Stimulant use (cocaine, amphetamines) lead to increased catecholamine neurotransmitter activity. While most of the known treatment of intoxication and withdrawal are supportive – such as hydration, sleep, and excessive stimulus reduction – there are some medications that have proven to be useful in acute intoxication and withdrawal management. A recent paper from Mass General outlines an inpatient treatment protocol for patients undergoing methamphetamine withdrawal.
In addition to behavioral based treatment, such as encouraging increased fluid and food intake, reducing excessive stimuli (noise, light, etc), encouraging both sleep and exercise, several medications can aid in the treatment of acute intoxication and withdrawal.
Ascorbic Acid 1000mg PO BID
Mitigates absorption/enhances excretion of methamphetamine
Mirtazapine 15-30mg PO qHS
For sleep disturbance/insomnia, aids with anxiety and depression
Diphenhydramine 25mg PO QID PRN
For mild agitation
Chlordiazepoxide 25mg PO TID PRN (or other benzodiazepines)
For anxiety
Quetiapine 25-50mg PO TID PRN
For moderate to severe agitation, paranoia, psychosis