MDMA (XTC)

Name: 

MDMA, ecstasy, XTC, molly/mandy (crystalline powder)

Effects: 

Euphoria, increased empathy, talkativeness, increased energy

Side effects:

Nausea, tremors, trismus, dehydration (hyponatremia), changed visual acuity, increased perspiration, dilated pupils, hyperthermia, increased heart rate and blood pressure, insomnia, fear and/or panic attacks. 

MDMA is moderately teratogenic, resulting in impaired motor function through neuro- and cardiotoxicity. 

Mechanism of action:

Primarily working as a presynaptic releasing agent of serotonin, norepinephrine, and dopamine through its activity at the trace-amine-associated receptor 1 (agonist) and vesicular monoamine transporter 2 (VMAT2). Works as a monoamine substrate competing with endogenous monoamines. MDMA inhibits both VMAT transporters. 

MDMA enters monoamine neurons by acting as monoamine substrate, activity at VMAT2 releases neurotransmitters from vesicles into cytosol, MDMA activity at TAAR1 moves neurotransmitters out of cytosol into synaptic cleft. 

MDMA reaches maximum concentration in the blood 1,5 - 3 hours after ingestion. Duration of effects 4-6 hours after which serotonin is depleted. 

Metabolism of MDMA occurs mainly through CYP450, CYP2D6, CYP3A4, and COMT. 

A number of drug interactions can occur between MDMA and other drugs, most notably CYP450 and CYP2D6 inhibitors (eg. ritonavir). Use of serotonergic drugs and MDMA may result in serotonin syndrome. Severe overdose and death have been described in people who took MDMA and MAO inhibitors (Nardil, Parnate, Aurorix, Manerix).

Substance and dosage: 

Pills, powder, capsules. The average pill contains 80-140mg. Currently, 10% of pills contain more than 150mg MDMA. Pills may contain derivatives like MDA or MDEA, increasing toxicity. 

Overdosage: 

Lethal reactions have been described in any dose, regardless of user experience. In high doses, MDMA induces a neuro-immune respons increasing blood-brain-barrier permeability. 

Cardiovascular: disseminated intravascular coagulation, intracranial haemorrhage, severe hypertension OR hypotension, hypotensive bleeding. 

Central nervous system: seizures, coma, hallucinations, anterograde and retrograde amnesia, cerebral edema. 

Musculoskeletal: Rhabdomyolysis leading to renal failure

Respiratory: Acute Respiratory Distress Syndrome

Metabolic: SIADH, hyponatremia, hyperpyrexia/thermia