Toxic Syndromes: Amphetamines & Other Stimulants

AMPHETAMINES & OTHER STIMULANTS

Stimulant drugs commonly abused in the USA include metham-phetamine (“crank,” “crystal”), methylenedioxymethamphetamine (MDMA, “ecstasy”), and cocaine (“crack”) as well as pharmaceu-ticals such as pseudoephedrine (Sudafed) and ephedrine (as such and in the herbal agent Ma-huang) . 

Caffeine is often added to dietary supplements sold as “metabolic enhancers” or “fat-burners.” Newer synthetic analogs of amphetamines such as 3,4-methylenedioxypyrovalerone (MDPV) and various deriva-tives of methcathinone are becoming popular drugs of abuse, often sold on the street as “bath salts” with names like “Ivory Wave,” “Bounce,” “Bubbles,” “Mad Cow,” and “Meow Meow.”

At the doses usually used by stimulant abusers, euphoria and wakefulness are accompanied by a sense of power and well-being. At higher doses, restlessness, agitation, and acute psychosis mayoccur, accompanied by hypertension and tachycardia. Prolonged muscular hyperactivity or seizures may contribute to hyperthermia and rhabdomyolysis. Body temperatures as high as 42°C (107.6°F) have been recorded. Hyperthermia can cause brain damage, hypotension, coagulopathy, and renal failure.Treatment for stimulant toxicity includes general supportive measures as outlined earlier. There is no specific antidote. Seizures and hyperthermia are the most dangerous manifestations and must be treated aggressively. Seizures are usually managed with intravenous benzodiazepines (eg, lorazepam). Temperature is reduced by removing clothing, spraying with tepid water, and encouraging evaporative cooling with fanning. For very high body temperatures (eg, > 40–41°C [104–105.8°F]), neuromuscular paralysis is used to abolish muscle activity quickly.