Four deaths occurred after people took moclobemide and MDMA ('ecstasy') together. The likely cause of death in each case was serotonin syndrome, a dangerous condition caused by the interaction between the two drugs. None of the victims had a prescription for moclobemide; each apparently took it to boost the effects of MDMA, leading to fatal outcomes. The authors call for warnings against uninformed efforts to enhance the effects of illicit drugs.
MDMA (ecstasy) can cause dangerously low sodium levels by triggering inappropriate secretion of the antidiuretic hormone arginine vasopressin (AVP). In eight healthy men given a low 40 mg dose of MDMA, plasma AVP rose significantly at 1, 2, and 4 hours. A negative correlation between MDMA and AVP at 1 hour suggested a metabolite might drive the increase. Testing MDMA and five of its metabolites on isolated rat hypothalamus tissue showed all compounds increased AVP release, with the major metabolite HMMA being the most potent and DHMA the least. Most compounds also enhanced AVP release in response to potassium stimulation. These in vitro results confirm that MDMA metabolites, not just the parent drug, contribute to AVP secretion.