Amphetamine-Related Psychiatric Disorders Treatment & Management

Updated: Sep 12, 2017
  • Author: Amy Barnhorst, MD; Chief Editor: Glen L Xiong, MD  more...
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Treatment

Medical Care

Initial treatment should include medically stabilizing the patient's condition by assessing his or her respiratory, circulatory, and neurologic systems. The offending substance may be eliminated by means of gastric lavage and acidification of the urine. Psychotropic medication can be used to stabilize an agitated patient with psychosis. Because most cases of amphetamine-related psychiatric disorders are self-limiting, removal of the amphetamines should suffice.

Induced emesis, lavage, or charcoal may be helpful in the event of overdose.

The excretion of amphetamines can be accelerated by the use of ammonium chloride, given either IV or orally (PO).

  • Amphetamine intoxication can be treated with ammonium chloride, often found in OTC expectorants, such as ammonium chloride (Quelidrine), baby cough syrup, Romilar, and P-V-Tussin.

  • The recommended dose to acidify the urine is ammonium chloride 500 mg every 2-3 hours.

  • The ingredients in OTC cough syrups vary, and the clinician should become familiar with 1 or 2 stock items for use in the emergency department.

  • Ammonium chloride (Quelidrine), an OTC expectorant, can be used in the absence of liver or kidney failure.

  • Administer IV fluids to provide adequate hydration.

  • If the patient is psychotic or if he or she is in danger of harming him or herself or others, a high-potency antipsychotic, such as haloperidol (Haldol), can be used. Exercise caution because of the potential for extrapyramidal symptoms, such as acute dystonic reactions, and neuroleptic malignant syndrome.

  • Agitation also can be treated cautiously with benzodiazepines PO, IV, or intramuscularly (IM). Lorazepam (Ativan) and chlordiazepoxide (Librium) are commonly used.

  • Administer naloxone (Narcan) in the event of concurrent opiate toxicity. Use caution to avoid precipitation of acute opioid withdrawal in a patient who has used high doses of opioid on a long-term basis.

  • Beta-blockers, such as propranolol (Inderal), can be used in the event of elevated blood pressure and pulse. They also may be helpful with anxiety or panic.

  • Psychiatric hospitalization may be necessary when psychosis, aggression, and suicidality cannot be controlled in a less restrictive environment.

  • If serotonin syndrome is suspected, stop all SSRI and SNRI medications.

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Consultations

Consultations with a neurologist, internal medicine specialist, psychiatrist, or social services may prove helpful.

Consult a psychiatrist for inpatient substance abuse treatment or further psychiatric stabilization.

Social services coordinate outpatient services, such as Alcoholics Anonymous and Narcotics Anonymous meetings and sober houses, and provide appointments. Some large metropolitan areas have groups that specifically focus on crystal methamphetamine abuse in the gay population.

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Activity

Patients intoxicated with amphetamines are dangerous, and their activity should be limited (eg, no driving) until their symptoms have resolved.

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