Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- uso compulsivo de estimulantes apesar de consequências negativas
- hipervigilância
- hiperexcitação
- ansiedade
- alucinações
- dor torácica
- paranoia
- pressão arterial (PA) elevada
- pupilas dilatadas
- taquicardia
- coçar a pele, lesões cutâneas, escoriações
- deterioração dos dentes, doenças da gengiva
- trismo, bruxismo
- dispneia
- hipertermia
Other diagnostic factors
- comportamento protegido/suspeito
- euforia
- estado de alerta
- aumento da concentração
- cefaleia
- irritabilidade
- agressividade
- náuseas e vômitos
- depressão
- anorexia
- atividade motora aumentada
- anedonia
- hemoptise
- acatisia
- arritmia cardíaca
- vasculite
- hemorragia cerebral
Risk factors
- eventos adversos na infância
- história de uso prévio de estimulantes
- venda/produção de drogas ou outro envolvimento com o sistema de justiça criminal
- uso de múltiplas substâncias
- história de atuar como "mula de tráfico", fazer body stuffing ou paraquedismo
- história de fabricação ou distribuição ilícita
- história de um transtorno de saúde mental
Diagnostic tests
1st tests to order
- perfil sanguíneo abrangente
- marcadores cardíacos sanguíneos
- creatina quinase sérica
- sorologia para hepatite
- sorologia do HIV
- exames toxicológicos da urina
- cromatografia gasosa acoplada à espectrometria de massa da urina ou do sangue
- eletrocardiograma (ECG)
- radiografia torácica
Tests to consider
- exames toxicológicos do sangue
- radiografia abdominal simples
- tomografia computadorizada (TC) abdominal
- ecocardiograma
Treatment algorithm
intoxicação aguda ou abstinência
adultos não gestantes e adolescentes
gestante
remissão sustentada
uso contínuo ou recaída
resistente a tratamento
Contributors
Authors
Timothy E. Albertson, MD, MPH, PhD, FRCP

Distinguished Professor of Medicine
Anesthesiology, Pharmacology and Toxicology, and Emergency Medicine
Division of Pulmonary and Critical Care Medicine
University of California Davis School of Medicine
Sacramento
CA
Disclosures
TEA declares that he has no competing interests.
Peer reviewers
Alexis Ritvo, MD, MPH
Assistant Professor and Addiction Psychiatry Fellowship Director
University of Colorado School of Medicine
Aurora
CO
Disclosures
AR declares that he is contracted as medical director for the Alliance for Benzodiazepines Best Practices, a non-profit organisation.
Maria Rahmandar, MD
Medical Director, Substance Use & Prevention Program
The Potocsnak Family Division of Adolescent and Young Adult Medicine
Ann & Robert H. Lurie Children's Hospital of Chicago
Assistant Professor
Northwestern University Feinberg School of Medicine
Chicago
IL
Disclosures
MR declares that she has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
National Institute on Drug Abuse. Methamphetamine research report: what is methamphetamine? Oct 2019 [internet publication].Full text
Paulus MP, Stewart JL. Neurobiology, clinical presentation, and treatment of methamphetamine use disorder: a review. JAMA Psychiatry. 2020 Sep 1;77(9):959-66.Full text Abstract
Substance Abuse and Mental Health Services Administration (SAMHSA). Treatment for stimulant use disorders: updated 2021. Treatment Improvement Protocol (TIP) series, no. 33. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999 (updated 2021).Full text Abstract
World Health Organization. Guidelines for identification and management of substance use and substance use disorders in pregnancy. Nov 2014 [internet publication].Full text
Siefried KJ, Acheson LS, Lintzeris N, et al. Pharmacological treatment of methamphetamine/amphetamine dependence: a systematic review. CNS Drugs. 2020 Apr;34(4):337-65.Full text Abstract
Soares E, Pereira FC. Pharmacotherapeutic strategies for methamphetamine use disorder: mind the subgroups. Expert Opin Pharmacother. 2019 Dec;20(18):2273-93. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Transtorno por uso de cocaína
- Hipertensão maligna
- Exposição a medicamentos anticolinérgicos
More DifferentialsGuidelines
- Engagement and Retention of Nonabstinent Patients in Substance Use Treatment
- The ASAM/AAAP clinical practice guideline on the management of stimulant use disorder
More GuidelinesPatient information
Transtorno relacionado ao uso de anfetamina e metanfetamina
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