Ecstasy adverse effects

An MDMA-related psychiatric adverse effect ecstasy been enhanced by an SSRI (107). 

Since atrial fibrillation is unusual in young people, the authors speculated that ecstasy may have contributed in this case even though this adverse effect has not been reported before. 

Other neurological adverse effects have been reported in a first-time ecstasy user (47). 

The authors reported that 12 cases of acute psychosis have previously been reported after the use of ecstasy once or twice. Based on a previously suggested hypothesis, they proposed that the psychosis was probably due to the indirect effects of MDMA on the dopaminergic system, secondary to serotonergic deregulation. Most patients who went on to develop a chronic psychosis were either chronic ecstasy users or multiple substance users. However, in the case mentioned here, after 6 months the patient still had symptoms of psychosis. The authors further suggested that genetically slow metaboli-zers of ecstasy are probably more vulnerable to this adverse effect, even with a single exposure. 

Several studies have focused on the cognitive effects of ecstasy, and a review of the adverse effects of MDMA in animals has raised concerns about potential toxicity in... 

The authors bemoaned the fact that ecstasy is still falsely considered to be harmless by most users. They emphasized that the classic user profile has changed over recent years, with non-rave party use increasing, as ecstasy is more readily available. They also observed that a quieter environment, which is supposed to reduce the risk of adverse effects, did not prevent this woman s death. According to her friends, who had ingested similar amounts of ecstasy from the same supply without any untoward effects, this had been her first experience with ecstasy. Her blood ecstasy concentration of 3.8 mg/1 was highly toxic. As her friends did not have any untoward reactions, the authors proposed that different people have... 

A 29-year-old man who took ecstasy and alcohol at a rave had no immediate adverse effects, slept well later on, and was in good health until he suddenly collapsed to the floor about 2 hours after waking. When seen 36... 

Several studies have focused on the cognitive effects of ecstasy, and a review of the adverse effects of MDMA in animals has raised concerns about potential toxicity in humans (57). MDMA can selectively damage brain serotonin (5-HT) neurons in animal brains, even at doses within the range of those typically used recreationally. In many studies, lasting reductions in various brain 5-HT markers have been reported in MDMA-treated animals. Axons of 5-HT neurons were damaged in MDMA-treated animals, including monkeys, and neurotoxic effects of MDMA have been observed in every animal species studied so far. In non-human primates, the toxic dose of MDMA closely approaches the dose used by humans. 

Some of the general more common adverse effects that have been reported by ecstasy users are shown in Table 4. 

The study of ecstasy with citalopram was primarily undertaken to find out how eestasy works, but on the basis of these results and animal studies it seems likely that patients already taking citalopram may not be able to get as high on usual doses of ecstasy, and some adverse effects may also be redueed. Furthermore, if the proposed mechanism of interaction is correct, the same is also likely to be true if they are taking any other SSRI and some cases have been reported. However, be aware of possible pharmaeokinetie interaetions with some SSRIs that are potent CYP2D6 inhibitors (e.g. fluoxetine, paroxetine), which may increase ecstasy levels. There is also a risk of increased serotonergic activity and there have been a few reports of interaetions involving other sympathomimetics and SSRIs or related drugs, see Phentermine + Fluoxetine , p.205. 

A journalist s account, based purely on anecdotal reports, claims that the illicit use of sildenafil with ecstasy (MDMA, methylenedioxymethamfet-amine) causes hammerheading because of the pounding headache and the prolonged and painful penile erections that require emergency medical treatment. The report does not say how much of each of these drugs is taken to produce these adverse effects. The outeome ean clearly be unpleasant, painful and, the priapism, potentially serious. 

It is currently being traded as herbal ecstasy due to its CNS stimulatiOTi that in overdoses can lead to hallucinations, paranoids, and psychosis [17], However, the large number of reports of serious adverse effects related to the use of this substance increased the attention to its use. 

In 14 healthy subjects, ketanserin attenuated the perceptual changes, emotional excitation, and acute adverse responses induced by ecstasy, but had little effect on positive mood, well-being, extroversion, and short-term sequelae (3). Body temperature was lower with ecstasy plus ketanserin than with ecstasy alone. 

Herbal substitutes for dru [s of abuse A variety of herbal mixtures are offered for sale in magazines, on the internet and in so-called smart , eco or head shops. Many are marketed as herbal Ecstasy and the plants included in the formulations include Yohimbe bark, Kava-Kava (Piper methysticum),Y-3 e.emi, Hops, Jaborandi and Alisma. One product contains Kava-Kava, Guarana, Uva Ursi and Cascara bark. Many of the products sold as herbal Ecstasy contain either Ephedra sinica (Ma huang) or the Indian plant Sida cordifolia which both contain the alkaloid ephedrine (see R03c, Chapter VI). Other alkaloids may also occur, such as pseudoephedrine, norephedrine and norpseudoephedrine. The side-effects of ephedrine include tachycardia, anxiety, insomnia and arrythmias and a hypotensive crisis may develop if monamine oxidase inhibitors are also taken. Many adverse reactions and more than 20 deaths have been attributed to ephedrine and Ephedra consumption. Research conducted in the US shows that the daily intake of some Ephedra products would give ephedrine levels well above the recommended therapeutic doses. 

Clear-cut conclusions cannot be drawn from the evidence presented in the reported studies. There is some evidence that the effects of alcohol are modified or reduced, but driving skills appear to remain impaired to some extent. There is also evidence of an increased risk of adverse cardiac effects. The increase in perceived total intoxication noted in one report has been suggested as a possible reason for the popularity of the illicit use of the combination. Consider also Alcohol -i- Ecstasy , p.62. 

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