A fluorine turns a medicinal benzodiazepine into NPS: the case of flualprazolam

Purpose The purpose of this review is to summarize the existing knowledge on flualprazolam, a novel ‘designer’ benzodiazepine that derives from the fluorination of the phenyl moiety in the ortho -position of alprazolam. Methods An extensive literature search was carried out in PubMed, Google Scholar and World Wide Web using relevant keywords. All articles found were gathered, and the available information is presented. Results This article reviews the existing knowledge on chemistry, pharmacology, toxicology, prevalence and current legal status of flualprazolam. Moreover, forensic and clinical cases where flualprazolam was involved worldwide, as well as flualprazolam seizures, along with the methods for its determination in biological samples are presented. Conclusions The recent flualprazolam-related cases have raised concerns to regulatory authorities and international stakeholders suggesting that flualprazolam should be under international control. The urgent international control of flualprazolam, despite the limited information on clinical effects and pharmacologic characteristics available, is an important measure for the prevention of its increasing abuse worldwide.