Effects of MDMA on body temperature in humans
Temperature October 31, 2014 DOI: 10.4161/23328940.2014.955433
Summary
MDMA, commonly known as Ecstasy, can cause a concerning rise in body temperature, with increases ranging from 0.2 to 0.8°C in healthy individuals. At higher doses, temperatures often exceed 38.0°C, even without physical exertion. This hyperthermia is linked to the release of neurotransmitters serotonin and norepinephrine, affecting heat regulation. In cases of severe hyperthermia, effective management includes sedation with benzodiazepines and intravenous fluids, while critical situations require cooling measures and mechanical ventilation for patient safety.
Abstract
Hyperthermia is a severe complication associated with the recreational use of 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy). In this review, the clinical laboratory studies that tested the effects of MDMA on body temperature are summarized. The mechanisms that underlie the hyperthermic effects of MDMA in humans and treatment of severe hyperthermia are presented. The data show that MDMA produces an acute and dose-dependent rise in core body temperature in healthy subjects. The increase in body temperature is in the range of 0.2-0.8°C and does not result in hyperpyrexia (>40°C) in a controlled laboratory setting. However, moderately hyperthermic body temperatures >38.0°C occur frequently at higher doses, even in the absence of physical activity and at room temperature. MDMA primarily releases serotonin and norepinephrine. Mechanistic clinical studies indicate that the MDMA-induced elevations in body temperature in humans partially depend on the MDMA-induced release of norepinephrine and involve enhanced metabolic heat generation and cutaneous vasoconstriction, resulting in impaired heat dissipation. The mediating role of serotonin is unclear. The management of sympathomimetic toxicity and associated hyperthermia mainly includes sedation with benzodiazepines and intravenous fluid replacement. Severe hyperthermia should primarily be treated with additional cooling and mechanical ventilation.