methamphetamine selections

methamphetamine

Pharmacokinetics: 1) metabolized in liver by cyt P450 2D6 to largely inactive metabolites 2) metabolites excreted by the kidney 3) elmination 1/2life 10-12 hours 4) can accumulate in the brain at levels 10x those in plasma [9] Adverse effects: 1) psychiatric a) insomnia b) agitation, anxiety, nervousness c) paranoia, hallucinations d) violence e) depression [4] 2) neurologic a) convulsions b) stroke c) selective injury to the striatum 3) metabolic a) hyperthermia b) metabolic acidosis 4) pulmonary a) hyperventilation, tachypnea b) pulmonary hypertension c) pulmonary edema 6) cardiovascular a) hypertension b) tachycardia, arrhythmia c) acute coronary syndrome d) aneurysm, aortic dissection e) cardiomyopathy, heart failure [8] - improvement seen only upon drug cessation [6] 7) renal a) rhabdomyolysis b) acute renal failure [3] 8) eyes: mydriasis 9) white matter changes seem in infants exposed to methamphetamine & tobacco in utero [5] 10) withdrawal after discontinuation [7] - inattentiveness, lack of vigilance - ibudilast may attenuate Drug interactions: - any pharmaceutical agent that inhibits cyt P450 2D6 may increase methamphetamine levels Laboratory: - methamphetamine in specimen - methamphetamine in hair - methamphetamine in serum/plasma/blood - methamphetamine in blood - methamphetamine in serum/plasma - methamphetamine in saliva - methamphetamine in gastric fluid - methamphetamine in stool - methamphetamine in meconium - methamphetamine in milk - methamphetamine in vitreous fluid - methamphetamine in urine Mechanism of action: 1) CNS stimulants 2) appetite suppressant Notes: - In methamphetamine laboratories: [3] - respiratory injuries caused by phosphine gas

Interactions

drug adverse effects (more general classes)

General

amphetamine (Mydayis)

Properties

MISC-INFO: elimination route LIVER therapeutic-range 10-50 NG/ML toxic-range >500 NG/ML

Database Correlations

PUBCHEM correlations

References

Clinical Guide to Laboratory Tests, 3rd ed. Teitz ed., W.B. Saunders, 1995
Prescriber's Letter 13(3): 2006 Cytochrome P450 drug interactions Detail-Document#: 220233 (subscription needed) http://www.prescribersletter.com
Lineberry TW & Bostwick JM Methamphetamine abuse: a perfect storm of complications Mayo Clin Proc 2006; 81:77
Briere FN et al Prospective associations between meth/amphetamine (speed) and MDMA (ecstasy) use and depressive symptoms in secondary school students J Epidemiol Community Health doi:10.1136/jech-2011-200706 PMID: 22516739 http://jech.bmj.com/content/early/2012/04/12/jech-2011-200706.abstract
Chang L, Oishi K, Skranes J et al. Sex-specific alterations of white matter developmental trajectories in infants with prenatal exposure to methamphetamine and tobacco. JAMA Psychiatry 2016 Nov 9; PMID: 27829078 - Roos A, Donald KA. Refining the understanding of the effects of prenatal methamphetamine and tobacco exposure on the developing brain. JAMA Psychiatry 2016 Nov 9 PMID: 27829080
Schurer S, Klingel K, Sandri M et al Clinical Characteristics, Histopathological Features, and Clinical Outcome of Methamphetamine-Associated Cardiomyopathy. JACC: Heart Failure. Volume 5, Issue 6, June 2017 PMID: 28571597 http://www.heartfailure.onlinejacc.org/content/5/6/435 - Ahmad T, Schroder JN, Januzzi JL Jr. Breaking Bad. The Heartbreak of Drug Abuse. JACC: Heart Failure. Volume 5, Issue 6, June 2017 PMID: 28571598 http://www.heartfailure.onlinejacc.org/content/5/6/446
Birath JB, Briones M, Amaya S et al. Ibudilast may improve attention during early abstinence from methamphetamine. Drug Alcohol Depend 2017 Jun 23; 178:386. PMID: 2870476
Manja V, Nrusimha A, Gao Y et al Methamphetamine-associated heart failure: a systematic review of observational studies. Heart. 2022 Dec 1;heartjnl-2022-321610. PMID: 36456204 https://heart.bmj.com/content/early/2022/11/15/heartjnl-2022-321610
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022

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