Mephentermine misuse: an emerging challenge and the potential role of mirtazapine-a case report

Mephentermine is a sympathomimetic amine with structural and pharmacological similarities to amphetamines. Despite its increasing misuse, particularly among athletes and bodybuilders, there is limited literature on its management. No pharmacological treatments have been approved for mephentermine misuse. We describe two cases of young adult males presenting with symptoms of mephentermine withdrawal, including insomnia, anxiety, and craving. Both had histories of prolonged intravenous mephentermine use, with one managed on an outpatient basis and the other as an inpatient. Mirtazapine was initiated in both cases and was associated with improvements in sleep, anxiety, craving and hyperarousal. Psychotic symptoms in one patient resolved with short-term risperidone. Both patients received brief motivational enhancement therapy and remained abstinent from all substances except tobacco during two months of follow-up. These cases highlight the potential utility of mirtazapine in managing mephentermine misuse, particularly for addressing withdrawal symptoms and craving. Given its noradrenergic and serotonergic profile and its demonstrated efficacy in methamphetamine use, mirtazapine may be a promising candidate for treatment. However, the findings are limited by the case series design and larger, controlled studies are needed to confirm its role in clinical management.