• Highly addictive
  • Increase cardiac activity
  • Excite CNS by increasing neurotransmitters
    • Norepinephrine
    • Serotonin
    • Dopamine
  • Toxicity
    • Sympathetic overdrive
      • Can be fatal
      • No antidote
      • Emergency management is based on clinical manifestations
      • Supportive care for agitation and cardiovascular symptoms
  • Withdrawal
    • Not an emergency
    • Supportive care
      • Quiet environment
      • Sleeping and eating at will
      • Suicide precautions if indicated

Assessment findings



  • Ensure patent airway.
  • Establish IV access and initiate fluid replacement as appropriate.
  • Obtain a 12-lead ECG and initiate ECG monitoring.
  • Treat ventricular dysrhythmias as appropriate with lidocaine, bretylium (Bretylol), or procainamide (Pronestyl).
  • Hypertension and chest pain may require administration of nitroprusside (Nipride) or phentolamine (Regitine).
  • Aspirin may be administered to lower the risk of myocardial infarction.
  • Administer IV diazepam (Valium) or lorazepam (Ativan) for seizures.
  • Administer IV antipsychotic drugs for psychosis and hallucinations.
  • Monitor vital signs and level of consciousness.
  • Initiate cooling measures for hyperthermia.
  • Palpitations
  • Tachycardia
  • Increased BP
  • Dysrhythmias
  • Myocardial ischemia or infarction

Central Nervous System

  • Feeling of impending doom
  • Euphoria
  • Agitation
  • Combativeness
  • Seizures
  • Hallucinations
  • Confusion
  • Paranoia
  • Fever


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