Bemegride

Bemegride (also marketed as Megimide) is a central nervous system stimulant and antidote for barbiturate poisoning^[1] as its chemoreceptor agonism increases mean tidal volume, thereby increasing respiration and the concentration of O₂ in blood although it may be theoretically used as a supportive measure in treating any depressant overdose. The drug’s synthesis was invented in 1911.^[2]

Bemegride is notable in legal history as the drug suspected serial killer Dr John Bodkin Adams failed to prescribe correctly to his patient Gertrude Hullett. Hullett took an overdose of barbiturates on 19 July 1956 but Adams only gave her a single 10cc dose of bemegride three days later on the 22nd, despite having acquired 100cc for her treatment. Hullett died the next day on 23 July 1956. Adams was charged but never tried for her murder.^[3]

Bemegride is also used to induce convulsions in experimental animals.^[4]

The original synthesis involves first the condensation of methylethylketone with two equivalents of cyanoacetamide. The product can be rationalized by assuming first aldol condensation of ketone and active methylene compound followed by dehydration to give 3. Conjugate addition of a second molecule of cyanoacetamide would afford 4. Addition of one of the amide amines to the nitrile would then afford the iminonitrile 5. The observed product 6 can be rationalized by assuming loss of the carboxamide under strongly basic conditions. Decarboxylative hydrolysis of 6 then leads to bemigride 7.