Treatment of Methamphetamine Overdose
There is no specific antidote for methamphetamine overdose. Treatment focuses on supportive care, managing symptoms, and addressing cardiovascular complications through standard resuscitation protocols. 1
Initial Assessment and Management
Immediate Priorities
- Ensure airway, breathing, and circulation
- Activate emergency response system immediately 1
- For patients in respiratory arrest: provide rescue breathing or bag-mask ventilation 1
- For patients in cardiac arrest: focus on high-quality CPR with compressions plus ventilation 1
Cardiovascular Management
- Monitor vital signs closely, particularly for hypertension and tachycardia
- For chest pain and cardiovascular symptoms:
Neurological/Psychiatric Management
- For agitation, psychosis, or seizures:
- Benzodiazepines are first-line (e.g., lorazepam or diazepam)
- Maintain a calm environment
- Physical restraints only if necessary for patient and staff safety
Hyperthermia Management
- Active cooling measures for temperature >39°C
- IV fluids for hydration and to prevent rhabdomyolysis
- Monitor for signs of rhabdomyolysis (muscle pain, dark urine)
Special Considerations
Diagnostic Testing
- 12-lead ECG to evaluate for cardiac ischemia
- Basic metabolic panel to assess electrolyte abnormalities
- Creatine kinase to evaluate for rhabdomyolysis
- Troponin levels to assess for cardiac injury
- Urine toxicology screen to confirm methamphetamine and identify polysubstance use
Cardiovascular Complications
- If ST-segment elevation is present and persists despite nitroglycerin/calcium channel blockers, consider coronary angiography 1
- For patients with significant coronary artery disease and methamphetamine-induced chest pain, percutaneous coronary intervention may be considered 1
Observation Period
- Patients should be observed in a healthcare setting until risk of recurrent toxicity is low and vital signs have normalized 1
- Monitor for at least 24 hours as most complications occur within this timeframe 1
Common Pitfalls and Caveats
- Do not administer beta-blockers alone as they may worsen coronary vasoconstriction by allowing unopposed alpha-adrenergic stimulation 1
- Do not delay standard resuscitative measures while attempting other interventions 1
- Screen for concurrent opioid use disorder as many patients use both methamphetamine and opioids ("goofball") 2
- Patients may avoid seeking care due to anticipated stigma, which can lead to worsened outcomes 3
- Methamphetamine overdose can present with symptoms similar to other conditions (e.g., acute coronary syndrome, stroke), so maintain a high index of suspicion in the appropriate clinical context