3-FPM

3-FPM drives norepinephrine release, producing sympathomimetic cardiovascular activation. Tachycardia occurred in 47% of clinical presentations (Bäckberg et al. 2016). Pre-existing hypertension substantially increases risk of hypertensive crisis, stroke, or cardiac event.

Pre-existing arrhythmias are exacerbated by catecholamine surge. Atrial fibrillation was documented in the IV use case report. T-wave inversions observed in overdose case (Benesch 2018).

Severe vasoconstriction documented with 3-FPM (Fawzy et al. 2017 — four-limb ischaemia). Pre-existing coronary artery disease creates high risk of myocardial ischaemia under catecholamine surge.

The most severe documented 3-FPM adverse event involved catastrophic peripheral vasospasm with four-limb ischaemia (Fawzy et al. 2017). Pre-existing peripheral vascular disease dramatically increases ischaemic risk even with non-IV routes.

Seizures occurred in 16% of STRIDA case series presentations (polysubstance context). Pre-existing seizure disorders are an absolute contraindication for catecholamine-releasing stimulants.

No 3-FPM-specific psychosis case reports exist, but delirium (which may include psychotic features) occurred in 37% of STRIDA presentations. All potent dopamine releasers carry established risk of precipitating psychosis in vulnerable individuals.

AKI requiring 26 days of CVVH was documented in the IV use case. Pre-existing renal compromise may increase vulnerability to vasospasm-induced renal hypoperfusion and reduce drug clearance (predominantly renal excretion as unchanged compound).

No 3-FPM-specific reproductive toxicity data exist. Class-level evidence from amphetamine exposure during pregnancy documents increased risk of adverse fetal outcomes. Contraindicated on precautionary grounds.

Combining any monoamine releasing agent with MAOIs is absolutely contraindicated. The synergistic catecholamine accumulation can produce life-threatening hypertensive crisis. No 3-FPM + MAOI case reports exist, but the pharmacological basis is unambiguous.

Phentermine-class sympathomimetics should be discontinued due to potential interactions with tramadol (Stephens 2005). This class-level interaction extends to 3-FPM. Combined seizure risk and potential serotonin syndrome.