Ecstasy, a recreational drug often thought to be safe, can cause serious acute adverse effects including hyperthermia, seizures, cardiac arrhythmias, liver toxicity, low sodium levels, and various psychiatric disorders. These effects are not due to overdose alone or the typical environment where the drug is used. In animal studies, Ecstasy damages serotonin-producing neurons at doses similar to those taken by humans, though its long-term effects on the human brain remain unknown. Because of the drug's popularity, both immediate and potential lasting harms warrant concern, and Ecstasy toxicity should be considered when diagnosing certain medical and psychiatric conditions.
MDMA (ecstasy) is metabolized by the cytochrome P450 enzyme debrisoquine hydroxylase, coded by the CYP2D6 gene. Between 3 and 10% of the Caucasian population carry mutations that make them poor metabolizers, potentially increasing their risk of adverse reactions. This study examined seven individuals who had severe toxicity or died from MDMA. None were homozygous for the CYP2D6 mutation. The authors suggest three explanations: non-dose-related toxicity may stem from contaminants or environmental factors; the genotyping may have missed rare mutations; or the sample was too small to detect a statistically significant effect.