Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity

Pharmacopsychiatry. 2017 May;50(3):87-95. doi: 10.1055/s-0042-123752. Epub 2017 Mar 15.


Consumption of methamphetamine (“crystal”) has spread dramatically over several European countries. The management of methamphetamine-induced acute disorders has become a growing challenge to the health system. Pharmacological treatment strategies for methamphetamine-induced intoxication syndromes, acute withdrawal symptoms, and methamphetamine-induced psychosis are particularly important.The development of interdisciplinary and evidence- and consensus-based (S3) German Guidelines was based on a systematic literature and guideline search on therapeutic interventions in methamphetamine-related disorders (April, June 2015). Consideration was given to 9 guidelines and 103 publications. Recommendations on pharmacological treatment strategies were drawn up using the nominal group technique.Overall, only limited evidence is available. Benzodiazepines are first-line medication for methamphetamine-induced intoxication syndromes, particularly when they present with acute agitation and aggressive behavior. There is no evidence-based medication for the treatment of methamphetamine-related withdrawal symptoms and cravings. When treating methamphetamine-induced psychosis, second-generation antipsychotics should be favored, given their more favorable side-effect profile. The indication for continuation of antipsychotic medication must be reviewed regularly. In most cases, the antipsychotic should be tapered off within 6 months.

Publication types

  • Review

MeSH terms

  • Animals
  • Central Nervous System Stimulants / adverse effects*
  • Evidence-Based Medicine* / methods
  • Evidence-Based Medicine* / standards
  • Humans
  • Methamphetamine / adverse effects*
  • Substance-Related Disorders / drug therapy*
  • Substance-Related Disorders / etiology*


  • Central Nervous System Stimulants
  • Methamphetamine