Stimulant toxicity: amphetamines, cocaine and ecstasy
How methamphetamine, cocaine and MDMA act, telling the sympathomimetic toxidrome from its mimics, treating agitation, hyperthermia, chest pain, sodium channel blockade and hyponatraemia, and the chronic harms and treatment of stimulant use disorder.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Methamphetamine, cocaine, MDMA and synthetic cathinones cause the sympathomimetic toxidrome: agitation, tachycardia, hypertension, hyperthermia, sweating and mydriasis.
- They kill through hyperthermia, arrhythmia, ACS, stroke, aortic dissection and, with MDMA, hyponatraemia and serotonin toxicity.
- Benzodiazepines treat the agitation, the tachycardia and the hypertension. Cool hard and early. Avoid beta-blockers in the acute phase.
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Sources
- Therapeutic Guidelines: Toxicology and Toxinology (December 2024 update)AU/NZTherapeutic Guidelines Limited, 2024
- Poisons Information Centre (13 11 26)AU/NZNSW Poisons Information Centre, Sydney Children's Hospitals Network, 2026
- McCord J et al. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association. Circulation 2008;117:1897-907American Heart Association, 2008
- Mittleman MA et al. Triggering of myocardial infarction by cocaine. Circulation 1999;99:2737-41Circulation, 1999
- Dunkley EJ et al. The Hunter Serotonin Toxicity Criteria. QJM 2003;96:635-42AU/NZQJM, 2003
- Isbister GK et al. Randomized controlled trial of intramuscular droperidol versus midazolam for violence and acute behavioral disturbance: the DORM study. Ann Emerg Med 2010;56:392-401AU/NZAnnals of Emergency Medicine, 2010
- Ezard N et al. Lisdexamfetamine in the treatment of methamphetamine dependence: a randomised, placebo-controlled trial (LiMA). Addiction 2025;120:1345-59AU/NZAddiction, 2025
- Trivedi MH et al. Bupropion and naltrexone in methamphetamine use disorder (ADAPT-2). N Engl J Med 2021;384:140-53New England Journal of Medicine, 2021
- Last updated
- 14 November 2026
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