Amphetamines withdrawal syndrome

Chan-Ob T, Kuntawogse N, Boonyanaruthee V. Bupropion for amphetamine withdrawal syndrome. J Med Assoc Thai 2001 84 1763-5. 

Uni 1ke other drugs of abuse, the diagnosis of PCP intoxication is often difficult because of the wide spectrum of clinical findings that occurs with this drug. PCP toxicity sometimes can be mistaken for delirium tremens, acute psychiatric illness, sedative/ hypnotic overdosage, amphetamine intoxication, or sedative/ hypnotic withdrawal syndromes. 

The answer is c. (Hardman, pp 574—575.) Phencyclidine is a hallucinogenic compound with no opioid activity Its mechanism of action is amphetamine-like. A withdrawal syndrome has not been described for this drug in human subjects. In overdose, the treatment of choice for the psychotic activity is the antipsychotic drug haloperidol. 

The clinical effects of amphetamine and its derivatives are very similar to those of cocaine, although the euphoria they produces may be less intense but last longer than that due to cocaine. Signs of amphetamine intoxication, toxicity, overdose, sensitization by production of an acute paranoid psychosis, and withdrawal syndrome are all similar to those described above for cocaine. 

Once an amphetamine abuser stops taking the drug, withdrawal symptoms begin as the body tries to adjust to the absence of the stimulant. This results in very uncomfortable and potentially life-threatening physical symptoms, called withdrawal syndrome. According to the World Health Organization (WHO), withdrawal is experienced by 87% of amphetamine users who stop the drug. 

Amineptine increases the release and reduces the reuptake of dopamine, and it is therefore not surprising that an amphetamine-like drug dependence has been reported (3-5). A withdrawal syndrome occurs and can be improved by clonidine (SEDA-16, 8). 

The literature on a withdrawal syndrome (SEDA-10, 17) has been expanded by further reports. One of these (33) involved the development of an acute toxic delirium 3 days after withdrawal of phenelzine, and another (34) concerned patients who became manic after withdrawal of isocarboxazid. A withdrawal state similar to that caused by withdrawal from amphetamines has been described after withdrawal of tranylcypromine (SEDA-16, 8) (SEDA-18,14). 

Mazindol is a tricyclic compound with central nervous system stimulant properties similar to those of amphetamine. It releases and blocks reuptake of dopamine and noradrenaline (1), and the actions of these catecholamines, not serotonin, are responsible for its anorectic activity. With fairly high doses (6 mg/day) central nervous system effects were reported in 30% of 23 patients (2). Euphoria does not occur at therapeutic doses, but can occur at higher doses. It has a much lower addiction potential than the amphetamines and practically no cases have been reported of a physical withdrawal syndrome. 

Opioids (especially methadone and heroin) are the most common cause of serious neonatal drug withdrawal symptoms. Other dmgs for which a withdrawal syndrome has been reported include phencyclidine (POP), cocaine, amphetamines, tricyclic antidepressants, phenothiazines, benzodiazepines, barbiturates, ethanol, clonidine, diphenhydramine, lithium, meprobamate, and theophylline. A careful dmg history from the mother should include illicit drugs, alcohol, and prescription and over-the-counter medications, and whether she is breast-feeding. 

Dependence may develop after chronic use of cocaine or amphetamines. The abstinence syndrome is characterized primarily by depression and craving with few measurable physiological effects. Thus, a drug that does not cause severe physical withdrawal symptoms can still be highly addictive. 

Cocaine is usually legally classified as an addictive drug though withdrawal doesn t cause the abstinence syndrome seen in junkies. Cocaine withdrawal causes symptoms similar to those seen in withdrawal from amphetamines — depression, fetigue and listlessness. 

K tt individualize dose for each patient. Transient dyskinesias may be caused by abrupt withdrawal. Enhances actions of CNS depressants, alcohol, anticonvulsants. Decreases actions of amphetamines. Severe hypotension with alcohol, epinephrine, antihypertensives. Antimuscarinics Increase intraocular pressure and reduce haloperidol effects. Lithium encephalopathic syndrome. ... 

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