„Ecstasy” (MDMA): Pharmakologie, Toxikologie und Behandlung der akuten Intoxikation

M. E. Liechti

doi:10.1055/s-2003-814969

NOTARZT, Table of Contents

NOTARZT 2004; 20(3): 94-99
DOI: 10.1055/s-2003-814969

Originalia

„Ecstasy” (MDMA): Pharmakologie, Toxikologie und Behandlung der akuten Intoxikation

„Ecstasy” (MDMA): Pharmacology, Toxicology, and Manangement of IntoxicationM. E. Liechti¹

¹Medizinische Klinik A (Chefarzt: Prof. Dr. F. Follath), Department für Innere Medizin, Universitätsspital Zürich

Nachdruck aus: Dtsch Med Wochenschr 2003; 128: 1361 - 1366 © Georg Thieme Verlag Stuttgart · New York · ISSN 0012-0472

Abstract

Zusammenfassung

„Ecstasy” (3,4-Methylendioxymethamphetamin, MDMA) ist eine in der Technoszene verbreitete Droge. Die vorliegende Übersicht konzentriert sich nach einer Zusammenfassung der Pharmakologie und Toxikologie von MDMA auf das Management einer Intoxikation mit MDMA oder andere Substanzen, die unter dem Namen Ecstasy verkauft werden.

Abstract

„Ecstasy” (3,4-methylene dioxymethamphetamine = MDMA) is a drug widely used among „techno” fans. The following survey after summarising the pharmacology and toxicology of MDMA, focusses on the management of an intoxication with MDMA or with other substances marketed under the „Exstasy” label.

Schlüsselwörter

„Ecstasy” - MDMA - andere „Ecstasy”-Substanzen - Intoxikation - Management

Key words

„Ecstasy” - MDMA - other „Ecstasy” drugs - toxicology - intoxication - management

Full Text

References

Literatur

1 Baggott M, Stuart R, Jerome L. Medical emergencies and adverse events in ecstasy users. In: Baggott M, Jerome L, Stuart R (eds) 3,4-Methylenedioxymethamphetamine (MDMA): A review of the English-language scientific and medical literature. Multidisciplinary Association for Psychodelic Studies http://www.maps.org
2 Balmelli C, Kupferschmidt H, Rentsch K, Schneemann M. Tödliches Hirnödem nach Einnahme von Ecstasy und Benzylpiperazin. Dtsch Med Wochenschr. 2001; 126 809-811
3 Benz R, Iten P X, Schmid M, Vogt M. Ein fremdes weißes Pulver. Schweiz Med Forum. 2002; 2 475-476
4 Boot B P, McGregor I S, Hall W. MDMA (Ecstasy) neurotoxicity: assessing and communicating the risks. Lancet. 2000; 355 1818-1821
5 Cole J C, Bailey M, Sumnall H R, Wagstaff G F, King L A. The content of ecstasy tablets: implications for the study of their long-term effects. Addiction. 2002; 97 1531-1536
6 Torre R de la, Farré M, Roset P N. et al . Pharmacology of MDMA in humans. Ann N Y Acad Sci. 2000; 914 225-237
7 Dughiero G, Schifano F, Forza G. Personality dimensions and psychopathological profiles of Ecstasy users. Human Psychopharmacol Clin Exp. 2001; 16 635-639
8 Gamma A, Liechti M E. The psychophysiology of substance-related disorders. In: D'haenen H, Boer JA Den, Willner P (eds) Biological Psychiatry. London; Wiley 2002: 467-493
9 Giroud C, Augsburger M, Sadeghipour F, Varesio E, Veuthey J-L, Rivier L. Ecstasy - la situation en Suisse romande. Composition des saisies, analyse des échantillons biologiques et brève revue de son action pharmacologique et de sa toxicité. Schweiz Rundsch Med Prax. 1997; 86 510-523
10 Gledhill J A, Moore D F, Bell D, Henry J A. Subarachnoidal haemorrhage associated with MDMA abuse. J Neurol Neurosurg Psychiat. 1993; 56 1036-1037
11 Gouzoulis-Mayfrank E, Daumann J, Sass H. Neurotoxische Langzeitschäden bei Ecstasy(MDMA)-Konsumenten: Überblick über den aktuellen Wissensstand. Nervenarzt. 2002; 73 405-421
12 Gouzoulis-Mayfrank E, Hermle L, Kovar K-A, Sass H. Die entaktogene „Ecstasy” (MDMA), „Eve” (MDE) und andere ringsubstituierte Methamphetaminderivate. Nervenarzt. 1996; 67 369-380
13 Gouzoulis-Mayfrank E, Thelen B, Habermeyer E. et al . Psychopathological, neuroendocrine and autonomic effects of 3,4-methylenedioxyethylamphetamine (MDE), psilocybin and d-methamphetamine in healthy volunteers. Psychopharmacology. 1999; 142 41-50
14 Harris D S, Baggott M, Mendelson J H, Mendelson J E, Jones R T. Subjective and hormonal effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans. Psychopharmacology. 2002; 162 396-405
15 Hartung T K, Schofield E, Short A I, Parr M JA, Henry J A. Hyponatriaemic states following 3,4-methylenedioxymethamphetamine (MDMA, „ecstasy”) ingestion. Q J Med. 2002; 95 431-437
16 Henry J A. Ecstasy and the dance of death. Br Med J. 1992; 305 5-6
17 Henry J A, Fallon J K, Kicman A T, Hutt A J, Cowan D A, Forsling M. Low-dose MDMA („Ecstacy”) induces vasopressin secretion. Lancet. 1998; 351 1784
18 Henry J A, Hill I R. Fatal interaction between ritonavir and MDMA. Lancet. 1998; 352 1751-1752
19 Henry J A, Jeffreys K J, Dawling S. Toxicity and deaths from 3,4-methylenedioxymethamphetamine („ecstasy”). Lancet. 1992; 340 384-387
20 Henry J A, Rella J G. Medical risks associated with MDMA use. In: Holland J (ed) Ecstasy: the complete guide - A comprehensive look at the risks and benefits of MDMA. Rochester, Vermont; Park Street Press 2001: 71-86
21 Hernández Lopez C, Farré M, Roset P N. et al . 3,4-Methylenedioxymethamphetamine (Ecstasy) and alcohol interactions in humans: psychomotor performance, subjective effects, and pharmacokinetics. J Pharmacol Exp Ther. 2002; 300 236-244
22 Johnston L D, O'Malley P M, Bachman J G. Monitoring the Future national survey results on drug use, 1975 - 2001. Volume I: Secondary school students. Bethesda, MD; National Institute on Drug Abuse 2002 NIH Publication No. 02-5106
23 Kupferschmidt H, Wyss P A, Fattinger K, Meier-Abt P J. Medizinische Probleme beim Konsum illegaler Drogen. In: Grundlagen der Arzneimitteltherapie. Basel; Documed 2001
24 Lange-Brock N, Berg T, Müller A R. et al . Akutes Leberversagen nach Konsum von Ecstasy (MDMA). Z Gastroenterol. 2002; 40 581-586
25 Lester S J, Baggott M, Welm S. et al . Cardiovascular effects of 3,4-methylenedioxymethamphetamine. A double-blind placebo-controlled trial. Ann Int Med. 2000; 133 969-973
26 Liechti M E, Achermann E. Das Pneumomediastinum. Dtsch Med Wochenschr. 2002; 127 2273-2276
27 Liechti M E, Baumann C, Gamma A, Vollenweider F X. Acute psychological effects of 3,4-methylenedioxymethamphetamine (MDMA, „Ecstasy”) are attenuated by the serotonin uptake inhibitor citalopram. Neuropsychopharmacology. 2000; 22 513-521
28 Liechti M E, Gamma A, Vollenweider F X. Gender differences in the subjective effects of MDMA. Psychopharmacology. 2001; 154 161-168
29 Liechti M E, Mathys J. Komatöses Zustandsbild bei einem 21-jährigen Partygänger. Internist. 2003; 44 215-218
30 Liechti M E, Saur M, Gamma A, Hell D, Vollenweider F X. Psychological and physiological effects of MDMA („Ecstasy”) after pretreatment with the 5-HT2 antagonist ketanserin in healthy humans. Neuropsychopharmacology. 2000; 23 396-404
31 Liechti M E, Vollenweider F X. Acute psychological and physiological effects of MDMA („Ecstasy”) after haloperidol pretreatment in healthy humans. Eur Neuropsychopharmacol. 2000; 10 289-295
32 Liechti M E, Vollenweider F X. The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine („Ecstasy”) in healthy volunteers. J Psychopharmacol. 2000; 14 269-274
33 Liechti M E, Vollenweider F X. Which neuroreceptors mediate the subjective effects of MDMA in humans? A summary of mechanistic studies. Hum Psychopharmacol Clin Exp. 2001; 16 589-598
34 Ling L H, Marchant C, Buckley N A, Prior M, Irvine R J. Poisoning with the recreational drug paramethoxyamphetamine. Med J Aust. 2001; 174 453-455
35 McCann U D, Szabo Z, Scheffel U, Dannals R F, Ficaurte G A. Positron emission tomographic evidence of toxic effect of MDMA („Ecstasy”) on brain serotonin neurons in human beings. Lancet. 1998; 352 1433-1437
36 Meyer L V. Suchtmittelnachweis. Internist. 1999; 40 601-604
37 Milroy C M, Clark J C, Forrest A RW. Pathology of deaths associated with ecstasy and eve misuse. J Clin Pathol. 1996; 49 149-153
38 Morgan M J. Ecstasy (MDMA): a review of its possible persistent psychological effects. Psychopharmacology. 2000; 152 230-248
39 Nichols D E. Differences between the mechanism of action of MDMA, MBDB, and the classical hallucinogens. Identification of a new therapeutic class: Entactogens. J Psychoactive Drugs. 1986; 18 305-313
40 Reneman L, Booij J, Reitsma J B. et al . Effects of dose, sex, and long-term abstention from use of toxic effects of MDMA (ecstasy) on brain serotonin neurons. Lancet. 2001; 358 1864-1869
41 Ricaurte G A, Yuan J, Hatzidimitriou G, Cord B J, McCann U D. Severe dopaminergic neurotoxicity in primates after a common recreational dose regimen of MDMA („Ecstasy”). Science. 2002; 297 2260-2263
42 SFA/ISPA .Ecstasy in der Schweiz, die erste repräsentative Studie zur Modedroge. Lausanne; SFA (Schweizerische Fachstelle für Alkohol- und andere Drogenprobleme) 1996
43 Soar K, Turner J JD, Parrott A C. Psychiatric disorders in Ecstasy (MDMA) users: a literature review focusing on personal predisposition and drug history. Hum Psychopharmacol Clin Exp. 2001; 16 641-645
44 Vastag B. Ecstasy experts want realistic messages. J Am Med Assoc. 2001; 286 777
45 Verheyden S L, Hadfield J, Calin T, Curran H V. Subacute effects of MDMA (plusmn 3,4-methylenedioxymethamphetamine, „ecstasy”) on mood: evidence of gender differences. Psychopharmacology. 2002; 161 23-31
46 Sydow K von, Lieb R, Pfister H, Höfler M, Wittchen H-U. Use, abuse and dependence of ecstasy and related drugs in adolescents and young adults - a transient phenomenon? Results of a longitudinal community study. Drug Alcohol Depend. 2002; 66 147-159
47 Williams H, Dratcu L, Taylor R, Roberts M, Oyefeso A. „Saturday night fever”: ecstasy related problems in a London accident and emergency department. J Accid Emerg Med. 1998; 15 322-367

Dr. med. Matthias E. Liechti

Medizinische Klinik A · Department für Innere Medizin · Universitätsspital Zürich

Rämistraße 100

8091 Zürich · Schweiz

Phone: 0041/1/255-1111

Fax: 0041/1/255-4445

Email: matthias.liechti@usz.ch