Ecstasy (3,4-methylenedioxymethamphetamine): cardiovascular effects and mechanisms.
D. Fonseca, D. M. Ribeiro, Margarida Tapadas, M. D. Cotrim
European Journal of Pharmacology May 7, 2021 DOI: 10.1016/j.ejphar.2021.174156 via Semantic Scholar
Summary
MDMA, also known as ecstasy, increases blood pressure and heart rate and can impair cardiac contractile function, cause arrhythmias, myocardial necrosis, and valvular heart disease, as well as vasoconstriction, disrupt vascular integrity, and alter haemostasis. These effects involve interactions with monoamine transporters and receptors, oxidative stress, and activation of matrix metalloproteinases. The review describes both the cardiovascular risks of recreational MDMA use and the unresolved risk/benefit ratio for its therapeutic use in psychiatry, especially in patients with underlying cardiovascular disease.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Keywords | Medicine Psychology |
| Citations | 23 |
| Key finding | MDMA intake produces multiple cardiovascular effects including increased blood pressure, heart rate, impaired cardiac contractile function, arrhythmias, myocardial necrosis, valvular heart disease, vasoconstriction, and altered haemostasis, mediated by mechanisms such as monoamine transporter interactions, oxidative stress, and MMP activation. |
Abstract
3,4-methylenedioxymethamphetamine or MDMA (known as "ecstasy") is a recreational drug of abuse, popular worldwide for its distinctive psychotropic effects. Currently, the therapeutic potential of MDMA in psychotherapy has attracted a lot of interest from the scientific community, despite the multitude of effects that this drug of abuse elicits on the human body. While neuronal effects have been the most studied, cardiovascular effects have also been described, as increased blood pressure and heart rate are the most recognizable. However, other effects have also been described at the cardiac (impaired cardiac contractile function, arrhythmias, myocardial necrosis and valvular heart disease) and vascular (vasoconstriction, disruption of vascular integrity and altered haemostasis) levels. Several mechanisms have been proposed, from the interaction with monoamine transporters and receptors to the promotion of oxidative stress or the activation of matrix metalloproteinases (MMPs). This review provides an overview of the cardiovascular implications of MDMA intake and underlying mechanisms, relevant when considering its consumption as drug of abuse but also when considering its therapeutic potential in psychiatry. Moreover, the risk/benefit ratio of the therapeutic use of MDMA remains to be fully elucidated from a cardiovascular standpoint, particularly in patients with underlying cardiovascular disease.