Complications
Associated with acute use and overdose. Coronary artery vasospasm may be related.[131]
Treated with standard therapy for myocardial infarction.
May occur with acute and longer-term use.
Both supraventricular and ventricular arrhythmias are the result of direct toxic stimulant effects and ischaemia.
Standard anti-arrhythmic agents for symptomatic arrhythmias are used.
May occur with both acute and longer-term use.[132]
May occur because of respiratory failure, vascular collapse, arrhythmias, and/or myocardial ischaemia secondary to acute or longer-term use.
Symptomatic treatment is indicated, including intubation, anti-arrhythmics, and vasopressors.
Associated with acute use or occurs as a complication of other chronic processes (e.g., vasculitis).
Treatment consists of intravenous benzodiazepines or barbiturates.
May occur as a result of acute or longer-term use within hours of intake from stimulant-induced vascular spasm or vasculitis.
Treatment goal is to carefully control hypertension.
Benefit of thrombolytics is unknown.
May occur because of acute toxic exposures to stimulants.
These patients are critically ill.
Treatment includes careful monitoring of respiration, blood pressure, and hydration.
May occur because of hypertension after acute or longer-term use.
Careful neurological and blood pressure monitoring are needed.
Evacuation of cerebral blood may be required.
Occurs either spontaneously with toxic stimulant exposure or from associated trauma.
Evacuation of the blood may be needed.
May occur acutely or as a result of longer-term use at toxic levels.
Treatment is avoidance of stimulant exposure.
May be cardiogenic or non-cardiogenic.
Amfetamine-associated acute or chronic cardiomyopathy and increased vascular volumes result in cardiogenic pulmonary oedema.
Standard therapy includes mechanical ventilation and medications that reduce afterload, increase contractility, and promote diuresis.
May occur secondary to use via the smoking or nasal route.
Symptomatic pneumothorax is treated with a chest tube.[135]
May occur secondary to smoking methamphetamine.
Careful treatment with bronchodilators is indicated.
Stimulant use may augment cardiac irritability associated with beta-agonists.
Includes altered mental status, neuromuscular abnormalities and resultant hyperthermia, and autonomic instability.
Probably occurs only with co-exposure to another serotonin-mediated drug, such as a monoamine oxidase inhibitor or a selective serotonin-reuptake inhibitor.
Symptomatic treatment includes external cooling and reducing further serotonergic drug exposure.
No specific antidote exists.
May occur with acute or longer-term use and is probably related to associated gastric ischaemia.
Traditional treatment includes stimulant avoidance, acid suppression, and testing for and (if present) treatment of Helicobacter pylori.
May occur after acute use but more commonly occurs with longer-term use.
Uterine blood flow changes and birth defects may occur with methamphetamine use.[136]
Treatment involves careful obstetric monitoring and avoidance of stimulants.
May occur acutely after profound toxicity, although likelihood is low.
Treatment includes supportive care with hydration and electrolytes.
If renal failure results, haemodialysis is used.
May occur acutely after intra-arterial injections and chronically with pre-existing vascular disease.
Treatment involves stimulant avoidance and revascularisation procedures.
A rare acute toxicity seen in critically ill patients experiencing an overdose.
Treatment includes supportive care and blood product replacement.
Seen with methamphetamine overdoses.
Often seen in fatal cases.
Caused by central serotonergic and dopaminergic effects and made worse by elevated environmental temperatures.
Treatment includes external cooling techniques and, for severe illness, intubation and paralysis (pancuronium).
Associated with longer-term use.
Treated with standard therapies used to treat pulmonary hypertension.[60]
Associated with longer-term use.
Results from intravenous methamphetamine use and associated talc crystals.
Vascular wall changes can occur, resulting in pulmonary hypertension.
No specific therapy is warranted except for stimulant cessation.
Probably due to increased blood pressures from prolonged drug use.
Standard invasive treatments using stents or surgical repair are recommended.[134]
Associated with longer-term use.
There are rare reports associated with longer-term use.
Treated with corticosteroids and discontinuation of stimulant use.
Associated with longer-term use.
Associated with longer-term use of intravenous stimulants.
Treated with antiviral agents directed at hepatitis B. Patients who use intravenous stimulants should be offered vaccination against hepatitis B.
Associated with longer-term use of intravenous stimulants.
Treated with antiviral agents directed at hepatitis C.
May occur with acute or longer-term use.
Treated with standard antihypertensive medications.
Theoretically, beta blockade without a vasodilator can result in unopposed alpha stimulation from the stimulant and a paradoxical elevation in blood pressure.
May occur after acute or longer-term use. Stimulant-induced psychosis can become chronic, with many cases of drug-induced psychosis diagnosed as schizophrenia in later years.[137]
Little evidence exists to support specific treatment with antipsychotic medications.
May occur acutely or after longer-term use.
May be associated with the depletion of central neurotransmitters. Additionally, may be an underlying pre-morbid condition.
Treatment includes avoidance of drug use and possibly psychotherapy and antidepressants.
May occur at any point.
Depletion of neurotransmitters in the reward centres of the brain may contribute to underlying depression.
Once the patient is stabilised, psychotherapy and antidepressants are used.
Note that withdrawal may be associated with significant symptoms of depression; clinicians should monitor the patient's mood and assess and mitigate against their risk of suicide during this period.[57]
May occur as a result of an acute toxic effect or with longer-term use accelerating pre-existing renal disease.
Treatment involves BP control and haemodialysis as needed.
Associated with endocarditis from non-sterile intravenous stimulant use.
Echocardiogram and blood cultures are obtained to rule out endocarditis.
Appropriate antibiotics are started based on culture and sensitivity results.
Risk is elevated because of increased risk-taking behaviour, including men having sex with men and especially intravenous methamphetamine use.[75]
Treatment includes avoidance of intravenous drug use and standard sexual preventions (e.g., barrier methods of contraception). High-intensity behavioural interventions have been shown to be more effective than passive or minimum treatment approaches in reducing substance use and sexual risk behaviours.[89]
Acute or longer-term use occurs as a result of psychosocial dysfunction; moreover, drug use leads to social alterations. As a result, criminal justice system involvement, physically harmful behaviour towards others, loss of family support and structure, problems at work and school, financial chaos, and reduced social and economic status may occur.[138]
Owing to increased risk taking and aggression, involvement with the criminal justice system (e.g., for drug sales, theft, armed robbery) is more common.[139]
Treatment includes stimulant avoidance, social support, and psychotherapy.
May occur after acute or longer-term use.
Is typically seen in critically ill hypotensive patients after intestinal leakage of high methamphetamine concentrations.
Treatment includes prevention of hypotension and further leakage.
Surgical removal of intestinal methamphetamine bags and activated charcoal treatment are a consideration.
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