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Methamphetamine Hydrochloride

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Overview

What is Methamphetamine Hydrochloride?

Methamphetamine Hydrochloride Tablets USP, chemically known as (S)-N,α-dimethylbenzeneethanamine hydrochloride, is a member of the amphetamine group of sympathomimetic amines. It has the following structural formula:

Methamphetamine Hydrochloride Tablets USP, contain 5 mg of methamphetamine hydrochloride USP for oral administration. In addition each tablet contains the following inactive ingredients: crospovidone, magnesium stearate, microcrystalline cellulose, povidone, and purified water.



What does Methamphetamine Hydrochloride look like?



What are the available doses of Methamphetamine Hydrochloride?

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What should I talk to my health care provider before I take Methamphetamine Hydrochloride?

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How should I use Methamphetamine Hydrochloride?

Methamphetamine hydrochloride tablets are indicated as an integral part of a total treatment program which typically includes other remedial measures (psychological, educational, social) for a stabilizing effect in children over 6 years of age with a behavioral syndrome characterized by the following group of developmentally inappropriate symptoms: moderate to severe distractibility, short attention span, hyperactivity, emotional lability, and impulsivity. The diagnosis of this syndrome should not be made with finality when these symptoms are only of comparatively recent origin. Nonlocalizing (soft) neurological signs, learning disability, and abnormal EEG may or may not be present, and a diagnosis of central nervous system dysfunction may or may not be warranted.

Methamphetamine hydrochloride tablets are given orally.

Methamphetamine should be administered at the lowest effective dosage, and dosage should be individually adjusted. Late evening medication should be avoided because of the resulting insomnia.


What interacts with Methamphetamine Hydrochloride?

Methamphetamine is contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors; hypertensive crisis may result. It is also contraindicated in patients with glaucoma, advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism or known hypersensitivity or idiosyncrasy to sympathomimetic amines. Methamphetamine should not be given to patients who are in an agitated state or who have a history of drug abuse.



What are the warnings of Methamphetamine Hydrochloride?

The most serious risks associated with ketorolac tromethamine are:

Serious Cardiovascular Events

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Children and Adolescents:



Adults:

Sudden Death and Pre-existing Structural Cardiac Abnormalities or Other Serious Heart Problems:

Hypertension and other Cardiovascular Conditions:

Stimulant medications cause a modest increase in average blood pressure (about 2 to 4 mmHg) and average heart rate (about 3 to 6 bpm), and individuals may have larger increases. While the mean changes alone would not be expected to have short-term consequences, all patients should be monitored for larger changes in heart rate and blood pressure. Caution is indicated in treating patients whose underlying medical conditions might be compromised by increases in blood pressure or heart rate, e.g., those with pre-existing hypertension, heart failure, recent myocardial infarction, or ventricular arrhythmia.

Assessing Cardiovascular Status in Patients being Treated with Stimulant Medications:

Children, adolescents, or adults who are being considered for treatment with stimulant medications should have a careful history (including assessment for a family history of sudden death or ventricular arrhythmia) and physical exam to assess for the presence of cardiac disease, and should receive further cardiac evaluation if findings suggest such disease (e.g., electrocardiogram and echocardiogram). Patients who develop symptoms such as exertional chest pain, unexplained syncope, or other symptoms suggestive of cardiac disease during stimulant treatment should undergo a prompt cardiac evaluation.

Psychiatric Adverse Events

Pre-existing Psychosis:

Administration of stimulants may exacerbate symptoms of behavior disturbance and thought disorder in patients with a pre-existing psychotic disorder.

Bipolar Illness:

Particular care should be taken in using stimulants to treat ADHD in patients with comorbid bipolar disorder because of concern for possible induction of a mixed/manic episode in such patients. Prior to initiating treatment with a stimulant, patients with comorbid depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.

Treatment emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without a prior history of psychotic illness or mania can be caused by stimulants at usual doses. If such symptoms occur, consideration should be given to a possible causal role of the stimulant, and discontinuation of treatment may be appropriate. In a pooled analysis of multiple short-term, placebo-controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.

Aggression:

Aggressive behavior or hostility is often observed in children and adolescents with ADHD, and has been reported in clinical trials and the postmarketing experience of some medications indicated for the treatment of ADHD. Although there is no systematic evidence that stimulants cause aggressive behavior or hostility, patients beginning treatment for ADHD should be monitored for the appearance of or worsening of aggressive behavior or hostility.

Long-Term Suppression of Growth:

Careful follow-up of weight and height in children ages 7 to 10 years who were randomized to either methylphenidate or non-medication treatment groups over 14 months, as well as in naturalistic subgroups of newly methylphenidate-treated and non-medication treated children over 36 months (to the ages of 10 to 13 years), suggests that consistently medicated children (i.e., treatment for 7 days per week throughout the year) have a temporary slowing in growth rate (on average, a total of about 2 cm less growth in height and 2.7 kg less growth in weight over 3 years), without evidence of growth rebound during this period of development. Published data are inadequate to determine whether chronic use of amphetamines may cause a similar suppression of growth, however, it is anticipated that they likely have this effect as well. Therefore, growth should be monitored during treatment with stimulants, and patients who are not growing or gaining height or weight as expected may need to have their treatment interrupted.

Seizure:

There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizures, in patients with prior EEG abnormalities in absence of seizures, and, very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. In the presence of seizures, the drug should be discontinued.

Peripheral Vasculopathy, including Raynaud’s Phenomenon:

Stimulants, including methamphetamine, used to treat ADHD are associated with peripheral vasculopathy, including Raynaud’s phenomenon. Signs and symptoms are usually intermittent and mild; however, very rare sequelae include digital ulceration and/or soft tissue breakdown. Effects of peripheral vasculopathy, including Raynaud’s phenomenon, were observed in post-marketing reports at different times and at therapeutic doses in all age groups throughout the course of treatment. Signs and symptoms generally improve after reduction in dose or discontinuation of drug. Careful observation for digital changes is necessary during treatment with ADHD stimulants. Further clinical evaluation (e.g., rheumatology referral) may be appropriate for certain patients.

Visual Disturbance:

Difficulties with accommodation and blurring of vision have been reported with stimulant treatment.


What are the precautions of Methamphetamine Hydrochloride?

General

Methamphetamine should be used with caution in patients with even mild hypertension.

Methamphetamine should not be used to combat fatigue or to replace rest in normal persons.

Prescribing and dispensing of methamphetamine should be limited to the smallest amount that is feasible at one time in order to minimize the possibility of overdosage.

Information for Patients

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Instruct patients to call their physician immediately with any signs of unexplained wounds appearing on fingers or toes while taking methamphetamine.



The patient should be informed that methamphetamine may impair the ability to engage in potentially hazardous activities, such as, operating machinery or driving a motor vehicle.

Circulation Problems in Fingers and Toes [Peripheral Vasculopathy, including Raynaud’s

Phenomenon]:

The patient should be cautioned not to increase dosage, except on advice of the physician.

Prescribers or other health professionals should inform patients, their families, and their caregivers about the benefits and risks associated with treatment with methamphetamine and should counsel them in its appropriate use. A patient Medication Guide is available for methamphetamine. The prescriber or health professional should instruct patients, their families, and their caregivers to read the Medication Guide and should assist them in understanding its contents. Patients should be given the opportunity to discuss the contents of the Medication Guide and to obtain answers to any questions they may have.

Drug Interactions

Insulin requirements in diabetes mellitus may be altered in association with the use of methamphetamine and the concomitant dietary regimen.

Methamphetamine may decrease the hypotensive effect of .

Methamphetamine should not be used concurrently with (see ).

Concurrent administration of and indirect-acting sympathomimetic amines such as the amphetamines, should be closely supervised and dosage carefully adjusted.

Phenothiazines

Drug/Laboratory Test Interactions

Literature reports suggest that amphetamines may be associated with significant elevation of plasma corticosteroids. This should be considered if determination of plasma corticosteroid levels is desired in a person receiving amphetamines.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Data are not available on long-term potential for carcinogenicity, mutagenicity, or impairment of fertility.

Pregnancy

Teratorgenic Effects

Pregnancy Category C. Methamphetamine has been shown to have teratogenic and embryocidal effects in mammals given high multiples of the human dose. There are no adequate and well-controlled studies in pregnant women. Methamphetamine should not be used during pregnancy unless the potential benefit justifies the potential risk to the fetus.

Nonteratogenic Effects

Infants born to mothers dependent on amphetamines have an increased risk of premature delivery and low birth weight. Also, these infants may experience symptoms of withdrawal as demonstrated by dysphoria, including agitation and significant lassitude.

Usage in Nursing Mothers

Amphetamines are excreted in human milk. Mothers taking amphetamines should be advised to refrain from nursing.

Pediatric Use

Safety and effectiveness for use as an anorectic agent in children below the age of 12 years have not been established.

Long-term effects of methamphetamine in children have not been established (see ).

Drug treatment is not indicated in all cases of the behavioral syndrome characterized by moderate to severe distractibility, short attention span, hyperactivity, emotional lability and impulsivity. It should be considered only in light of the complete history and evaluation of the child. The decision to prescribe methamphetamine tablets should depend on the physician's assessment of the chronicity and severity of the child's symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics.

When these symptoms are associated with acute stress reactions, treatment with methamphetamine is usually not indicated.

Clinical experience suggests that in psychotic children, administration of methamphetamine tablets may exacerbate symptoms of behavior disturbance and thought disorder.

Amphetamines have been reported to exacerbate motor and phonic tics and Tourette's syndrome. Therefore, clinical evaluation for tics and Tourette's syndrome in children and their families should precede use of stimulant medications.

Geriatric Use

Clinical Studies of methamphetamine did not include sufficient numbers of subjects age 65 years and over to determine whether elderly subjects respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal or cardiac function, and of concomitant disease or other drug therapy observed in this population.


What are the side effects of Methamphetamine Hydrochloride?

The following are adverse reactions in decreasing order of severity within each category that have been reported:

Cardiovascular:

Central Nervous System:

Gastrointestinal:

Hypersensitivity:

Endocrine:

Musculoskeletal:

Miscellaneous:

To report SUSPECTED ADVERSE REACTIONS, contact West-Ward Pharmaceuticals Corp. at 1-800-962-8364 or FDA at 1-800-FDA-1088 or .


What should I look out for while using Methamphetamine Hydrochloride?

Methamphetamine is contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors; hypertensive crisis may result. It is also contraindicated in patients with glaucoma, advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism or known hypersensitivity or idiosyncrasy to sympathomimetic amines. Methamphetamine should not be given to patients who are in an agitated state or who have a history of drug abuse.

Tolerance to the anorectic effect usually develops within a few weeks. When this occurs, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued (see ).


What might happen if I take too much Methamphetamine Hydrochloride?

Manifestations of acute overdosage with methamphetamine include restlessness, tremor, hyperreflexia, rapid respiration, confusion, assaultiveness, hallucinations, panic states, hyperpyrexia, and rhabdomyolysis. Fatigue and depression usually follow the central stimulation. Cardiovascular effects include arrhythmias, hypertension or hypotension, and circulatory collapse. Gastrointestinal symptoms include nausea, vomiting, diarrhea, and abdominal cramps. Fatal poisoning usually terminates in convulsions and coma.

Consult with a Certified Poison Control Center regarding treatment for up to date guidance and advice. Management of acute methamphetamine intoxication is largely symptomatic and includes gastric evacuation, administration of activated charcoal, and sedation. Experience with hemodialysis or peritoneal dialysis is inadequate to permit recommendations in this regard.

Acidification of urine increases methamphetamine excretion, but is believed to increase risk of acute renal failure if myoglobinuria is present. Intravenous phentolamine (Regitine) has been suggested for possible acute, severe hypertension, if this complicates methamphetamine overdosage. Usually a gradual drop in blood pressure will result when sufficient sedation has been achieved. Chlorpromazine has been reported to be useful in decreasing CNS stimulation and sympathomimetic effects.

*Regitine is a registered trademark of Novartis.


How should I store and handle Methamphetamine Hydrochloride?

Store at controlled room temperature, 20° to 25°C (68° to 77°F) [ USP]. The USP defines controlled room temperature as a temperature maintained thermostatically that encompasses the usual and customary working environment of 20° to 25°C (68° to 77°F); that results in a mean kinetic temperature calculated to be not more than 25°C; and that allows for excursions between 15° and 30°C (59° and 86°F) that are experienced in pharmacies, hospitals, and warehouses. Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016Methamphetamine Hydrochloride Tablets USP 5 mg tablets are supplied as a round, white to off-white, biconvex, debossed tablet with "54" on one side and "681" on the other side.StorageStore at 20º to 25ºC (68º to 77ºF). [See USP Controlled Room Temperature.]Dispense in a tight, light resistant, child-resistant container as defined in the USP/NF.Distr. by: Pharmaceuticals Corp.Eatontown, NJ 0772410008165/02 Revised August 2016


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Clinical Information

Chemical Structure

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Clinical Pharmacology

Methamphetamine is a sympathomimetic amine with CNS stimulant activity. Peripheral actions include elevation of systolic and diastolic blood pressures and weak bronchodilator and respiratory stimulant action. Drugs of this class used in obesity are commonly known as "anorectics" or "anorexigenics". It has not been established, however, that the action of such drugs in treating obesity is primarily one of appetite suppression. Other central nervous system actions, or metabolic effects, may be involved, for example.

Adult obese subjects instructed in dietary management and treated with "anorectic" drugs, lose more weight on the average than those treated with placebo and diet, as determined in relatively short-term clinical trials.

The magnitude of increased weight loss of drug-treated patients over placebo-treated patients is only a fraction of a pound a week. The rate of weight loss is greatest in the first weeks of therapy for both drug and placebo subjects and tends to decrease in succeeding weeks. The origins of the increased weight loss due to the various possible drug effects are not established. The amount of weight loss associated with the use of an "anorectic" drug varies from trial to trial, and the increased weight loss appears to be related in part to variables other than the drug prescribed, such as the physician-investigator, the population treated, and the diet prescribed. Studies do not permit conclusions as to the relative importance of the drug and non-drug factors on weight loss.

The natural history of obesity is measured in years, whereas the studies cited are restricted to a few weeks duration; thus, the total impact of drug-induced weight loss over that of diet alone must be considered clinically limited.

The mechanism of action involved in producing the beneficial behavioral changes seen in hyperkinetic children receiving methamphetamine is unknown.

In humans, methamphetamine is rapidly absorbed from the gastrointestinal tract. The primary site of metabolism is in the liver by aromatic hydroxylation, N-dealkylation and deamination. At least seven metabolites have been identified in the urine. The biological half-life has been reported in the range of 4 to 5 hours. Excretion occurs primarily in the urine and is dependent on urine pH. Alkaline urine will significantly increase the drug half-life. Approximately 62% of an oral dose is eliminated in the urine within the first 24 hours with about one-third as intact drug and the remainder as metabolites.

Non-Clinical Toxicology
Methamphetamine is contraindicated during or within 14 days following the administration of monoamine oxidase inhibitors; hypertensive crisis may result. It is also contraindicated in patients with glaucoma, advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism or known hypersensitivity or idiosyncrasy to sympathomimetic amines. Methamphetamine should not be given to patients who are in an agitated state or who have a history of drug abuse.

Tolerance to the anorectic effect usually develops within a few weeks. When this occurs, the recommended dose should not be exceeded in an attempt to increase the effect; rather, the drug should be discontinued (see ).

Insulin requirements in diabetes mellitus may be altered in association with the use of methamphetamine and the concomitant dietary regimen.

Methamphetamine may decrease the hypotensive effect of .

Methamphetamine should not be used concurrently with (see ).

Concurrent administration of and indirect-acting sympathomimetic amines such as the amphetamines, should be closely supervised and dosage carefully adjusted.

Phenothiazines

Methamphetamine should be used with caution in patients with even mild hypertension.

Methamphetamine should not be used to combat fatigue or to replace rest in normal persons.

Prescribing and dispensing of methamphetamine should be limited to the smallest amount that is feasible at one time in order to minimize the possibility of overdosage.

The following are adverse reactions in decreasing order of severity within each category that have been reported:

Cardiovascular:

Central Nervous System:

Gastrointestinal:

Hypersensitivity:

Endocrine:

Musculoskeletal:

Miscellaneous:

To report SUSPECTED ADVERSE REACTIONS, contact West-Ward Pharmaceuticals Corp. at 1-800-962-8364 or FDA at 1-800-FDA-1088 or .

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Reference

This information is obtained from the National Institute of Health's Standard Packaging Label drug database.
"https://dailymed.nlm.nih.gov/dailymed/"

While we update our database periodically, we cannot guarantee it is always updated to the latest version.

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Professional

Clonazepam Description Each single-scored tablet, for oral administration, contains 0.5 mg, 1 mg, or 2 mg Clonazepam, USP, a benzodiazepine. Each tablet also contains corn starch, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and povidone. Clonazepam tablets USP 0.5 mg contain Yellow D&C No. 10 Aluminum Lake. Clonazepam tablets USP 1 mg contain Yellow D&C No. 10 Aluminum Lake, as well as FD&C Blue No. 1 Aluminum Lake. Chemically, Clonazepam, USP is 5-(o-chlorophenyl)-1,3-dihydro-7-nitro-2H-1,4-benzodiazepin-2-one. It is a light yellow crystalline powder. It has the following structural formula: C15H10ClN3O3 M.W. 315.72
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Tips

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Interactions

Interactions

A total of 440 drugs (1549 brand and generic names) are known to interact with Imbruvica (ibrutinib). 228 major drug interactions (854 brand and generic names) 210 moderate drug interactions (691 brand and generic names) 2 minor drug interactions (4 brand and generic names) Show all medications in the database that may interact with Imbruvica (ibrutinib).