Rhabdomyolysis in MDMA Intoxication: A Rapid and Underestimated Killer. “Clean” Ecstasy, a Safe Party Drug?

Eede, Herve Vanden; Montenij, Leon J.; Touw, Daan; Norris, Elizabeth

doi:10.1016/j.jemermed.2009.04.057

Cited by 25 publications

(11 citation statements)

References 10 publications

(7 reference statements)

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“…For traditional amphetamines, mainly sympathomimetic adverse effects (e.g., anxiety, insomnia, headaches, mydriasis, bruxism, dry mouth, hyperthermia, hypertension, tachycardia, chest pain, palpitations, anorexia, nausea, vomiting, and abdominal pain) can be expected for newly emerged amphetamine-derived designer drugs (Carvalho et al 2012;Derlet et al 1989;Dolder et al 2017;Heal et al 2013;Vizeli and Liechti 2017;Wijers et al 2017). Hyperthermia is a significant contributor to potentially severe adverse effects of amphetamines, including disseminated intravascular coagulation, renal failure, and rhabdomyolysis (Bingham et al 1998;Carvalho et al 2012;Cunningham 1997;Fahal et al 1992;Ginsberg et al 1970;Greene et al 2003;Halachanova et al 2001;Henry et al 1992;Kendrick et al 1977;Richards et al 1999;Screaton et al 1992;Vanden Eede et al 2012). The uncoupling of oxidative phosphorylation in skeletal muscle through the activation of uncoupling protein 3 (UCP-3) and agonism at adrenergic receptors by norepinephrine release has previously been identified as an important contributor to MDMA-induced hyperthermia (Mills et al 2003(Mills et al , 2004.…”

Section: Adverse Effects Of Amphetaminesmentioning

confidence: 99%

Designer drugs: mechanism of action and adverse effects

2020

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Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at l-opioid receptors and c-aminobutyric acid-A (GABA A) or GABA B receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB 1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT 2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.

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Section: Adverse Effects Of Amphetaminesmentioning

confidence: 99%

Designer drugs: mechanism of action and adverse effects

2020

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“…However, in our patient, immobilization, coma, acid–base and electrolyte disturbances were excluded as the causative factors for rhabdomyolysis. Additionally, the patient denied the combined use of illicit drugs (ecstasy, heroin, or cocaine) which can lead to rhabdomyolysis 8 , 9 . As a result, and according to basic research, we believe that the direct toxic effect of ethanol in skeletal muscles through disruption of adenosine triphosphatase pump function, breakdown of the muscle membrane, and alteration of the sarcoplasmic reticulum, or induction of cytochrome P450 may play a crucial role in the skeletal muscles’ disintegration 10 , 11 .…”

Section: Discussionmentioning

confidence: 99%

Nontraumatic rhabdomyolysis with short‐term alcohol intoxication – a case report

Papadatos

Deligiannis

Bazoukis

et al. 2015

Clinical Case Reports

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“…This, and the widespread though erroneous belief that "ecstasy is safe", have promoted the vogue for MDMA among youth (Eede et al, 2009;Kalant et al, 2001). Wide variations in the concentration of MDMA (1-207 mg/tablet) and the presence of several concomitants in seized tablets have been reported (Cole et al, 2002;Duterte et al, 2009;Makino et al, 2003;Teng et al, 2006;Vogels et al, 2009).…”

Section: Introductionmentioning

confidence: 99%

Pharmacodynamic interactions between MDMA and concomitants in MDMA tablets on extracellular dopamine and serotonin in the rat brain

Ikeda

Igari

Fuchigami

et al. 2011

European Journal of Pharmacology

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Baseline levels of dopamine and 5-HT in the striatum were 16.5±7.7 and 3.5±1.7 nM (mean ± standard deviation), respectively. After a single administration of MDMA (10 mg/kg, i.p.), a dramatic increase in extracellular dopamine (C max : 36.1-fold vs. baseline) and 5-HT levels (C max : 9.3-fold vs. baseline) was observed. When rats were co-administered with methamphetamine (1, 5 or 10 mg/kg) with MDMA, the dopamine levels induced by MDMA increased in a methamphetamine-dose-dependent manner (C max : 2.5-, 3.5-, and 3.8-fold vs. MDMA). A similar trend was observed in 5-HT levels (C max : 1.1-, 1.3-, and 1.8-fold vs. MDMA). In contrast, ketamine and caffeine showed synergistic effects on the monoamine levels induced by MDMA, whereas the individual administration of either of these compounds did not affect monoamine levels. Ketamine (1, 5 mg/kg) decreased the dopamine levels induced by MDMA (C max : 0.9-and 0.7-fold vs. MDMA) and increased the 5-HT levels induced by MDMA (C max : 1.4-and 1.6-fold vs. MDMA), and co-administration of caffeine (20 2 mg/kg) with MDMA increased dopamine levels (C max : 1.7-fold vs. MDMA). These results suggest that exposure to multiple drugs in addition to MDMA can have neurotoxic effects. 249 words

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Rhabdomyolysis in MDMA Intoxication: A Rapid and Underestimated Killer. “Clean” Ecstasy, a Safe Party Drug?

Cited by 25 publications

References 10 publications

Designer drugs: mechanism of action and adverse effects

Designer drugs: mechanism of action and adverse effects

Nontraumatic rhabdomyolysis with short‐term alcohol intoxication – a case report

Pharmacodynamic interactions between MDMA and concomitants in MDMA tablets on extracellular dopamine and serotonin in the rat brain

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