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Methamphetamine – Uses, Dosage, Side Effects, Interactions

Methamphetamine is a member of the class of amphetamines in which the amino group of (S)-amphetamine carries a methyl substituent. It has a role as a neurotoxin, a psychotropic drug, a central nervous system stimulant, a xenobiotic and an environmental contaminant. It is a member of amphetamines and a secondary amine. It is functionally related to a (S)-amphetamine. It is a conjugate base of a methamphetamine(1+).
Metamfetamine (methamphetamine) is a psychostimulant and sympathomimetic drug, and a member of the amphetamine group of sympathomimetic amines. Methamphetamine can induce effects such as euphoria, increased alertness and energy, and enhanced self-esteem. It is a scheduled drug in most countries due to its high potential for addiction and abuse. The FDA withdrew its approval for the use of all parenteral drug products containing methamphetamine hydrochloride, a metamfetamine salt.
Methamphetamine is an Amphetamine Anorectic and Central Nervous System Stimulant. The physiologic effect of methamphetamine is by means of Appetite Suppression and Central Nervous System Stimulation and Increased Sympathetic Activity.
Methamphetamine has been reported in Senegalia berlandieri and Vachellia rigidula with data available.
Methamphetamine is an amphetamine with central nervous system (CNS) stimulating activity. Methamphetamine acts by both facilitating the release of catecholamines, particularly noradrenalinedopamine and serotonin, from nerve terminals in the brain and by inhibiting their uptake. This leads to an increase in synaptic concentration of these neurotransmitters and results in increased stimulation of postsynaptic receptors.
METHAMPHETAMINE is a small molecule drug with a maximum clinical trial phase of IV (across all indications) that was first approved in 1943 and is indicated for attention deficit hyperactivity disorder and has 2 investigational indications. This drug has a black box warning from the FDA. Breast Feeding; Lactation; Milk, Human; Street Drugs; Sympathomimetics; Dopamine Agents; Central Nervous System Stimulants; Adrenergic Agents; Wakefulness-Promoting Agents
Methamphetamine is a psychostimulant and sympathomimetic drug. It is a member of the amphetamine group of sympathomimetic amines. Methamphetamine can induce effects such as euphoria, increased alertness and energy, and enhanced self-esteem. It is a scheduled drug in most countries due to its high potential for addiction and abuse.
A central nervous system stimulant and sympathomimetic with actions and uses similar to DEXTROAMPHETAMINE. The smokable form is a drug of abuse and is referred to as crank, crystal, crystal meth, ice, and speed.

Mechanism of Action

Methamphetamine enters the brain and triggers a cascading release of norepinephrinedopamine and serotonin. To a lesser extent methamphetamine acts as a dopaminergic and adrenergic reuptake inhibitor and in high concentrations as a monamine oxidase inhibitor (MAOI). The mechanism of action involved in producing the beneficial behavioral changes seen in hyperkinetic children receiving methamphetamine is unknown. Appears to exert most or all of its effect in the CNS by causing release of biogenic amines, especialy norepinephrine and dopamine, from storage sites in nerve terminals. It may also slow down catecholamine metabolism by inhibiting monoamine oxidase. The toxic effects of methamphetamine on dopamine and serotonergic neurons have recently been linked to the endogenous formation of c-hydroxy dopamine and 5, 7 dihydrotryptamine, respectively. The ability of methamphetamine to both release dopamine and serotonin as well as to inhibit monoamine oxidase activity leads to the non-enzymatic oxidation of dopamine and serotonin. Methamphetamine induced neuronal damage is mediated by the production of free radicals. This drug causes a long lasting depletion of dopamine and serotonin in the striatum and that pre-treatment alteration of this effect by four different antioxidants, as well as an inhibitor of superoxidase dismutase, indicate that oxygen free radicals have a role in methamphetamine induced neurotoxicity.
Methamphetamine is a potent central nervous system stimulant which affects neurochemical mechanisms responsible for regulating heart rate, body temperature, blood pressure, appetite, attention, mood and responses associated with alertness or alarm conditions. The acute effects of the drug closely resemble the physiological and psychological effects of an epinephrine-provoked fight-or-flight response, including increased heart rate and blood pressure, vasoconstriction (constriction of the arterial walls), bronchodilation, and hyperglycemia (increased blood sugar). Users experience an increase in focus, increased mental alertness, and the elimination of fatigue, as well as a decrease in appetite.
Methamphetamine enters the brain and triggers a cascading release of norepinephrine, dopamine and serotonin. To a lesser extent methamphetamine acts as a dopaminergic and adrenergic reuptake inhibitor and in high concentrations as a monamine oxidase inhibitor (MAOI). The mechanism of action involved in producing the beneficial behavioral changes seen in hyperkinetic children receiving methamphetamine is unknown.

Drug Indications

  1. For the treatment of Attention Deficit Disorder with Hyperactivity (ADHD) and exogenous obesity.
  2. Sympathomimetics; Dopamine Agents; Central Nervous System Stimulants; Adrenergic Agents; Wakefulness-Promoting Agents
  1. Adrenergic Agents; Adrenergic Uptake Inhibitors; Appetite Depressants; Central Nervous System Stimulants; Dopamine Agents; Dopamine Uptake Inhibitors; Sympathomimetics.
  2. Methamphetamine also is used as an adjunct to psychological, educational, social, and other remedial measures in the treatment of attention deficit hyperactivity disorder (ADHD).
  3. Methamphetamine has been used as an adjunct to caloric restriction in the short-term (i.e., a few weeks) treatment of exogenous obesity. However, short-term or intermittent therapy with methamphetamine is unlikely to maintain a long-term benefit, and prolonged administration of methamphetamine for the treatment of obesity is not indicated.
  4. To stimulate central & sympathetic nervous systems to overcome depression, incr blood pressure by vasoconstriction, & as antidote to barbiturate overdosage. Resp stimulant. Reliability as post-anesthetic analeptic has been questioned.
  5. As an integral part of a total treatment program for attention deficit disorder with hyperactivity, which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in patients with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate to severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity

Contraindications

  • Known hypersensitivity to amphetamine, or any of the ingredients in this product
  • With monoamine oxidase inhibitors (MAOIs) or within 14 days of stopping MAOIs (including MAOIs such as linezolid or IV methylene blue) due to an increased risk of hypertensive crisis.
  • Having thoughts of suicide
  • Tourette syndrome
  • Hyperthyroidism
  • Bipolar disorder
  • Psychotic disorder
  • Drug abuse
  • Behaving with excessive cheerfulness or activity
  • Chronic muscle twitches or movements
  • Aggressive behavior
  • Increased ophthalmic pressure
  • Hypertension
  • History of a heart attack
  • Coronary artery disease
  • Cardiomyopathy
  • Arrhythmia
  • Chronic heart failure
  • Stroke
  • Atherosclerosis
  • Numbness
  • Prickling
  • Tingling of fingers and toes
  • Seizures
  • Loss of appetite
  • Weight loss
  • Breastfeeding mothers
  • Increased cardiovascular event risk
  • Structural disorder of the heart
  • Chronic kidney disease stage 4 (severe) or 5 (failure)
  • Kidney disease with a likely reduction in kidney function
  • Allergic reaction to sympathomimetic agents or amphetamine analogs

Dosage

Strengths: 5 mg; 10 mg; 15 mg

Pediatric Dose for Attention Deficit Disorder

6 years and older:

  • Initial dose: 5 mg orally once or twice a day
  • Titration dose: May increase daily dosage by 5 mg at weekly intervals until achieving optimum clinical response
  • Maintenance dose: The usual effective dose is 20 to 25 mg per day.
  • The total daily dose may be given in 2 divided doses.

Administration advice:

  • Before therapy, assess for the presence of cardiac disease (i.e., perform a careful history, family history of sudden death or ventricular arrhythmia, and physical exam).
  • Before therapy, assess the family history and clinically evaluate patients for motor or verbal tics or Tourette’s syndrome.
  • Administer this drug at the lowest effective dosage; individually adjust dosage.
  • Avoid late evening medication due to the resulting insomnia.

General:

  • The diagnosis of attention deficit disorder with hyperactivity should not be made with finality when the symptoms (moderate to severe distractibility, short attention span, hyperactivity, emotional lability, impulsivity) are only of comparatively recent origin.
  • Nonlocalizing (soft) neurological signs, learning disability, and abnormal electroencephalogram may or may not be present, and a diagnosis of CNS dysfunction may or may not be warranted.
  • Hypersensitivity reactions (e.g., angioedema, anaphylactic reactions) have been reported in patients treated with other amphetamine products.
  • Prescribing and dispensing of this drug should be limited to the smallest amount feasible at one time to minimize the possibility of overdosage.

Side Effects

People who use methamphetamine feel an acute, powerful short rush for about 5 to 30 minutes, which varies based on different routes of use. The drug also causes an enhanced energy level, decreases appetite, and creates euphoria for a range of 6 to 12 hours.

The Most Common

  • Decreased appetite
  • Nausea
  • Psychosis
  • Tachycardia
  • Hypertension
  • Increased body temperature
  • Panic attack
  • Mydriasis (dilation of pupils)
  • Disturbed sleep patterns
  • Violent, bizarre, and erratic behavior
  • Hallucinations and irritability
  • Seizures, convulsions, and death from high doses
  • Long-lasting damage to the blood vessel of the heart and brain
  • Lung, liver, and kidney damage
  • Hypertension that can lead to heart attacks, strokes, and death
  • Severe tooth degeneration
  • In cases where the drug was sniffed, destruction of soft tissues in the nose
  • In cases where the drug was smoked, respiratory problems
  • In cases where the drug was injected, infectious diseases, cellulitis, and abscesses
  • Weight loss and malnutrition
  • Disorientation, apathy, confusion, and exhaustion
  • Severe psychological dependence
  • Psychosis
  • Depression
  • Damage to the brain structure similar to Alzheimer disease, epilepsy, and stroke

More Common

  • aggressive
  • agitation
  • angry
  • blurred vision
  • change in consciousness
  • chest pain or discomfort
  • confusion
  • dark urine
  • diarrhea
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fainting
  • fast breathing
  • fast, slow, or irregular heartbeat
  • fever
  • headache
  • inability to speak
  • loss of consciousness
  • muscle cramps, spasms, pain, or stiffness
  • nausea
  • nervousness
  • overactive reflexes
  • pain or discomfort in the arms, jaw, back, or neck
  • pale, clammy skin
  • palpitations
  • pounding in the ears
  • restlessness
  • seeing, hearing, or feeling things that are not there
  • seizures
  • shivering
  • slow or fast heartbeat
  • slurred speech
  • stomach cramps
  • sweating
  • talking or acting with excitement you cannot control
  • temporary blindness
  • thirst
  • tremor
  • trouble breathing
  • unusual tiredness or weakness
  • vomiting
  • weakness in the arm or leg on one side of the body, sudden and severe

Rare

  • bad, unusual, or unpleasant (after) taste
  • change in taste
  • constipation
  • decreased interest in sexual intercourse
  • dry mouth
  • hives or welts, itching, or skin rash
  • inability to have or keep an erection
  • indigestion
  • loss in sexual ability, desire, drive, or performance
  • passing of gas
  • redness of the skin
  • weight loss

The last stage of methamphetamine misuse happens when the person who inappropriately uses methamphetamine becomes paranoid and irritable because of a lack of sleep for about 3 to 15 days. This behavior is called “tweaking,” and the person with this behavior is known as the “tweaker.” Usually, tweakers continue to require more methamphetamine to get to the original high. This effect is difficult to achieve, which causes frustration and irritability, and unsteady behavior in the tweaker. Because tweakers are unpredictable, they can behave violently, can get involved in domestic arguments, spur-of-the-moment offenses, and become a danger to others or themselves. A tweaker can behave normally and have clear eyes, concise speech, and brisk movements; however, careful observation will indicate that the person’s eye movement is much faster than normal (up to 10 times). They have a minor quiver voice and jerky movements. Some tweakers minimize or cover these physical symptoms by using a depressant like alcohol or opioids; however, the use of a depressant by the tweaker increases his or her negative feelings of paranoia, irritability, and frustration significantly. Other people around these users should use extreme caution because of their unpredictable behaviors.

Drug Interactions

Pregnancy and Lactation

Pregnancy and Lactation

Because there is no published experience with methamphetamine as a therapeutic agent during breastfeeding, an alternate drug may be preferred, especially while nursing a newborn or preterm infant. One expert recommends that amphetamines not be used therapeutically in nursing mothers.

Methamphetamine should not be used as a recreational drug by nursing mothers because it may impair their judgment and childcare abilities. Methamphetamine and its metabolite, amphetamine, are detectable in breastmilk and infant’s serum after abuse of methamphetamine by nursing mothers. However, these data are from random collections rather than controlled studies because of ethical considerations in administering recreational methamphetamine to nursing mothers. Other factors to consider are the possibility of positive urine tests in breastfed infants which might have legal implications, and the possibility of other harmful contaminants in street drugs. Breastfeeding is generally discouraged in mothers who are actively abusing amphetamines. In mothers who abuse methamphetamine while nursing, withholding breastfeeding for 48 to 100 hours after the maternal use been recommended, although in many mothers methamphetamine is undetectable in breastmilk after an average of 72 hours from the last use. It has been suggested that breastfeeding can be reinstated 24 hours after a negative maternal urine screen for amphetamines.

Effects in Breastfed Infants

A 2-month-old infant whose mother used illicit street methamphetamine recreationally by nasal inhalation was found dead 8 hours after a small amount of breastfeeding and ingestion of 120 to 180 mL of formula. The infant’s serum methamphetamine concentration on autopsy was 39 mcg/L. Although the infant’s mother was convicted of child endangerment for the use of methamphetamine during breastfeeding, the role that methamphetamine played in the infant’s death has been questioned because of the low infant serum methamphetamine concentration and the mother’s alleged minimal breastfeeding.

South Australian government pathologists reported the death of a breastfed infant who was co-sleeping with its mother. Methamphetamine was found in a “significant” concentration in the infant on autopsy and the drug in breastmilk was thought to be potentially contributory to the death. These authors also reported that in prior deaths of infants under 12 months of age, detectable methamphetamine and its metabolite, amphetamine, may have been partially obtained via breastmilk. Pathologists from the New Zealand government confirmed similar findings in their country.

Effects on Lactation and Breastmilk

A single oral dose of 0.2 mg/kg to a maximum of 17.5 mg of d-methamphetamine was given to 6 subjects (4 male and 2 female). Serum prolactin concentrations were unchanged over a period of 300 minutes after the dose.

In 2 papers by the same authors, 20 women with normal physiologic hyperprolactinemia were studied on days 2 or 3 postpartum. Eight received dextroamphetamine 7.5 mg intravenously, 6 received 15 mg intravenously and 6 who served as controls received intravenous saline. The 7.5 mg dose reduced serum prolactin by 25 to 32% compared to control, but the difference was not statistically significant. The 15 mg dose significantly decreased serum prolactin by 30 to 37% at times after the infusion. No assessment of milk production was presented. The authors also quoted data from another study showing that a 20 mg oral dose of dextroamphetamine produced a sustained suppression of serum prolactin by 40% in postpartum women.

 

FAQ

◈ What is methamphetamine?

Methamphetamine is also known as metamfetamine, methylamphetamine, and desoxyephedrine. Other names for methamphetamine include “meth,” “crystal meth,” “crank,” “speed” or “ice.” Methamphetamine has been smoked, snorted, swallowed, injected, inhaled, taken rectally, or dissolved under the tongue.Methamphetamine has been used illegally without medical supervision. It has also been prescribed by a healthcare provider for attention deficit hyperactivity disorder (ADHD). This sheet will focus on the use of methamphetamine without medical supervision.

◈ I take methamphetamine. Can it make it harder for me to get pregnant?

Methamphetamine has not been studied to see if using it could make it harder to get pregnant.

◈ I just found out that I am pregnant, should I stop taking methamphetamine?

If you are using methamphetamine without medical supervision (sometimes called recreational use), treatment is available to help you stop. Talk to your healthcare provider as soon as possible so that you can start treatment. If you do not have a healthcare provider, call the national number for drug treatment referral at 800-662-4357. When you call, let them know that you are pregnant so that you can get connected to the best facility to meet your needs.

◈ Does taking methamphetamine increase the chance of miscarriage?

Miscarriage is common and can occur in any pregnancy for many different reasons. Based on the studies reviewed, methamphetamine use might increase the chance for miscarriage.

◈ Does taking methamphetamine increase the chance of birth defects?

Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. Based on the studies reviewed, it is not known if methamphetamine increases the chance for birth defects above the background risk. Information on whether methamphetamine increases the chance of birth defects is mixed. This makes it hard to know the actual risks for each person who uses methamphetamine.

◈ What can I do to find out if the baby has a birth defect or other problems?

It is important to talk with your healthcare provider about any exposures you have had during your pregnancy. They can help you find treatment or support and can go over any screening options that are available. A detailed ultrasound can screen for some birth defects. There is no test in pregnancy that can look for learning problems. Once your baby is born, you should also tell your child’s healthcare provider so your baby can get the care that is best for them.

◈ Does taking methamphetamine in pregnancy increase the chance of other pregnancy-related problems?

Methamphetamine use has been linked to a higher chance for preterm delivery (delivery before 37 weeks of pregnancy), poor growth (babies born too small and/or with a small head size), and low birth weight (weighing less than 5 pounds, 8 ounces [2500 grams] at birth). Some studies have suggested that methamphetamine use in pregnancy can increase the chance for high blood pressure, placental abruption (the placenta pulls away from the uterus) and for fetal death or infant death. Some studies also show an association between methamphetamine misuse and a higher chance of postpartum mood disorders. Pregnancy complications are more likely to happen when methamphetamine is used throughout the whole pregnancy or when taken at high doses.

◈ Will my baby have withdrawal if I continue to take methamphetamine?

When people who are pregnant use methamphetamines near the end of their pregnancy, babies could show signs of withdrawal after they are born. Symptoms can include trouble eating, sleeping too little or too much, having floppy (poor) muscle control or tight muscles, being jittery, and / or having a hard time breathing. Withdrawal symptoms usually go away within a few weeks but can last for a few months. The baby might need to be admitted to the special care nursery (NICU). It is important that your healthcare providers know you are taking methamphetamine so that if symptoms occur your baby can get the care that is best for them.

◈ Does taking methamphetamine in pregnancy affect future behavior or learning for the child?

Studies have suggested that children who were exposed to methamphetamine during pregnancy could have a higher chance for changes in their brain development, as well as learning and behavior problems later in life.

◈ Breastfeeding while taking methamphetamine:

Methamphetamine can pass into breast milk. Methamphetamine should not be used without medical supervision while breastfeeding. If methamphetamine is used, it has been suggested to express and discard breastmilk for 48-100 hours. Be sure to talk to your healthcare provider about all of your breastfeeding questions.

◈ If a male takes methamphetamine, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?

Methamphetamine misuse might affect the sperm, making it harder to get someone pregnant. Studies have not been done to see if methamphetamine could increase the chance of birth defects above the background risk. In general, exposures that fathers or sperm donors have are unlikely to increase risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy.

References

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