Management of Mephedrone Overdose

Initial Assessment and Stabilization

The American Heart Association recommends immediately assessing airway, breathing, and circulation with continuous cardiorespiratory monitoring in patients with mephedrone overdose, with the priority being securing the airway and providing assisted ventilation if respiratory depression occurs 1, 2
Obtaining IV access and performing bedside glucose testing to rule out hypoglycemia as a cause of altered mental status is crucial in the initial assessment of patients with mephedrome overdose 2, 4

The American College of Cardiology suggests that benzodiazepines are the first-line treatment for agitation, anxiety, and seizures associated with sympathomimetic overdose, and should be titrated to achieve adequate sedation and control of sympathomimetic symptoms 5, 4
For persistent severe hypertension or tachycardia despite benzodiazepines, consider short-acting beta-blockers or calcium channel blockers cautiously, while avoiding pure beta-blockers in isolation due to risk of unopposed alpha-adrenergic stimulation 5

A comprehensive metabolic panel, complete blood count, urine drug screen, and arterial or venous blood gas are recommended in the diagnostic workup of patients with mephedrone overdose 4

The American Heart Association advises against assuming naloxone will be helpful in mephedrone overdose, as it is not an opioid and naloxone has no role in pure mephedrone toxicity, unless there is suspicion of co-ingestion with opioids 1, 6
The use of flumazenil is also not recommended if benzodiazepines were administered therapeutically or if co-ingestion with other substances is suspected, as this can precipitate seizures 7, 4

Patients with mephedrone overdose should be observed in a healthcare setting until vital signs normalize and psychiatric symptoms resolve, with a minimum observation period extending until sympathomimetic symptoms completely resolve 6, 2, 8
Mandatory psychiatric evaluation before discharge is necessary to assess for substance use disorder and suicide risk, as compulsive use patterns and addiction have been documented 2