The International Classification of Diseases (ICD) 10th Revision (ICD-10) recognises ‘stimulant dependence syndrome’ and ‘stimulant withdrawal state’ [8]. However, neither diagnostic tool differentiates between AMPH/MA and other non-cocaine stimulant SUDs; while the 11th Revision of the ICD narrows the definition to “stimulant dependence including amphetamines, methamphetamine or methcathinone” [9]. In this paper, we have reviewed articles using all of the above classifications and sometimes interchangeably and our search included both terms. Most reviewed articles had eligibility criteria that included either the DSM-IV or DSM-V diagnostic criteria, and so we have combined the terms as dependence/use disorder. Based on observations that the isomers of amphetamine evoke very large and rapid increases in the efflux of dopamine and noradrenaline in the PFC and dopamine in the striatum, it was predicted that these drugs would be highly effective in the treatment of ADHD. It is generally accepted that the efficacy of the amphetamines is not different from that of methylphenidate (Faraone et al., 2006; James et al., 2001; Pelham et al., 2005), which is the other major stimulant used to treat ADHD.
Press Release
There were no significant differences between the peak increases in systolic and diastolic blood pressure evoked by 50 mg lisdexamfetamine administered intravenously and orally. It has long been accepted that in ADHD there is dysregulation of the brain catecholaminergic systems in the PFC and its connections to subcortical regions including the striatum (Arnsten and Dudley, 2005; Durston, 2003; Russell et al., 2005). Finally, excess monoamines within the nerve terminal are catabolised by the mitochondrial-bound enzyme, MAO. Inhibition of MAO would further augment the quantity of neurotransmitter that is available for retro-transport into the synapse. Amphetamine’s isomers have long been known to be inhibitors of this important catabolising enzyme (Mantle et al., 1976; Miller et al., 1980; Robinson, 1985).
Medical Professionals
Five studies examined the opioid antagonist naltrexone, including two that used an extended-release formulation [29, 56] and one that used an implant [63]. An additional study reported on naltrexone and n-acetyl cysteine (see below). The https://ecosoberhouse.com/ 43 studies examined 23 individual pharmacotherapies, most individually and some in combination. Table 3 lists the pharmacotherapies reviewed, and the proposed mechanisms of action related to their use in studies of MA/AMPH dependence.
Changes in the brain
Although this mechanism is often discounted because amphetamine is a relatively weak inhibitor of MAO, in the situation where amphetamine is concentrated in presynaptic nerve terminals, shown in Figure 3, it is probable that some inhibition of this enzyme would occur. Inhibition of [3H]monoamine uptake into rat brain synaptosomes by amphetamine’s enantiomers in vitro. Amphetamine overdose represents a large burden of dependency and toxicity worldwide, stemming from both legitimate and recreational ingestion of amphetamine and its derivatives by nearly 36 million users annually. During the intervention, these people gather together to have a direct, heart-to-heart conversation with the person about the consequences of addiction. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. These drugs can cause severe intoxication, which results in dangerous health effects or even death.
For longitudinal studies, odds ratios were derived based on the number of cases reported in the exposed (amphetamines) group relative to the non-exposed group for the reported timeframe. If studies reported more than two outcome groups, we aggregated the groups by summing data from the contingency table to form the necessary categories (e.g. combining mild to moderate and severe dependence groups to form an aggregate dependence category). The details of data extracted for each comparison can be found in Supplement E. The studies reviewed here report on a variety of outcomes defined, measured and analysed differently across most publications.
- Unfortunately, the small number of studies that were eligible for inclusion in the meta-analysis meant that we could not robustly examine what factors were driving heterogeneity.
- As indicated above, it is the combination of the rapid rate of increase and magnitude of effect that accounts for the powerful stimulant effects of amphetamine.
- For this update of the review, one author (UK) inspected the search hits by reading titles and abstracts.
- Therefore, obtaining medication histories should always be a focus during the evaluation of patients who are intoxicated.
- There is a wide variety of substances available in different forms that could be habit-forming and pose a threat to your health if misused.
- Methamphetamine is hepatically metabolized and renally eliminated, similarly to amphetamine.
- At present, there is no evidence to guide selection of medications that might relieve symptoms of amphetamine withdrawal for patients in initial abstinence from chronic amphetamine use.
International Patients
After administration of equivalent doses of lisdexamfetamine and IR d-amphetamine (1.5 mg/kg ip as d-amphetamine base), the observed plasma PK profiles for the pharmacologically active moiety, d-amphetamine, were very different. The AUC0-480 min values were identical, but the maximum concentration reached in plasma (the Cmax) was 50% lower after administration of lisdexamfetamine and the time to Cmax (the tmax) was doubled (Jackson et al., 2011). These observations are entirely consistent with the postulated rate-limited enzymatic conversion of lisdexamfetamine to d-amphetamine. This difference in PK characteristics had a profound impact on the pharmacological effects of these two compounds in rats (Figure 5). Lisdexamfetamine produced a gradual and sustained increase in striatal dopamine efflux, whereas the increase produced by IR d-amphetamine was faster in onset, reaching a peak at 30 min, and it subsequently declined more rapidly (Figure 5).
Similarly, the choice between residential or ambulatory treatment settings for longer term rehabilitation programmes may be determined by factors such as social supports, housing, employment and legal status of the patient. A summary of the reviewed studies is presented in Table 4, and an extended version is available in Supplementary Table 1 (see ESM). In addition, the data collected by both amphetamine addiction reviewers can be located in its entirety in the Supplementary Data (see ESM). The authors wish to thank Shire Pharmaceuticals for their support funding a portion of the writers’ time for the literature review and writing of this manuscript. The authors wish to state that the material presented in this review reflect only their views and not necessarily those of the Shire Pharmaceuticals.
Can You Overdose on Amphetamines?
