Tox In Focus

Focused Clinical Reference

Vol. 30 · Fluoro-2oxo-PCE · July 2026

Drug Quick Reference

Drug Class / Mechanism

Novel dissociative hallucinogen

NMDA receptor antagonist (presumed)

Street Names

'2-FXE', 'CanKet' (2F-2oxo-PCE)

Fluorexetamine, 'FXE' (3F-2oxo-PCE)

Routes of Administration

Powders, capsules, tablets

Insufflation, oral

Commonly Detected With

Fentanyl, xylazine · NPS benzodiazepines, nitazenes

Metabolism

Human data limited; presumed oxidative

Extrapolated from related ketamine analogues

Window of Detection

Not established in humans

LC-MS/MS confirmation only

Control Status

No accepted medical use

Regulatory status evolving

FLUORO-2OXO-PCE

A novel dissociative NMDA antagonist emerging alongside fentanyl

Fluoro-2oxo-PCE is a novel dissociative hallucinogen structurally related to ketamine and PCP analogues, presumed to act as an NMDA-receptor antagonist. The name covers multiple positional isomers, including 2F-2oxo-PCE ('2-FXE', 'CanKet') and 3F-2oxo-PCE (fluorexetamine, FXE), which the assay measures together but cannot distinguish. It has no accepted medical use.¹

Why This Matters Now

Fluoro-2oxo-PCE-class compounds are being detected across multiple US states and are often found alongside fentanyl, xylazine, NPS benzodiazepines, and nitazenes, combinations that substantially raise the risk of severe outcomes including death.¹ Because it is a designer dissociative outside routine panels, exposure is easily missed.³

⚠ Suspect a designer dissociative when dissociation, agitation, or hyperthermia occurs with a negative routine panel, especially alongside fentanyl or other adulterants; request targeted LC-MS/MS.

Clinical Presentation

INTOXICATION

Dissociation, perceptual distortion

Confusion, hallucinations

Agitation

Tachycardia, hypertension

Hyperthermia, dehydration, seizures (severe)

WITHDRAWAL

Human data limited

Psychological effects with heavy use

Low mood, anxiety

Craving

Course not characterized

Important: Dissociative intoxication can include agitation, hyperthermia, and seizures; management is supportive. Frequent co-exposure to fentanyl and other adulterants means a dissociative presentation may mask concurrent opioid or sedative toxicity.

UDT Considerations

Fluoro-2oxo-PCE is not on standard immunoassay panels and requires targeted LC-MS/MS. The assay reports total fluoro-2oxo-PCE and does not distinguish positional isomers (2F-2oxo-PCE, 3F-2oxo-PCE/fluorexetamine).⁵ Human pharmacokinetics and the detection window are not established; metabolism has been characterized only for closely related ketamine analogues, and the persistence of specific human markers is uncertain.² Interpret a positive as recent exposure without a validated window.⁴

Clinical Guidance

Order targeted LC-MS/MS when a designer dissociative is suspected; routine panels do not detect it.¹
Recognize that a positive does not identify which positional isomer, the dose, or the route.⁵
Evaluate for co-present fentanyl, xylazine, NPS benzodiazepines, and nitazenes.¹
Do not assume a defined detection window; human pharmacokinetics are not established.⁴
Correlate with the clinical picture; provide supportive care for dissociative and autonomic effects.

Point-of-Care Testing Availability

Available strips

No point-of-care strip detects fluoro-2oxo-PCE.

Clinical use

It is not on standard immunoassay panels.

Limitations

Identification requires targeted LC-MS/MS; positional isomers are not distinguished.

FLUORO-2OXO-PCE | Clinical & Program Guidance

Tox In Focus Vol. 30 · July 2026 · Page 2 of 2

Interpreting the Test Result

▲ If Testing Is Positive

Confirms recent exposure. Detection indicates recent use, but no validated human detection window exists.

Isomer not identified. The result may be any positional isomer (2F, or 3F/fluorexetamine).

Consider adulterants. Frequently found with fentanyl and other high-risk substances.

▼ If Testing Is Negative or Not Done

Window undefined. Absence does not reliably exclude earlier use; human pharmacokinetics are unknown.

Not on routine panels. Only targeted LC-MS/MS detects it.

Timing and cutoff. Absence may reflect timing or levels below the cutoff.

Metabolism & Urinary Markers

Fluoro-2oxo-PCE analytes; positional isomers are measured together, not separated.

Metabolite	Clinical Significance
Fluoro-2oxo-PCE (total)	Reported as total; positional isomers (2F, 3F/FXE) are not distinguished.
2F-2oxo-PCE	'2-FXE', 'CanKet'; one of the isomers encountered in the supply.
3F-2oxo-PCE (fluorexetamine)	'FXE'; a distinct positional isomer with similar effects.

Key References

Denn MT, et al. 2F-2oxo-PCE: a new synthetic hallucinogen identified in recreational drug markets across North America. CFSRE Public Alert; 2024.
Larabi IA, et al. Metabolic profiling of deschloro-N-ethyl-ketamine and identification of new target metabolites. Drug Test Anal. 2021;13(6):1108-1117.
Park M, et al. Simultaneous determination of 2-fluoro-2-oxo-PCE, MDMA, and ketamine in postmortem blood by LC-MS/MS. Forensic Toxicol. 2026;44(1):248-256.
Frankenfeld F, et al. In vivo and in vitro metabolic fate and urinary detectability of five deschloroketamine derivatives. Metabolites. 2024;14(5):270.
Taruvinga DT, et al. Fluorexetamine and 2-fluoro-2-oxo-PCE: new dissociative hallucinogens in forensic toxicology and drug chemistry casework. SOFT Annual Meeting; 2023.

DISCLAIMER: This document is intended for clinical reference and educational purposes only. It does not constitute medical, legal, or professional advice and should not replace independent clinical or programmatic judgment. Content reflects published data available at time of preparation. ToxiPharm LLC makes no warranties regarding completeness or applicability in all settings. | © 2026 ToxiPharm LLC | toxipharm.org