Episode 908: Sympathomimetic Drugs - The Emergency Medical Minute

Episode 908: Sympathomimetic Drugs

Contributor: Taylor Lynch MD

Educational Pearls:

  • Overview:
    • Sympathomimetic drugs mimic the fight or flight response, affecting monoamines such as dopamine, norepinephrine, and epinephrine
    • Limited therapeutic use, often abused.
  • Types:
    • Amphetamines: Methamphetamine, Adderall, Ritalin, Vyvanse
    • MDMA (Ecstasy)
    • Cocaine (Both hydrochloride salt & free based crack cocaine)
    • Theophylline (Asthma treatment)
    • Ephedrine (For low blood pressure)
    • BZP, Oxymetazoline (Afrin), Pseudoephedrine (Sudafed)
    • MAO Inhibitors (treatment-resistant depression)
  • Mechanisms:
    • Act on adrenergic and dopaminergic receptors.
    • Cocaine blocks dopamine and serotonin reuptake.
    • Methamphetamines increase stimulatory neurotransmitter release
    • MAO Inhibitors prevent neurotransmitter breakdown.
  • Symptoms:
    • Agitation, tachycardia, hypertension, hyperactive bowel sounds, diuresis, hyperthermia.
    • Severe cases: Angina, seizures, cardiovascular collapse.
  • Diagnosis:
    • Clinical examination and history.
    • Differentiate from anticholinergic toxidrome by diaphoresis and hyperactive bowel sounds.
    • Tests: EKG, cardiac biomarkers, chest X-ray, blood gas, BMP, CK, coagulation studies, U-tox screen.
  • Treatment:
    • Stabilize ABCs, IV hydration, temperature monitoring, benzodiazepines.
    • Avoid beta-blockers due to unopposed alpha agonism.
    • Whole bowel irrigation for body packers; surgical removal if packets rupture.
    • IV hydration for high CK levels.
    • Observation period often necessary.
  • Recap:
    • Mimic sympathetic nervous system.
    • Key symptoms: Diaphoresis, hyperactive bowel sounds.
    • Treatment: Supportive care, benzodiazepines.
    • Use poison control as a resource.


  1. Costa VM, Grazziotin Rossato Grando L, Milandri E, Nardi J, Teixeira P, Mladěnka P, Remião F. Natural Sympathomimetic Drugs: From Pharmacology to Toxicology. Biomolecules. 2022;12(12):1793. doi:10.3390/biom12121793

  2. Kolecki P. Sympathomimetic Toxicity From Emergency Medicine. Medscape. Updated March 11, 2024. https://emedicine.medscape.com/article/818583-overview

  3. Williams RH, Erickson T, Broussard LA. Evaluating Sympathomimetic Intoxication in an Emergency Setting. Lab Med. 2000;31(9):497-508. https://doi.org/10.1309/WVX1-6FPV-E2LC-B6YG

Summarized by Steven Fujaros | Edited by Jorge Chalit, OMSIII



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