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Combining ecstasy and ethanol: higher risk for toxicity? A review
Eefje Vercoulen1, Laura Hondebrink2
1Department of Drug Monitoring and Policy, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
Critical Reviews in Toxicology
|February 19, 2021
Summary
Combining ecstasy (3,4-methylenedioxymethamphetamine (MDMA)) with ethanol increases toxicity risk. While MDMA pharmacokinetics are unaffected, ethanol significantly alters MDMA
Area of Science:
- Pharmacology
- Toxicology
- Neuroscience
Background:
- Ecstasy (3,4-methylenedioxymethamphetamine, MDMA) use often co-occurs with ethanol consumption.
- The combined toxicological risks of MDMA and ethanol are not well understood.
- General drug combination use is linked to increased toxicity.
Purpose of the Study:
- To review existing literature on the pharmacokinetic and pharmacodynamic interactions between MDMA and ethanol.
- To assess the impact of concurrent ethanol exposure on MDMA's effects in human, animal, and in vitro studies.
Main Methods:
- Literature review of human, animal, and in vitro studies examining MDMA and ethanol co-exposure.
- Analysis of changes in MDMA pharmacokinetics (blood concentration).
- Analysis of changes in MDMA pharmacodynamics (e.g., locomotor activity, body temperature, neurological effects).
Main Results:
- MDMA pharmacokinetics (blood concentration) were not significantly altered by concurrent ethanol exposure.
- MDMA pharmacodynamics were affected, with increased locomotor activity and decreased body temperature observed.
- Ethanol appeared to aggravate MDMA-induced effects on other pharmacodynamic aspects, though findings were sometimes inconclusive.
Conclusions:
- Concurrent ethanol exposure increases the risk of MDMA toxicity.
- Increased toxicity is primarily due to altered MDMA pharmacodynamics, not pharmacokinetics.
- The clinical relevance of ethanol's effect on MDMA-induced hyperthermia in humans requires further investigation.
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