What is the role of metabolism in the pathophysiology of MDMA toxicity?

Updated: Dec 20, 2017
  • Author: In-Hei Hahn, MD, FACEP, FACMT; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

About 75% is renally excreted unchanged; the rest is metabolized in the liver, specifically by the hepatic enzyme CYP 2D6 and catechol–O–methyl transferase (COMT). [8] Of note, a small subset of the population is either missing the liver enzyme CYP2D6 and COMT genotypes. Others have decreased function due to inhibition from medications such as the protease inhibitor ritonovir, which may be implicated in severe toxicity such as serotonin syndrome, hepatitis, disseminated intravascular coagulation, hyponatremia, and fatalities caused by the inability to metabolize MDMA. [9]


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