īenzodiazepines (BZOs) are the first-line medications in the treatment of toxicity from stimulants, including methamphetamine. The most common signs and symptoms of stimulant toxicity in children are irritability, agitation, hyperactivity, ataxia, seizure, inconsolable or constant body movements, roving eye movements, cortical blindness, hyperthermia, tachycardia, hypertension, vomiting, respiratory distress, and rhabdomyolysis. Even though accidental opioid poisonings remain more common in Iranian children, this change in adult drug use patterns presents a challenge for clinical practice, since no appropriate antidote exists for stimulant poisoning. The hidden nature of stimulant abuse among family members has also resulted in a dramatic increase in the frequency of accidental stimulant toxicity in children. In recent years, Iran has seen a rise in the prevalence of stimulant abuse, including from methamphetamine, methylphenidate, and ecstasy. However, considering the higher potency of clonazepam, it seems that lorazepam is the safer benzodiazepine for oral maintenance treatment of methamphetamine-induced agitation in children and can be used with minimal complications. ConclusionsĬlonazepam and lorazepam treatment was equally effective at similar doses. There was no report of benzodiazepine complications in either group. Two in each group (13.3%) needed re-administration of intravenous diazepam due to persistent agitation. The most common symptoms/signs were agitation (29 96.7%), mydriatic pupils (26 86.7%), and tachycardia (20 66.6%). The source of poisoning was methamphetamine exposure from oral ingestion in 23 (76.7%) and passive inhalation in 7 (23.3%) patients. The median age (range) was 15 (6-144) months.

In a single-center clinical trial, intravenous diazepam (0.2 mg/Kg) was initially administered to all methamphetamine-poisoned pediatric patients to control their agitation, followed by a single dose of oral clonazepam (0.05 mg/Kg n = 15) or oral lorazepam (0.05 mg/Kg n = 15) to prevent relapse of toxicity. To evaluate the efficacy of oral clonazepam versus oral lorazepam following initial parenteral benzodiazepine administration to control methamphetamine-induced agitation in children.

Antidote to benzodiazepine