What is MDMA toxicity?

Updated: May 30, 2020
  • Author: In-Hei Hahn, MD, FACEP, FACMT; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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The substance 3,4-methylenedioxymethamphetamine (MDMA [ie, ecstasy, XTC, Adam, E, X, clarity, Stacy, Molly]) is an amphetamine derivative that has gained significant popularity in recent years and has become the recreational drug of choice for many adolescents and young adults. Individuals who take MDMA describe a sense of euphoria, loss of inhibition, a feeling of closeness and/or empathy, and increased sensuality.

At the root of MDMA's widespread popularity is the mistaken belief that it is a safe drug with little toxicity and a long duration of action. In fact, MDMA has addictive psychoactive properties and unpredictable toxicity, and its abuse has led to an alarming increase in emergency department (ED) visits worldwide.

Patients with MDMA toxicity may present with central nervous system, cardiovascular, gastrointestinal, skin, and other manifestations (see Presentation). They should be evaluated for hyperthermia, dehydration, hyponatremia, seizures, hypertensive crises, cardiac dysrhythmias, and possible signs of serotonin syndrome (see Workup). Most patients with MDMA overdose improve with supportive care, but life-threatening complications may result from severe toxicity (see Treatment).

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