AB-FUBINACA

supraventricular tachycardia, atrial fibrillation, conduction abnormalities, structural cardiac pathology, long QT syndrome

Supraventricular tachycardia has been documented during AB-FUBINACA exposure. The bidirectional cardiovascular response (tachyarrhythmia or bradycardia) is unpredictable, making pre-existing arrhythmia or structural heart disease a high-risk condition.

COPD, severe asthma, respiratory insufficiency

Full CB1 agonism produces CNS depression that may compromise respiratory function in individuals with pre-existing respiratory disease. The primary ROA (smoked) adds direct pulmonary insult.

epilepsy, history of seizures, seizure threshold-lowering medication use

Synthetic cannabinoids as a class are associated with seizure risk. Individuals with pre-existing seizure disorders or those taking medications that lower seizure threshold face elevated risk.

schizophrenia, schizoaffective disorder, first-degree family history of psychotic disorders, prior psychotic episodes

All high-potency CB1 full agonists carry elevated psychosis risk compared to cannabis. Individuals with personal or first-degree family history of schizophrenia-spectrum disorders face heightened vulnerability to acute psychotic episodes and potentially persistent symptoms.

cirrhosis, severe hepatic insufficiency, acute liver failure

CYP-dependent metabolism means severe liver disease could substantially reduce clearance. The active (S)-enantiomer already has unusually low predicted hepatic clearance (0.34 mL/min/kg); further impairment could extend exposure duration.

chronic kidney disease, acute kidney injury history, single kidney

Animal data demonstrates nephrotoxic potential. The SCRA class is associated with AKI in humans. Pre-existing renal disease may lower the threshold for injury.

ketoconazole use, itraconazole use, ritonavir/cobicistat use, clarithromycin use

Theoretical increased exposure from decreased hepatic metabolism. CYP3A4 assignment is by structural analogy, not direct phenotyping. Clinical significance is unquantified.

pregnancy, lactation, planned conception

Contraindicated by absence of safety data. Mouse studies show reproductive toxicity and genotoxicity has been demonstrated in human cell cultures. No human reproductive studies exist.

opioid use disorder, opioid maintenance therapy, concurrent opioid analgesic use, concurrent synthetic opioid use

Documented fatality from AB-FUBINACA combined with synthetic opioid U-47700. The combination produces additive CNS and respiratory depression. AB-FUBINACA has been detected as an adulterant in unregulated supplies, meaning opioid users may be exposed unknowingly.