From the Research
The antipsychotic of choice for methamphetamine-induced psychosis is typically a second-generation (atypical) antipsychotic such as olanzapine or risperidone, with olanzapine being the preferred option due to its better safety and tolerability profile as shown in the most recent and highest quality study 1.
Key Considerations
- Olanzapine can be started at 5-10 mg daily, while risperidone is usually initiated at 1-2 mg twice daily.
- These medications help manage symptoms like paranoia, hallucinations, and agitation that occur during methamphetamine psychosis.
- Treatment duration depends on symptom resolution, typically ranging from days to weeks, with gradual tapering once the patient stabilizes.
- Atypical antipsychotics are preferred because they have fewer extrapyramidal side effects compared to first-generation antipsychotics and address both the dopaminergic and serotonergic dysregulation caused by methamphetamine use.
Additional Treatment Options
- For severe agitation, benzodiazepines like lorazepam (1-2 mg) may be added initially.
- Treatment should occur in a safe environment with vital sign monitoring, hydration support, and comprehensive substance use assessment.
- The underlying methamphetamine use disorder must be addressed through appropriate referrals for addiction treatment to prevent recurrence of psychosis.
Evidence Summary
The most recent and highest quality study 1 suggests that antipsychotics, including olanzapine, haloperidol, quetiapine, olanzapine, and risperidone, are effective in reducing or controlling psychotic episodes induced by amphetamine use with no adverse events. Another study 2 found that olanzapine was superior to haloperidol in terms of safety and tolerability, with significantly fewer extrapyramidal symptoms. Overall, the evidence supports the use of atypical antipsychotics, particularly olanzapine, as the first-line treatment for methamphetamine-induced psychosis.