Background: The abuse and accidental overdose of both prescribed and illicit amphetamine and related compounds such as methamphetamine, “bath salts,” methylphenidate, cathinone (“khat”), and MDMA (“ecstasy”) is a worldwide problem affecting millions. Patients experiencing toxicity from these drugs frequently present to the emergency department and may have serious consequences from their hyperadrenergic state, such as acute coronary syndrome, stroke, acute heart and renal failure.
Objective of the Review: Medical management of these patients has changed over time as new therapies have been developed, with control of agitation and hyperadrenergic state being the top priorities to prevent secondary injuries.
Discussion: Control of agitation with benzodiazepines and antipsychotics is an important first step but may not alleviate the tachycardia, hypertension, and hyperthermia these patients often experience. Unlike cocaine, the half-lives of these drugs are several hours with increased potential for pathologic sequelae. The risk of adverse events may not be linear with the long half-lives of these compounds. This requires the treating clinician to be flexible to different therapeutics and adjust management accordingly.
Conclusion: In this comprehensive review, the pharmacology, pathophysiology, and level of evidence behind treatment of patients with toxicity from amphetamine, its analogues, and related derivatives are discussed and recommendations given. The development of potential new therapeutics and future research direction are also discussed.
Author(s): John R. Richards, MD, Robert W. Derlet, MD, Timothy E. Albertson, MD, MPH, PhD, B. Zane Horowitz, MD, and Richard A. Lange, MD, MBA