MAOIs Ecstasy

MAO has been inhibited. As a result, transmitter accumulates in the cytoplasm and is exported into the synapse via the membrane-bound transporter. The ensuing (impulse-independent) sympathetic arousal can be disastrous, culminating in a hypertensive crisis and stroke. Although this process is a pharmacological curiosity and certainly contributed to the demise of MAOIs, it is possibly overrated (Tyrer 1979) it has been estimated that the number of deaths associated with the use of the MAOI, tranylcypromine, amounts to only 1 per 14000 patient years. However, this sequence of events echoes exactly the acute actions of methylenedioxymethamphetamine (MDMA, Ecstasy ) and undoubtedly accounts for some of the deaths attributed to this drug. 

MAOIs, monoamine oxidase inhibitors MDMA, methylenedioxy-methamphetamine (ecstasy) SSRIs, selective serotonin reuptake inhibitors. Serotonin Syndrome and Similar Syndromes... 

MDMA (3.4-methylenedioxymethylamphetamjne EA 1475 XTC Ecstasy E ) has amphetamine-like actions, and induces release of, and is a (re-) uptake inhibitor of 5-hydroxytryptamine. Also, it is a monoamine-oxidase INHIBITOR (MAOI, type A), slowing catabolism of 5-HT. It is a PSYCHOTROPIC AGENT and drug of abuse. 

The concurrent use of non-selective MAOIs and amfetamines and related drugs can result in a potentially fatal hypertensive crisis and/or serotonin syndrome. Interactions have been reported for amfetamine, dexamfetamine, metamfetamine, and methylpheni-date. Interactions have also been reported with the illicit drug ecstasy (MDMA, methylenedioxymethamfetamine) when taken with phenelzine or moclobemide. The manufacturers of fenfluramine and dexfenfluramine contraindicated their use with MAOIs. 

Four patients died after taking moclobemide and ecstasy (MDMA, methylenedioxymethamfetamine). The clinical evidence is limited, but in each case the forensic pathologist concluded that the cause of death was the combined use of these drugs. It was suggested that what happened is consistent with the serotonin syndrome, although the evidence is fairly slim. Two patients had taken maximum therapeutic doses and two moderate overdoses of moclobemide. Note that moclobemide had not been prescribed to any of them. Post-mortem analysis also found the presence of dextromethorphan in one patient, which was thought to have contributed, see also MAOIs or RIMAs -i- Dextromethorphan , p.ll34. 

Kaskey GB. Possible interaction between an MAOI and "Ecstasy". AmJP chiatry (1992) 149,411-2. 

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