Table 2. Symptom-oriented pharmacotherapy as a component of acute treatment.

Symptom	Treatment options	Recommendations
Methamphetamine intoxication with acute agitation or markedly fluctuating state with unpredictable responses	– Once psychotherapeutic de-escalating measures have been exhausted, benzodiazepines are the treatment of choice, as soon as adequate provisions for intervention and monitoring are in place	↑↑
Depressive-anxious symptoms with exhaustion and/or hypersomnia during methamphetamine withdrawal	– Bupropion or a drive-increasing tricyclic antidepressant such as desipramine	↔
Sleep disturbances and/or agitation during methamphetamine withdrawal	– The drugs of choice, according to expert opinion, are sedating antidepressants or low-potency sedating antipsychotic drugs – Avoid hypnotic agents!	Antidepressants: ↔ Low-potency sedating antipsychotic drugs: ↔
Methamphetamine-induced psychotic manifestations	– Atypical antipsychotic drugs – Benzodiazepines in addition, as needed, for a short time only – R eassess the indication and discontinue within 6 months if possible	Atypical antipsychotic drugs: ↑ Benzodiazepines: ↔
Acute depressive and/or anxious state with endangerment to self or others during methamphetamine withdrawal	– Benzodiazepines as needed, for a short time only	↔
In case of multiple unsuccessful prior withdrawal attempts	– Dexamphetamine only in individual cases & in an inpatient setting – Taper to off within 2 weeks	↔ ↔
Marked craving during methamphetamine withdrawal	– Acetylcysteine as needed, 600–1200 mg/day	↔

↑↑, strong recommendation; ↑, recommendation; ↔, open recommendation