Combining MDMA (ecstasy) with moclobemide, a reversible MAO-A inhibitor, can cause fatal serotonin toxicity. Four deaths in Australia are reported where this drug interaction led to symptoms including hyperthermia, hyperkalemia, profuse sweating, twitching, and shaking. Two cases had moclobemide concentrations consistent with prescribed doses, while two had higher, toxic levels. Three of the four individuals had some form of heart disease. Despite known risks, few fatalities from this combination have been documented.
MDMA (ecstasy) is increasingly used and often combined with pharmaceutical drugs, especially serotonergic medications, raising concerns about toxicity and dangerous interactions. A review of all closed coronial cases in Victoria, Australia, from 2002 to 2008 identified 106 fatalities where MDMA was detected. Of these, 43 cases (41%) involved the concurrent use of MDMA with other drugs, including pharmaceuticals that could cause adverse reactions. Four cases were high-risk, involving the combination of MDMA and moclobemide, with additional moderate- and minor-risk cases. These findings underscore the need to recognize and publicize potentially lethal drug interactions, particularly serotonin toxicity.