"Herbal Ecstasy": a case series of adverse reactions

To report five cases of adverse effects associated with the ingestion of "Herbal Ecstasy" tablets and discuss possible mechanisms of toxicity.

Composition of the "Herbal Ecstasy" tablets was determined by discussions with distributors and with MEDSAFE: Reference to relevant texts and an internet and Medline literature search was used to identify articles of interest

Three patients complained of minor symptoms such as perceptual disturbances, anorexia, inability to sleep, dizziness, palpitations and paresthesia. A fourth patient presented with palpitations and ventricular bigeminy, and a fifth patient presented with headache, vomiting, and a hypertensive crisis. Different brands of "Herbal Ecstasy" have different compositions, some containing caffeine and kava, and one contained ephedrine.

These five patients presented with adverse reactions to "Herbal Ecstasy" ranging from minor to major. Knowledge of the possible mechanisms of toxicity will help plan therapy in cases of major toxicity.