Education of the patient and family is essential. Club drug overdose usually resolves with full recovery within seven hours. Severe drug reactions can occur even with a small dose and may require critical care. Special care must be taken for immediate control of hyperthermia, hypertension, rhabdomyolysis, and serotonin syndrome. There are no specific antidotes except for flunitrazepam, a benzodiazepine that responds to flumazenil. The primary management is supportive care, with symptomatic control of excess central nervous system stimulation or depression. Flumazenil is more effective in reversing sedation or coma in benzodiazepine intoxication than patients with multiple drug overdoses. It is useful in reversing coma due to benzodiazepine overdose. Toxicologic screening generally is not available for club drugs. Flumazenil is also indicated for the management and treatment of benzodiazepine overdose in adults. It comes in oral strips, lozenges, liquids, or liquid-filled capsules and formulations often combine the drug with guaifenesin, acetaminophen, and pseudoephedrine. Persons who have adverse reactions to these club drugs are likely to consult a family physician. Dextromethorphan is a drug used in many over-the-counter cough and cold medicines for its antitussive effects. Any club drug overdose should therefore be suspected as polydrug use with the actual substance and dose unknown. Club drugs often are adulterated or misrepresented. Club drugs usually are taken orally and may be taken in combination with each other, with alcohol, or with other drugs. These drugs are popular because of their low cost and convenient distribution as small pills, powders, or liquids. The most widely used club drugs are 3,4-methylenedioxymetham-phetamine (MDMA), also known as ecstasy gamma-hydroxybutyrate (GHB) flunitrazepam (Rohypnol) and ketamine (Ketalar). Club drugs are substances commonly used at nightclubs, music festivals, raves, and dance parties to enhance social intimacy and sensory stimulation.
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