Antipsychotics for the treatment of sympathomimetic toxicity: A systematic review

Pharmacotherapy treatment of stimulant use disorder

“…Take Home Points: Patients with methamphetamine intoxication can present with symptoms of agitation, hypertension, tachycardia, hyperthermia, and dysrhythmias. [11][12][13] Severe complications, such as rhabdomyolysis, acute kidney injury, seizure, intracranial bleeds, and myocardial infarction, are also reported. 12,13 The use of amphetamine and methamphetamine can lead to the development of an acute psychotic disorder that requires hospitalization in the emergency room or psychiatric unit.…”

“…[11][12][13] Severe complications, such as rhabdomyolysis, acute kidney injury, seizure, intracranial bleeds, and myocardial infarction, are also reported. 12,13 The use of amphetamine and methamphetamine can lead to the development of an acute psychotic disorder that requires hospitalization in the emergency room or psychiatric unit. 6,14 Although most patients require less than 24 hours in the ED, some patients may need inpatient psychiatric treatment for ongoing psychosis, suicidality, and depressive symptoms.…”

“…11 Antipsychotics are generally reserved as a second-line treatment option due to the risk of adverse reactions, such as lowering seizure threshold, QT interval prolongation, and hyperthermia. 12 There is a lack of randomized clinical trials (RCTs) on the safety and efficacy of antipsychotics for methamphetamine intoxication because patients often present to the ED unable to provide information on substance ingestions. In a retrospective chart review 13 of ED patients with acute behavioral disturbances from methamphetamine intoxication, successful sedation (sedation assessment tool 1) was achieved in 180/226 patients (80%) who received oral medications, such as diazepam (68%), a combination of diazepam and olanzapine (29%), and olanzapine alone (3%).…”

“…Clinicians should tailor the treatment based on specific circumstances and characteristics of the individual patients. 12,13 Case 2: Persistent MAP and MUD…”

“… 15 , 16 Benzodiazepines are often used as first-line therapy for the treatment of severe agitation or aggression during methamphetamine intoxication. 11 , 12 Addition of antipsychotics may be considered if benzodiazepines are not sufficient or symptoms of hallucinations and delusions are present. 11 Antipsychotics are generally reserved as a second-line treatment option due to the risk of adverse reactions, such as lowering seizure threshold, QT interval prolongation, and hyperthermia.…”