Key messages

• The sympathomimetic effects of the amphetamines cause tachycardia, potentially fatal cardiac arrhythmias, myocardial infarction, cardiomyopathy, and hypertension which may lead to cerebrovascular accidents.

• The central stimulant properties can lead to euphoria, confusion, agitation, anorexia, hallucinations, psychosis, and convulsions.

• Hyperthermia may be associated with amphetamines, particularly when 3,4-methylenedioxymethamphetamine (MDMA, ecstasy) is used as a 'dance drug', with possible complications of hypotensive collapse, disseminated intravascular coagulation, rhabdomyolysis, and acute renal failure.

• In some cases excessive water drinking has led to acute hyponatremia cerebral edema which, rarely, may be fatal.

• There is no specific antidote for amphetamine toxicity. Management should be symptomatic and supportive.

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