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Cardiovascular Effects of 3,4-Methylenedioxymethamphetamine: A Double-Blind, Placebo-Controlled Trial

Steven J. Lester, MD; Matthew Baggott, BA; Susette Welm, MA; Nelson B. Schiller, MD; Reese T. Jones, MD; Elyse Foster, MD; and John Mendelson, MD
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Copyright ©2004 by the American College of Physicians


Ann Intern Med. 2000;133(12):969-973. doi:10.7326/0003-4819-133-12-200012190-00012
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Background: The psychoactive stimulant 3,4-methylenedioxymethamphetamine (MDMA), also known as “ecstasy,” is widely used in nonmedical settings. Little is known about its cardiovascular effects.

Objective: To evaluate the acute cardiovascular effects of MDMA by using transthoracic two-dimensional and Doppler echocardiography.

Design: Four-session, ascending-dose, double-blind, placebo-controlled trial.

Setting: Urban hospital.

Patients: Eight healthy adults who self-reported MDMA use.

Intervention: Echocardiographic effects of dobutamine (5, 20, and 40 µg/kg of body weight per minute) were measured in a preliminary session. Oral MDMA (0.5 and 1.5 mg/kg of body weight) or placebo was administered 1 hour before echocardiographic measurements in three weekly sessions.

Measurements: Heart rate and blood pressure were measured at regular intervals before and after MDMA administration. Echocardiographic measures of stroke volume, ejection fraction, cardiac output, and meridional wall stress were obtained 1 hour after MDMA administration and during dobutamine infusions.

Results: At a dose of 1.5 mg/kg, MDMA increased mean heart rate (by 28 beats/min), systolic blood pressure (by 25 mm Hg), diastolic blood pressure (by 7 mm Hg), and cardiac output (by 2 L/min). The effects of MDMA were similar to those of dobutamine, 20 and 40 µg/kg per minute. Inotropism, measured by using meridional wall stress corrected for ejection fraction, decreased after administration of dobutamine, 40 µg/kg per minute, but did not change after either dose of MDMA.

Conclusions: Modest oral doses of MDMA increase heart rate, blood pressure, and myocardial oxygen consumption in a magnitude similar to dobutamine, 20 to 40 µg/kg per minute. In contrast to dobutamine, MDMA has no measurable inotropic effects.

Figures

Grahic Jump Location
Figure.
Comparison of the effects of dobutamine or 3,4-methylenedioxymethamphetamine (MDMA) on peak heart rate (top), cardiac output (middle), and ratio of meridional wall stress to ejection fraction (bottom).

Error bars represent standard deviation.

Grahic Jump Location

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