Methaqualone is a sedative-hypnotic medication that was widely prescribed during the mid-20th century. It was marketed under various brand names, including Quaalude ( KWAY-lood) and Sopor, typically containing 300 mg of methaqualone per tablet. A combination drug known as Mandrax was sold primarily in Europe, containing 250 mg of methaqualone and 20 mg of diphenhydramine in a single tablet. Methaqualone belongs to the quinazolinone class of compounds. Its commercial production was discontinued in many countries during the mid-1980s due to widespread misuse, addiction, and associated public health concerns. However, methaqualone continues to be used as a recreational drug in certain places such as South Africa and elsewhere up to the present. In addition, methaqualone analogues with at least 100-fold greater potency than methaqualone itself such as mephenaqualone have emerged as novel designer drugs in the late 2010s and early 2020s.
Medical use Methaqualone's sedative-hypnotic properties were first identified in 1955. It gained popularity during the 1960s and 1970s for the treatment of insomnia, and as a general sedative and muscle relaxant. However, due to its abuse potential, it was eventually withdrawn from medical use. The drug was classified as pregnancy category D, meaning there was evidence of risk to the human fetus, and it was not recommended during pregnancy. Like other GABAergic substances, prolonged use of methaqualone can lead to drug tolerance, physical dependence, and withdrawal symptoms upon cessation.
Overdose An overdose of methaqualone can lead to coma and death. Additional effects are delirium, convulsions, hypertonia, hyperreflexia, vomiting, kidney failure, and death through cardiac or respiratory arrest. Methaqualone overdose resembles barbiturate poisoning, but with increased motor difficulties and a lower incidence of cardiac or respiratory depression. The standard single tablet adult dose of Quaalude brand of methaqualone was 300 mg when made by Lemmon. A dose of 8000 mg is lethal and a dose as little as 2000 mg could induce a coma if taken with an alcoholic beverage.
Pharmacology
Pharmacodynamics Methaqualone acts primarily as a sedative, reducing anxiety and inducing sleep. It binds to GABAA receptors, where it functions as a positive allosteric modulator at many receptor subtypes, enhancing the inhibitory effects of the neurotransmitter GABA. It shows negligible affinity for a wide array of other potential targets, including other receptors and neurotransmitter transporters. This action is similar to that of benzodiazepines like diazepam. Unlike most benzodiazepines, however, methaqualone may also act as a negative allosteric modulator at certain GABAA receptor subtypes, producing excitatory effects in neurons expressing those receptors. As such, methaqualone is considered a mixed GABAA receptor modulator. The binding site for methaqualone on the GABAA receptor complex is distinct from those of benzodiazepines, barbiturates, and neurosteroids, though it may partially overlap with the etomidate binding site.
Pharmacokinetics Methaqualone reaches peak plasma concentrations within a few hours of administration. Its elimination half-life ranges between 20 and 60 hours, contributing to its sedative effects and potential for accumulation with repeated dosing.
Chemistry
Analogues
Analogues of methaqualone with at least 100-fold greater potency such as mephenaqualone have been described.
History Methaqualone was first synthesized in India in 1951 by Indra Kishore Kacker and Syed Husain Zaheer, who were conducting research on finding new antimalarial medications. In 1962, methaqualone was patented in the United States by Wallace and Tiernan. By 1965, it was the most commonly prescribed sedative in Britain, where it has been sold legally under the names Malsed, Malsedin, and Renoval. In 1965, a methaqualone/antihistamine combination was sold as the sedative drug Mandrax in Europe, by Roussel Laboratories (now part of Sanofi S.A.). In 1972, it was the sixth-bestselling sedative in the US, where it was legal under the brand name Quaalude. Sold in the United States under the brand name Quaalude, methaqualone was moved to Schedule I in 1984 after prescription controls failed to curb diversion. Quaalude in the United States was originally manufactured in 1965 by the pharmaceutical firm William H. Rorer, Inc., based in Fort Washington, Pennsylvania. The drug name "Quaalude" is a portmanteau, combining the words "quiet interlude" and shared a stylistic reference to another drug marketed by the firm, Maalox. In 1978, Rorer sold the rights to manufacture Quaalude to the Lemmon Company of Sellersville, Pennsylvania. At that time, Rorer chairman John Eckman commented on Quaalude's bad reputation stemming from illegal manufacture and use of methaqualone, and illegal sale and use of legally prescribed Quaalude: "Quaalude accounted for less than 2% of our sales, but created 98% of our headaches." Both companies still regarded Quaalude as an excellent sleeping drug. Lemmon, well aware of Quaalude's public image problems, used advertisements in medical journals to urge physicians "not to permit the abuses of illegal users to deprive a legitimate patient of the drug". Lemmon also marketed a small quantity under another name, Mequin, so doctors could prescribe the drug without the negative connotations. The rights to Quaalude were held by the JB Roerig & Company division of Pfizer, before the drug was discontinued in the United States in 1985, mainly due to its psychological addictiveness, widespread abuse, and illegal recreational use. A 2024 Hungarian investigative documentary reported on large-scale production and sales of the drug by the Hungarian People's Republic to the United States in the 1970s and 1980s. It asserts that a Hungarian state-owned company utilized connections to Colombian drug cartels to facilitate the sale of extraordinary amounts to the United States.
Brand names Methaqualone was sold under the brand name Quaalude (sometimes stylized "Quāālude" in the United States and Canada), and Mandrax in the UK, South Africa, and Australia.
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