatal respiratory depression. It also interacts with CYP3A4 inhibitors (such as grapefruit juice and certain antibiotics), which can increase its potency and prolong its effects, leading to overdose at lower doses.