Medications and Health Conditions that Pose Considerable Risk to MDMA Users
Known Contraindicated Medications:
Monoamine Oxidase Inhibitors (MAO Inhibitors, or MAOIs)
A MAO Inhibitor (“MAO” is pronounced like “cow”) is a type of prescription antidepressant. Some of the more common ones include Nardil, Parnate and Marplan. These drugs are very dangerous to combine with MDMA and can result in a potentially fatal condition known as “serotonin syndrome.” A number of people have died after consuming Ecstasy while currently taking a prescription MAO Inhibitor.
If you are currently taking a MAO Inhibitor you would probably know (MAO Inhibitors are usually prescribed for depression accompanied with anxiety). If for any reason you are unsure, find out before you decide to take ecstasy. If you know you are taking a MAO Inhibitor and you want to take ecstasy at some point, you should quit the MAO Inhibitor for at least two weeks prior to the ecstasy. (Be sure and assess carefully the pros and cons of stopping your daily medication.)
Note: MAO Inhibitors are different from SSRIs. Serotonin reuptake inhibitors like Prozac, Paxil and Zoloft do not interact dangerously with MDMA. However, MDMA use may interfere with the effectiveness of SSRI medications.
Drugs metabolized through the same liver enzyme as MDMA
Some drugs are metabolized (broken down) through the same liver enzyme as MDMA, known as the CYP2D6 enzyme (pronounced “sip-two-dee-six”). If you take MDMA along with another drug that is metabolized by the CYP2D6 enzyme, they will both be metabolized much more slowly, as the same enzymes struggle to break down two drugs at the same time. It is like taking a higher dose of both drugs, and this can be dangerous, especially if the other drug has a low overdose threshold.
Ritonivar, for example, is a protease inhibitor used in the treatment of HIV that is metabolized by the CYP2D6 enzyme. At least one person has died from taking MDMA while on Ritonivar. Other drugs metabolized by CYP2D6 include codeine and other opiate derivatives, as well as DXM, an ingredient found in many over-the counter cough medications.
Be especially careful about DXM, because it is commonly found in fake ecstasy tablets. Don’t combine different brands of E. Accidentally getting DXM is bad enough, but accidentally combining it with real Ecstasy is even worse.
Note: Prozac is also metabolized by the CYP2D6 enzyme. Taking E while on Prozac will inhibit the breakdown of both the Prozac and the E. However, Prozac also prevents users from experiencing the desired effects. The unique relationship between MDMA and Prozac deserves special consideration. See our neurotoxicity page as well as our Ecstasy Slideshow for more information.
Pre-existing Health Conditions
- Heart Conditions: 125mg of MDMA will increase a person’s resting heart rate approximately 30 beats per minute. MDMA also produces a significant increase in blood pressure. This means that people with heart conditions are more vulnerable to heart attacks or other heart complications if they take MDMA.
- Liver Problems: Your liver filters toxins from your blood. Contrary to some rumors, there is no method of ingesting MDMA that will “bypass” your liver. While there is little evidence that MDMA causes liver damage on its own, people with hepatitis or other liver ailments may be vulnerable to liver damage if they consume MDMA.
- Seizures: Seizures can be very short, lasting only a second, or they can be very long, lasting many minutes. Strobe lights can often trigger seizures in people. People prone to seizures are more likely to experience them if they take MDMA. Always call an ambulance if somebody falls unconscious or starts having a seizure.
- Psychiatric Disorders: MDMA, like many psychoactive drugs, can exacerbate the symptoms of mental illness, particularly depression.
- Malignant Hyperthermia: Some diseases, like Central Core Disease, make people more susceptible to heatstroke. Another name for this kind of heatstroke is “malignant hyperthermia.” MDMA raises the risk of malignant hyperthermia in people with Central Core Disease. Always call an ambulance if somebody falls unconscious or starts having a seizure.
- Other susceptibility to heatstroke: Some people may simply be more prone to heatstroke or hyperthermia than others. This could be a genetic trait, or it may result from certain chronic illnesses and even diseases someone has had in the past. There are anecdotal reports, for example, that patients who have survived meningitis have an increased sensitivity to heat, even years after their recovery. If you have had meningitis, have a chronic illness or a predisposition to heat sensitivity, or if members of your immediate family are heat sensitive, you should think carefully before taking MDMA. MDMA increases the risk of heatstroke, and heatstroke is the cause of the vast majority of MDMA-related fatalities.