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Phencyclidine (PCP) intoxication in adults

Kennon Heard, MD
Jason Hoppe, DO
Section Editor
Stephen J Traub, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Despite a fall in popularity since the 1970s, phencyclidine (PCP) remains a commonly abused drug that accounts for a significant number of poison center calls and hospitalizations. Early identification and prompt symptomatic treatment are vital to avoid possible sequelae, including rhabdomyolysis and seizures.

PCP is a synthetic arylcycloalkylamine discovered in 1926 and subsequently developed as Sernyl in the 1950s for use as a nonnarcotic anesthetic [1,2]. Sernyl exerted a calming effect at low anesthetic doses and induced cataplexy at higher doses, but it did not markedly suppress blood pressure or respiration. The use of Sernyl as a dissociative anesthetic was discontinued due to postoperative dysphoria and hallucinations, and by 1967 was limited to veterinary use [1]. In April of 1979, all legal manufacturing of PCP in the United States was terminated [3].

In the early 1970s a laboratory investigation of PCP derivatives led to the discovery of ketamine. Ketamine is 5 to 10 percent as potent as Sernyl and is now used clinically to induce dissociative anesthesia. Ketamine is also abused as a recreational drug.

PCP's popularity as a drug of abuse peaked in the 1970s. During the late 1970s, one urban psychiatric hospital in the US found that 63 of 145 consecutive patients sampled over a 48-hour period tested positive for PCP [4]. Since that time, hospital visits and poison center calls related to PCP use have declined, although it remains an important drug of abuse [5].

The basic pharmacology, clinical manifestations, and management of PCP intoxication in adults will be reviewed here. The management of PCP poisoning in children, ketamine poisoning, and other issues related to the management of the poisoned patient are discussed elsewhere. (See "Phencyclidine (PCP) intoxication in children and adolescents" and "Ketamine poisoning" and "General approach to drug poisoning in adults".)


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Literature review current through: Sep 2016. | This topic last updated: Sep 19, 2016.
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  1. Pali MJ, Tharratt RS, Albertson TE. Phencyclidine and its congeners. In: Critical Care Toxicology, 1st ed, Brent J, Wallace KL, Burkhart KK, et al (Eds), Mosby, Philadelphia 2005. p.777.
  2. CHEN G, ENSOR CR, RUSSELL D, BOHNER B. The pharmacology of 1-(1-phenylcyclohexyl) piperidine-HCl. J Pharmacol Exp Ther 1959; 127:241.
  3. Wright HH, Cole EA, Batey SR, Hanna K. Phencyclidine-induced psychosis: eight-year follow-up of ten cases. South Med J 1988; 81:565.
  4. Yago KB, Pitts FN Jr, Burgoyne RW, et al. The urban epidemic of phencyclidine (PCP) use: clinical and laboratory evidence from a public psychiatric hospital emergency service. J Clin Psychiatry 1981; 42:193.
  5. American Association of Poison Control Centers Annual Reports. http://aapcc.org/ (Accessed on October 10, 2013).
  6. Shesser R, Jotte R, Olshaker J. The contribution of impurities to the acute morbidity of illegal drug use. Am J Emerg Med 1991; 9:336.
  7. Liden CB, Lovejoy FH Jr, Costello CE. Phencyclidine. Nine cases of poisoning. JAMA 1975; 234:513.
  8. Pali MJ, Tharratt RS, Albertson TE. Phencyclidine and its congeners. In: Critical Care Toxicology, 1st ed, Brent J, Wallace KL, Burkhart KK, et al (Eds), Mosby, Philadelphia 2005. p.777.
  9. Holland JA, Nelson L, Ravikumar PR, Elwood WN. Embalming fluid-soaked marijuana: new high or new guise for PCP? J Psychoactive Drugs 1998; 30:215.
  10. McCarron MM, Schulze BW, Thompson GA, et al. Acute phencyclidine intoxication: incidence of clinical findings in 1,000 cases. Ann Emerg Med 1981; 10:237.
  11. Cook CE, Brine DR, Jeffcoat AR, et al. Phencyclidine disposition after intravenous and oral doses. Clin Pharmacol Ther 1982; 31:625.
  12. Tschirgi T. Phencyclidine: A hidden risk of illicit drug use. Pharm Alert 1990; 19:1.
  13. Hofer KE, Degrandi C, Müller DM, et al. Acute toxicity associated with the recreational use of the novel dissociative psychoactive substance methoxphenidine. Clin Toxicol (Phila) 2014; 52:1288.
  14. Chenoweth JA, Gerona RR, Ford JB, et al. Altered mental status and end organ damage associated with the use of gacyclidine: a case series. J Med Toxicol 2015; 11:115.
  15. Aniline O, Pitts FN Jr. Phencyclidine (PCP): a review and perspectives. Crit Rev Toxicol 1982; 10:145.
  16. Javitt DC, Zukin SR. Recent advances in the phencyclidine model of schizophrenia. Am J Psychiatry 1991; 148:1301.
  17. Akunne HC, Reid AA, Thurkauf A, et al. [3H]1-[2-(2-thienyl)cyclohexyl]piperidine labels two high-affinity binding sites in human cortex: further evidence for phencyclidine binding sites associated with the biogenic amine reuptake complex. Synapse 1991; 8:289.
  18. Wolfe SA Jr, De Souza EB. Sigma and phencyclidine receptors in the brain-endocrine-immune axis. NIDA Res Monogr 1993; 133:95.
  19. Cook CE, Brine DR, Quin GD, et al. Phencyclidine and phenylcyclohexene disposition after smoking phencyclidine. Clin Pharmacol Ther 1982; 31:635.
  20. Aronow R, Done AK. Phencyclidine overdose: an emerging concept of management. JACEP 1978; 7:56.
  21. Donaldson JO, Baselt RC. CSF phencyclidine. Am J Psychiatry 1979; 136:1341.
  22. Jackson JE. Phencyclidine pharmacokinetics after a massive overdose. Ann Intern Med 1989; 111:613.
  23. Caravatti EM. Hallucinogenic drugs. In: Medical Toxicology, 3rd ed, Dart RC, Caravatti EM, McGuigan MA, et al (Eds), Lippincott, Williams, and Wilkins, Philadelphia 2004. p.1106.
  24. Milhorn HT Jr. Diagnosis and management of phencyclidine intoxication. Am Fam Physician 1991; 43:1293.
  25. Dominici P, Kopec K, Manur R, et al. Phencyclidine Intoxication Case Series Study. J Med Toxicol 2015; 11:321.
  26. Bailey DN. Phencyclidine abuse. Clinical findings and concentrations in biological fluids after nonfatal intoxication. Am J Clin Pathol 1979; 72:795.
  27. Barton CH, Sterling ML, Vaziri ND. Phencyclidine intoxication: clinical experience in 27 cases confirmed by urine assay. Ann Emerg Med 1981; 10:243.
  28. Bessen HA. Intracranial hemorrhage associated with phencyclidine abuse. JAMA 1982; 248:585.
  29. Eastman JW, Cohen SN. Hypertensive crisis and death associated with phencyclidine poisoning. JAMA 1975; 231:1270.
  30. Crosley CJ, Binet EF. Cerebrovascular complications in phencyclidine intoxication. J Pediatr 1979; 94:316.
  31. McCarron MM, Schulze BW, Thompson GA, et al. Acute phencyclidine intoxication: clinical patterns, complications, and treatment. Ann Emerg Med 1981; 10:290.
  32. Akmal M, Valdin JR, McCarron MM, Massry SG. Rhabdomyolysis with and without acute renal failure in patients with phencyclidine intoxication. Am J Nephrol 1981; 1:91.
  33. Kessler GF Jr, Demers LM, Berlin C, Brennan RW. Letter: Phencyclidine and fatal status epilepticus. N Engl J Med 1974; 291:979.
  34. Carls KA, Ruehter VL. An evaluation of phencyclidine (PCP) psychosis: a retrospective analysis at a state facility. Am J Drug Alcohol Abuse 2006; 32:673.
  35. Budai B, Iskandar H. Dextromethorphan can produce false positive phencyclidine testing with HPLC. Am J Emerg Med 2002; 20:61.
  36. Simpson GM, Khajawall AM, Alatorre E, Staples FR. Urinary phencyclidine excretion in chronic abusers. J Toxicol Clin Toxicol 1982; 19:1051.
  37. Hoffman, RJ, Saddock, V, Nelson, L. Effect of ketamine on phencyclidine immunoassays (abstract). J Toxicol Clin Toxicol 2001; 39:523.
  38. Schier J. Avoid unfavorable consequences: dextromethorpan can bring about a false-positive phencyclidine urine drug screen. J Emerg Med 2000; 18:379.
  39. Levine BS, Smith ML. Effects of diphenhydramine on immunoassays of phencyclidine in urine. Clin Chem 1990; 36:1258.
  40. Santos PM, López-García P, Navarro JS, et al. False positive phencyclidine results caused by venlafaxine. Am J Psychiatry 2007; 164:349.
  41. Hull MJ, Griggs D, Knoepp SM, et al. Postmortem urine immunoassay showing false-positive phencyclidine reactivity in a case of fatal tramadol overdose. Am J Forensic Med Pathol 2006; 27:359.
  42. Ly BT, Thornton SL, Buono C, et al. False-positive urine phencyclidine immunoassay screen result caused by interference by tramadol and its metabolites. Ann Emerg Med 2012; 59:545.
  43. Rengarajan A, Mullins ME. How often do false-positive phencyclidine urine screens occur with use of common medications? Clin Toxicol (Phila) 2013; 51:493.
  44. Geraci MJ, Peele J, McCoy SL, Elias B. Phencyclidine false positive induced by lamotrigine (Lamictal®) on a rapid urine toxicology screen. Int J Emerg Med 2010; 3:327.
  45. Giannini, AJ, Nageotte, C, Loiselle, RH, et al. Comparison of chlorpromazine, haloperidol and pimozide in the treatment of phencyclidine psychosis: DA-2 receptor specificity. J Toxicol Clin Toxicol 1984-1985; 22:573.
  46. COHEN BD, LUBY ED, ROSENBAUM G, GOTTLIEB JS. Combined sernyl and sensory deprivation. Compr Psychiatry 1960; 1:345.
  47. Grayson B, Idris NF, Neill JC. Atypical antipsychotics attenuate a sub-chronic PCP-induced cognitive deficit in the novel object recognition task in the rat. Behav Brain Res 2007; 184:31.
  48. Picchioni AL, Consroe PF. Activated charcoal--a phencyclidine antidote, or hog in dogs. N Engl J Med 1979; 300:202.
  49. Barton CH, Sterling ML, Vaziri ND. Rhabdomyolysis and acute renal failure associated with phencyclidine intoxication. Arch Intern Med 1980; 140:568.
  50. Allen WR, O'Barr TP, Corby DG. Hemoperfusion of phencyclidine in the dog. Int J Artif Organs 1985; 8:101.
  51. Hardin JS, Wessinger WD, Proksch JW, Owens SM. Pharmacodynamics of a monoclonal antiphencyclidine Fab with broad selectivity for phencyclidine-like drugs. J Pharmacol Exp Ther 1998; 285:1113.
  52. Lacy HM, Gunnell MG, Laurenzana EM, Owens SM. Engineering and characterization of a mouse/human chimeric anti-phencyclidine monoclonal antibody. Int Immunopharmacol 2008; 8:1.