Low-dose MDMA (“ecstasy”) induces vasopressin secretion

Henry, John A.; Fallon, John K.; Kicman, Andrew T.; Hutt, Andrew J.; Cowan, David; Forsling, Mary L.

doi:10.1016/s0140-6736(05)78744-4

Cited by 135 publications

(84 citation statements)

References 4 publications

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“…Henry and colleagues demonstrated that small doses of MDMA (40 mg; common "street dose" is 100 mg) led to a significant increase in AVP levels (from 1.14-1.88 pmol/L to 2.46-9.16 pmol/L) within 1-2 hours after dosing. As expected, this rise in AVP led to a decrease in serum sodium levels, with a concomitant rise in urine osmolality (53). A more recent study documented a slight fall in serum sodium levels in "rave" attendees who used ecstasy compared with a control group of nonusers (61).…”

Section: Clinical Manifestations Of Ecstasy Use and Underlying Pathogsupporting

confidence: 53%

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Nephrotoxic Effects of Common and Emerging Drugs of Abuse

Pendergraft

Herlitz

Thornley‐Brown

et al. 2014

Clinical Journal of the American Society of Nephrology

111

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The kidneys can be injured in diverse ways by many drugs, both legal and illegal. Novel associations and descriptions of nephrotoxic effects of common and emerging drugs of abuse have appeared over the past several years. Anabolic androgenic steroids, illicitly used by athletes and others for decades to increase muscle mass and decrease body fat, are emerging as podocyte toxins given recent descriptions of severe forms of FSGS in long-term abusers. Synthetic cannabinoids, a new group of compounds with marijuana-like effects, recently became popular as recreational drugs and have been associated with an atypical form of AKI. 3,4-Methylenedioxymethamphetamine, commonly known as ecstasy, is a widely used synthetic recreational drug with mood-enhancing properties and a constellation of toxicities that can result in death. These toxic effects include hyperthermia, hypotonic hyponatremia due to its arginine vasopressin secretagogue-like effects, rhabdomyolysis, and cardiovascular collapse. Cocaine, a serotonin-norepinephrine-dopamine reuptake inhibitor that serves as an illegal stimulant, appetite suppressant, and anesthetic, also causes vasoconstriction and rhabdomyolysis. Recent adulteration of much of the world's supply of cocaine with levamisole, an antihelminthic agent with attributes similar to but distinct from those of cocaine, appears to have spawned a new type of ANCAassociated systemic vasculitis. This review discusses the nephrotoxic effects of these common and emerging drugs of abuse, of which both community and health care providers should become aware given their widespread abuse. Future investigation into pathogenetic mechanisms associated with these drugs is critical and may provide a window into ways to lessen and even prevent the nephrotoxic effects of these drugs of abuse and perhaps allow a deeper understanding of the nephrotoxicities themselves.

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Section: Clinical Manifestations Of Ecstasy Use and Underlying Pathogsupporting

confidence: 53%

“…Furthermore, reuptake of these neurotransmitters is also inhibited. Ecstasy has also been documented to lead to the release of AVP, perhaps through the serotonin system (52,53).…”

Section: Clinical Manifestations Of Ecstasy Use and Underlying Pathogmentioning

confidence: 99%

Nephrotoxic Effects of Common and Emerging Drugs of Abuse

Pendergraft

Herlitz

Thornley‐Brown

et al. 2014

Clinical Journal of the American Society of Nephrology

111

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“…Our study, which was intended to specifically test this hypothesis, provides support that such a gender difference does indeed exist. This gender difference may involve a number of physiological factors, including metabolic and hormonal interactions and other mechanisms of homeostatic regulation (20,27,28,32,36,38). This presumes that any female-associated risk of adverse outcomes associated with Ecstasy is mediated entirely through hyponatremia.…”

Section: Discussionmentioning

confidence: 99%

“…MDMA administration stimulated ADH release from rat hypothalamus in vitro (26) and in healthy, normally hydrated human male volunteers, with a drop in serum sodium accompanying the rise in serum ADH (27). Additional evidence for MDMA-induced ADH secretion has been provided by determination of elevated levels of ADH in a patient with hyponatremic coma after Ecstasy ingestion (20).…”

Section: Discussionmentioning

confidence: 99%

Patterns of Ecstasy-Associated Hyponatremia in California

Rosenson

Smollin

Sporer

et al. 2007

Annals of Emergency Medicine

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Study objective: To describe the clinical characteristics of patients with Ecstasy (MDMA)-associated hyponatremia (serum sodium less than 130 mmol/L) reported to the California Poison Control System (CPCS) over a five-year period and to determine if a gender difference exists among patients with Ecstasy-associated hyponatremia. Methods:We performed a retrospective review of cases involving Ecstasy intoxication reported to the CPCS and recorded in its computerized database from January 1, 2000 through October 9, 2005 We excluded all "information only" calls, cases managed at home, cases with no gender specified and cases in which the outcome was coded as "no effect", "unrelated -probably not responsible", "confirmed non-exposure", "judged as non-toxic-expect no effect", and "minimal clinical effects possible". Confirmation of exposure to MDMA was based on the history of use and, when available, urine toxicology screen testing positive for MDMA or amphetamine derivatives. Hyponatremia was defined as a measured serum sodium less than 130 mmol/L.Results: A total of 1,436 cases involving Ecstasy were reported to the CPCS over the 5-year study period, of which 891 were excluded based on the criteria described above. Of the 545 cases that met inclusion criteria, 296 (54.3%) were females and 249 (45.7%) were males. There were 188 cases (34.5%) with a documented serum sodium, including 73/188 (38.8%) with hyponatremia (Na < 130 mmol/L). Of the 73 subjects with hyponatremia, there were 55 (75.3%) females and 18 (24.7%) males; of the 115 non-hyponatremic subjects 50 (43.5%) were female and 65 (56.5%) male. There was no observed gender difference in the ascertainment of serum sodium levels. Among patients with a documented serum sodium level, female gender was 3 associated with increased odds of hyponatremia by univariate analysis (OR 3.97; 95% CI 2.08 -7.59). Conclusion:Female gender was associated with increased odds of hyponatremia among persons with Ecstasy intoxication and a documented serum sodium level reported to CPCS from 2000 -2005. Multiple potential study confounders, including spectrum bias, incomplete laboratory data and individual differences in subject characteristics prevent determination of causality regarding gender differences in the incidence of Ecstasy-associated hyponatremia and its complications.

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“…Included in the metabolites in the COMT pathway of degradation is a major metabolite, 4-hydroxy-3-methoxymethamphetamine (HMMA). HMMA has been documented as a more potent inducer of ADH secretion (13)(14)(15)(16)(17). As discussed next, the effects of this metabolite on the pituitary could explain the variable incidence of hyponatremia seen in ecstasy users.…”

Section: Pharmacologymentioning

confidence: 94%

The Agony of Ecstasy

Campbell

Rosner

2008

Clinical Journal of the American Society of Nephrology

107

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Ecstasy (MDMA, 3,4-methylenedioxymethamphetamine) is commonly used by college-aged individuals. Ecstasy leads to feelings of euphoria, emotional empathy, and increased energy. These effects come at a significant risk for complications. Ecstasy has been associated with acute kidney injury that is most commonly secondary to nontraumatic rhabdomyolysis but also has been reported in the setting of drug-induced liver failure and drug-induced vasculitis. More common, ecstasy has led to serious hyponatremia and hyponatremia-associated deaths. Hyponatremia in these cases is due to a "perfect storm" of ecstasy-induced effects on water balance. Ecstasy leads to secretion of arginine vasopressin as well as polydipsia as a result of its effects on the serotonergic nervous pathways. Compounding these effects are the ready availability of fluids and the recommendation to drink copiously at rave parties where ecstasy is used. The effects of ecstasy on the kidney as well as therapeutic measures for the treatment of ecstasy-induced hyponatremia are presented.

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Low-dose MDMA (“ecstasy”) induces vasopressin secretion

Cited by 135 publications

References 4 publications

Nephrotoxic Effects of Common and Emerging Drugs of Abuse

Nephrotoxic Effects of Common and Emerging Drugs of Abuse

Patterns of Ecstasy-Associated Hyponatremia in California

The Agony of Ecstasy

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