What is the treatment to reverse a methamphetamine overdose?

Management of Methamphetamine Overdose

There is no specific antidote or reversal agent for methamphetamine overdose; management focuses on supportive care, treating cardiovascular complications with benzodiazepines and calcium channel blockers, and addressing agitation while avoiding beta-blockers which may worsen vasospasm. 1, 2

Initial Assessment and Stabilization

• Immediately assess airway, breathing, circulation, and neurological status in patients with suspected methamphetamine overdose 2
• Obtain an ECG to evaluate for cardiac ischemia, arrhythmias, or other cardiovascular complications 2
• Check cardiac biomarkers, including troponin, to assess for myocardial injury 2
• Monitor vital signs with particular attention to blood pressure, heart rate, and temperature, as hyperthermia occurs in approximately 5% of cases 3

Management of Cardiovascular Complications

• For chest pain with suspected coronary vasospasm, administer sublingual nitroglycerin or intravenous calcium channel blockers as first-line therapy 1, 2
• Avoid pure beta-blockers as they may worsen coronary vasospasm by allowing unopposed alpha-adrenergic stimulation 1, 2
• For hypertension, use benzodiazepines as first-line agents to reduce sympathetic stimulation 2
• If severe hypertension persists, calcium channel blockers can be used 2
• Combined alpha-beta blockers should only be used with extreme caution if absolutely necessary 1, 2

Management of Agitation and Psychosis

• Benzodiazepines are the first-line treatment for agitation, hallucinations, and psychosis associated with methamphetamine overdose 3
• Oral sedation is effective in approximately 61% of patients with acute behavioral disturbance; the remainder may require parenteral sedation 3
• Avoid physical restraints when possible, as they may worsen rhabdomyolysis and hyperthermia 3

Treatment of Hyperthermia

• Actively cool patients with temperatures above 39°C (102.2°F) using external cooling methods 3
• Administer benzodiazepines to reduce muscle activity and heat production 2
• Ensure adequate hydration to prevent complications from hyperthermia 4

Monitoring and Supportive Care

• Patients with ECG changes and normal cardiac biomarkers should be observed in a monitored setting for at least 24 hours 2
• Check creatine kinase levels to assess for rhabdomyolysis, which occurs in approximately 30% of severe cases 3
• Monitor renal function, as acute kidney injury occurs in about 13% of methamphetamine overdose presentations 3
• Most patients (84%) can be managed within the emergency department with a median length of stay of 14 hours 3

Common Pitfalls to Avoid

• Do not administer beta-blockers in acute methamphetamine intoxication, as they may worsen coronary vasospasm 1, 2
• Do not underestimate the risk of rhabdomyolysis and acute kidney injury, which are common complications 3
• Recognize that methamphetamine-related cardiac complications can occur even with normal coronary arteries due to vasospasm 2
• Be aware that serious complications such as intracranial bleeds, seizures, and myocardial infarction are rare but possible 3

Self-Care Strategies for Mild "Overamping"

• For mild cases not requiring emergency care, general self-care strategies include adequate hydration, rest, and sleep 4
• Patients often do not seek medical attention for psychological effects unless severe 4
• Fatal acute methamphetamine overdose is relatively rare compared to opioid overdose, but deaths related to methamphetamine use have increased 180% from 2015 to 2019 5