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Review
. 2020 May;16(5):357-369.
doi: 10.1080/17425255.2020.1749262. Epub 2020 Apr 12.

MDMA interactions with pharmaceuticals and drugs of abuse

Esther Papaseit  1   2 , Clara Pérez-Mañá  1   2 , Marta Torrens  2   3 , Adriana Farré  2   3 , Lourdes Poyatos  1   2 , Olga Hladun  1   2 , Arantza Sanvisens  1 , Roberto Muga  1   2 , Magi Farré  1   2
Affiliations
Review

MDMA interactions with pharmaceuticals and drugs of abuse

Esther Papaseit et al. Expert Opin Drug Metab Toxicol. 2020 May.

Abstract

Introduction: MDMA (3,4-methylenedioxymethamphetamine), a synthetic ring-substituted amphetamine, has become one of the most widely used recreational psychostimulant drugs in the world. Among recreational ecstasy/MDMA users, polydrug use is a phenomenon whose common purpose is to experience the synergistic effect of the combined drugs, moderate MDMA effects, prevent potential toxicity, enhance a high or come down from a high from other drugs, or simply to treat existing medical conditions. Thus, MDMA-drug interactions (MDMA-DIs) lead to a higher risk of acute and life-threatening MDMA toxicity.Areas covered: This article provides an overview of the MDMA-DIs with pharmaceuticals and drugs of abuse. In addition, available evidence is summarized along with clinical recommendations. Finally, the increasing importance of MDMA-DIs is highlighted.Expert opinion: There is a reduced number of published MDMA-DIs studies and scarce clinically significant MDMA-DIs documented in the literature. Experimental evidence points out the relevance of MDMA-DI's when MDMA is co-administered with pharmaceuticals that are metabolized by the CYP2D6 due to MDMA inhibitory action and in the case of repeated MDMA administration (MDMA-MDMAIs).

Keywords: 3,4-methylenedioxymethamphetamine (MDMA); acute MDMA toxicity; drug interaction (DI); pharmacodynamics; pharmacokinetics; polydrug use.

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