What is the treatment for mild to moderate amphetamine overdose?

• A. Naloxone
• B. Antipsychotics
• C. Supportive care and benzodiazepines
• D. Flumazenil

Answer: (C)

Overactive sympathetic activity from amphetamine overdose is best managed with supportive care and benzodiazepines. There’s no specific antidote for amphetamines, so the priority is to calm the patient, reduce agitation, and blunt the excessive adrenergic drive. Benzodiazepines do this effectively by enhancing GABA activity, which decreases agitation, lowers heart rate and blood pressure, reduces tremors, and provides anticonvulsant protection if seizures threaten. Supportive care—continuous monitoring of vital signs, IV access, fluid support, and cooling as needed—addresses complications like dehydration, overheating, and potential rhabdomyolysis.

Naloxone targets opioids, so it’s not helpful for pure amphetamine overdose. Flumazenil reverses benzodiazepines and can precipitate seizures or severe agitation in stimulant overdoses, making it inappropriate. Antipsychotics may be used for severe agitation or psychosis, but they are not first-line in mild to moderate cases due to potential side effects and not addressing the underlying sympathetic overdrive.