Surviving life-threatening MDMA (3,4-methylenedioxymethamphetamine, ecstasy) toxicity caused by ritonavir (RTV)

@article{Papaseit2012SurvivingLM,
  title={Surviving life-threatening MDMA (3,4-methylenedioxymethamphetamine, ecstasy) toxicity caused by ritonavir (RTV)},
  author={Esther Papaseit and Ant{\`o}nia V{\'a}zquez and Clara P{\'e}rez-Ma{\~n}{\'a} and Mitona Pujadas and Rafael de la Torre and Mag{\'i} Farr{\'e} and Joan Miquel Nolla},
  journal={Intensive Care Medicine},
  year={2012},
  volume={38},
  pages={1239-1240}
}
Dear Editor, Ritonavir (RTV) and MDMA (3,4methylenedioxymethamphetamine, ecstasy) are both substrates and/or potent inhibitors of the cytochrome P450 isoenzyme CYP2D6. Because of the potentially high toxicity of MDMA, the concomitant use of MDMA with any dose of RTV is contraindicated [1]. We report the first case of a subject treated chronically with RTV surviving a lifethreatening MDMA intoxication. A 23-year-old Caucasian HIVpositive man treated with RTV 100 mg/day, atazanavir 300 mg/day… 

MDMA interactions with pharmaceuticals and drugs of abuse

TLDR
This article provides an overview of the MDMA-DIs with pharmaceuticals and drugs of abuse and 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.

How MDMA's pharmacology and pharmacokinetics drive desired effects and harms.

TLDR
The desirable and adverse effects of MDMA are extensions of its fascinating pharmacologic and pharmacokinetic profile and knowledge of the constellation of these factors is needed for education, prevention of harm, and treatment.

MDMA, methamphetamine, and CYP2D6 pharmacogenetics: what is clinically relevant?

In vitro human studies show that the metabolism of most amphetamine-like psychostimulants is regulated by the polymorphic cytochrome P450 isozyme CYP2D6. Two compounds, methamphetamine and

Key interindividual determinants in MDMA pharmacodynamics

TLDR
The aim of this review is to present the main interindividual determinants in MDMA pharmacodynamics, with special emphasis on sex-gender, race-ethnicity, genetic differences, interactions, and MDMA acute toxicity, as well as possible therapeutic use.

Amphetamine-related intoxications in people living with HIV: An observational study in an emergency department in Barcelona (Spain) from 2018 to 2020.

TLDR
Amphetamine-related intoxication causes high morbidity in people living with HIV and healthcare providers serving these patients should consider incorporating harm-reduction measures in the prevention of amphetamine- related intoxication.

Increasing emergency department admissions for chemsex-related intoxications in Barcelona, Spain, among people living with HIV: an observational study from 2018 to 2020

TLDR
Chemsex-related intoxications are an increasing clinical problem in people living with HIV and should be routinely screened and addressed in clinical practice, particularly for people with mental illness and low CD4 cell counts, who are at higher risk for severe intoxications.

Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review.

TLDR
This systematic review offers a compilation of existing research on psychiatric drug-drug interactions with MDMA or psilocybin and focuses on pharmacodynamic, physiological, and subjective outcomes of drug- drug interactions.

Novel Phenethylamines and their Potential Interactions with Prescription Drugs: A Systematic Critical Review.

TLDR
A drug-drug (phenethylamine-prescription drug) interaction potential is anticipated, mainly involving monoamine oxidases for 2C-B and 4- FA, with monoamine transporters being more specific to 4-FA.

nteracciones graves o potencialmente letales entre antirretrovirales otros medicamentos

TLDR
The interactions between antiretrovirals and other drugs that can cause significant damage to patients, or even be life-threatening and of whom clinicians, especially those not directly treating HIV-infected patients, should be aware are reviewed.

References

SHOWING 1-6 OF 6 REFERENCES

Sex Differences in 3,4-Methylenedioxymethamphetamine (MDMA; Ecstasy)-Induced Cytochrome P450 2D6 Inhibition in Humans

TLDR
This study assessed the inhibition and recovery half-life of CYP2D6 and CYP3A4 activity in female subjects by administering the probe drug dextromethorphan before and repeatedly after MDMA administration, and found an apparent decrease in a decrease in dextrochemical clearance.

The Consequences of 3,4-Methylenedioxymethamphetamine Induced CYP2D6 Inhibition in Humans

TLDR
A controlled clinical trial was conducted in 15 healthy male subjects whereby a probe drug, dextromethorphan (DEX), was administered after an oral dose of 1.5 mg/kg MDMA to evaluate changes in CYP2D6 activity.

Non-linear pharmacokinetics of MDMA ('ecstasy') in humans.

TLDR
The lack of linearity of MDMA pharmacokinetics (in a window of doses compatible with its recreational use) is a more general phenomenon as it concerns the whole population independent of their CYP2D6 genotype.

Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma-hydroxybutyrate.

TLDR
A patient infected with HIV-1 who was treated with ritonavir and saquinavir is described and experienced a prolonged effect from a small dose of methylenedioxymetamphetamine (MDMA or ecstacy) and a nearly fatal reaction from a large dose of gamma-hydroxybutyrate (GHB).

MDMA, methamphetamine, and CYP2D6 pharmacogenetics: what is clinically relevant?

In vitro human studies show that the metabolism of most amphetamine-like psychostimulants is regulated by the polymorphic cytochrome P450 isozyme CYP2D6. Two compounds, methamphetamine and

Fatal interaction between ritonavir and MDMA