Controlled trials of ecstasy administration in humans
DOI:
https://doi.org/10.20882/adicciones.457Keywords:
MDMA, pharmacokinetics, pharmacological effects, controlled clinical trialAbstract
Objective: to compile and analyse knowledge about the pharmacodynamics and pharmacokinetics of MDMA from controlled clinical trials in humans. Methods: the typical design of the trials was masked (double blind), randomized, cross-over, and controlled with placebo and/or an active drug. Results: MDMA increases the heart rate, arterial blood pressure, oxygen consumption by the heart and produced an enlargement of the QTC interval in the ECG. No statistical differences were found with placebo in the increase of body temperature. MDMA induce euphoria, wellbeing and activation. Neither ilusions nor hallucinations were described. An increase of beta activity and a decrease of alpha activity in the EEG was seen. A dose-dependent increase in the plasma levels of ACTH, cortisol, prolactin, dehydroepiandrosterone and vasopresine was observed. Immunogically, MDMA posses an immunosupresor effect. Its pharmacokinetic properties seems to be non-lineal, with a tendency to accumulation at high doses. Conclusion: the results obtained in these controlled clinical trials increase our previous knowledge on MDMA and add new data related to its hormonal and immunological effects. Further studies are needed in order to better understand the effects and toxicity of MDMA.References
Baños JE, Farré M. Principios de Farmacología Clínica. Bases científicas de la utilización de medicamentos. Barcelona: Masson, 2002.
Camí J, Farré M. Extasis, la droga de la ruta del bakalao. Med Clín (Barc) 1996; 106:711-76.
Camí J, Farré M, Mas M, Roset PN, Poudevida S, Mas A, San L, de la Torre R,. Human pharmacology of 3,4-Methylenedioxymethamphetamine ("Ecstasy"): Psychomotor performance and subjective effects. J Clin Psychopharmacol 2000;
:455-466.
Chang L, Grob CS, Ernst T, Itti L, Mishkin FS, Jose-Melchor R, Poland RE. Effect of ecstasy [3,4-methylenedioxymethamphetamine (MDMA)]
on cerebral blood flow: a co-registered SPECT and MRI study. Psychiat Res Neuroimaging 2000: 98:15-28
De la Torre R, Farré M, Ortuño J, Mas M, Brenneisen R, Roset PN, Segura J, Camí J. Non-linear pharmacokinetics of MDMA (‘ecstasy’) in
humans. Br J Clin Pharmacol, 2000a;49:104-9.
De la Torre R, Farré M, Roset PN, Hernández-López C, Mas M, Ortuño J, Menoyo E, Pizarro N, Segura J, Cami J. Pharmacology of MDMA in humans. An N Y Acad Sci 2000b;914:225-37.
De la Torre R, Ortuño J, Mas M, Farre M, Segura J. Fatal MDMA intoxication. Lancet. 1999;13;353:593.
Fallon JK, Kicman AT, Henry JA, Milligan PJ, Cowan DA, Hut AJ. Stereospecific analysis and enantiomeric disposition of 3, 4-methylenedioxymethamphetamine (Ecstasy) in humans. Clin
Chem 1999;45:1058-69.
Farré M, de la Torre R. Pharmacokinetics of MDMA in humans: toxicological relevance. Adiktologie 2002;1 (suppl): 32-34.
Farré M, Mas M, Molina L, Camí J. Long QT syndromes induced by ecstasy and other recreational drugs. Electronic letters to Heart.
Heart 2000a; 83:627-633. (http://heart.bmjjournals.com/cgi/eletters/83/627, consultada 30-09-2000)
Farré M, Roset PN, de la Torre R, Poudevida S, Hernández-López C, Peiró AM, Menoyo E, Sánchez I, Camí J. Farmacología clínica de la 3,4-metilenodioximetanfetamina (MDMA, éxtasis). Conductas Adictivas 2001a; 1: 1-4 (www.conductas adictivas.org; consultado 18-03-2002).
Farré M, Roset PN, Hernández-López C, Poudevida S, Menoyo E, de la Torre R, Ortuño J, Peiró A, Camí J. Repeated administration of MDMA to healthy volunteers. Drug Alcohol Depend
b;63 (suppl):175.
Farré M, Roset PN, Tomillero A, Hernández-López C, Poudevida S, de la Torre R, Ortuño J, Camí J. MDMA repeated administration in humans: a dose-finding pilot study. Drug Alcohol Depend 2000b;60 (suppl 1):173.
Farré M, Roset P.N, de la Torre R, Segura M, Ortuño J, Peiró AM, Torrens M, Pacifici R, Zuccaro P, Camí J. Interaction of paroxetine
and MDMA in humans. Drug Alcohol Depend 2002; 66 (suppl 1):196.
Forsling M, Fallon JK, Kicman AT, Hutt AJ, Cowan DA, Henry JA.. Arginine vasopressin release in response to the administration of 3,4-methylenedioxymethamphetamine ("ecstasy"): is metabolism
a contributory factor?. J Pharm Pharmacol 2001;53:1357-63.
Forsling ML, Fallon JK, Shah D, Tilbrook GS, Cowan DA, Kicman AT, Hutt AJ. The effect of 3,4-methylenedioxymethamphetamine (MDMA,
'ecstasy') and its metabolites on neurohypophysial hormone release from the isolated rat hypothalamus. Br J Pharmacol
;135:649-56.
Frei E, Gamma A, Pascual-Marqui R, Lehmann D, Hell D, Vollenweider FX. Localization of MDMA-induced brain activity in healthy volunteers using low resolution brain electromagnetic tomography (LORETA). Hum Brain Mapp 2001; 14:152-65.
Gamma A, Buck A, Berthold T, Liechti ME, Vollenweider FX. 3,4-Methylenedioxymethamphetamine (MDMA) modulates cortical and limbic brain activity as measured by [H(2)(15)O]-PET in healthy humans. Neuropsychopharmacology 2000;23:388-95.
Gouzoulis-Mayfrank E, Schreckenberger M, Sabri O, Arning C, Thelen B, Spitzer M, Kovar KA, Hermle L, Bull U, Sass H. Neurometabolic
effects of psilocybin, 3,4- methylenedioxyethylamphetamine (MDE) and dmethamphetamine in healthy volunteers. A double-blind, placebocontrolled PET study with [18F]FDG. Neuropsychopharmacology 1999a;20:565-81.
Gouzoulis-Mayfrank E, Thelen B, Habermeyer E, Kunert HJ, Kovar KA, Lindenblatt H, Hermle L, Spitzer M, Sass H. Psychopathological, neuroendocrine and autonomic effects of 3,4- methylenedioxyethylamphetamine (MDE), psilocybin and d-methamphetamine in healthy volunteers. Results of an experimental doubleblind placebo- controlled study. Psychopharmacology (Berl) 1999b;142:41-50.
Grob CS, Poland RE, Chang L, Ernst T. Psychobiologic effects of 3,4-methylenedioxymethamphetamine in humans: methodological considerations and preliminary observations. Behav Brain Res 1996;73:103-7.
Harris DS, Baggott M, Mendelson JH, Mendelson JE, Jones RT. Subjective and hormonal effects of 3,4-methylenedioxymethamphetamine (MDMA) in humans. Psychopharmacology (Berl) 2002;162:396-405.
Henry JA, Fallon JK, Kicman AT, Hutt AJ, Cowan DA, Forsling M. Low-dose MDMA ("ecstasy") induces vasopressin secretion. Lancet
;351:1784.
Hernández-López C, Farré M, Roset PN, Menoyo E, Pizarro N, Ortuño J, Torrens M, Camí J, de La Torre R. 3,4-Methylenedioxymethamphetamine (ecstasy) and alcohol interactions in humans: psychomotor performance, subjective
effects, and pharmacokinetics. J Pharmacol Exp Ther 2002;300:236-44.
Holland J. The history of MDMA. En: Holland J, editor. Ecstasy: the complete guide. Rochester: Park Street Press; 2001. p. 11-20.
Kleinman AM, Holland J. Clinical research with MDMA: a worldwide review. En: Holland J, editor. Ecstasy: the complete guide. Rochester: Park Street Press; 2001. p. 297-316.
Kraemer T, Maurer HH (2002) Toxicokinetics of amphetamines: metabolism and toxicokinetic data of designer drugs, amphetamine,
methamphetamine, and their N-alkyl derivatives. Ther Drug Monit 24: 277-89.
Lester SJ, Baggott M, Welm S, Schiller NB, Jones RT, Foster E, Mendelson J. Cardiovascular Effects of 3,4-Methylenedioxymethamphetamine. A Double-Blind, Placebo-Controlled Trial. Ann Intern Med 2000;133:969-73
Liechti ME, Baumann C, Gamma A, Vollenweider FX. Acute psychological effects of 3,4-methylenedioxymethamphetamine
(MDMA, "Ecstasy") are attenuated by the serotonin uptake inhibitor
citalopram. Neuropsychopharmacology 2000a; 22:513-21.
Liechti ME, Gamma A, Vollenweider FX. Gender differences in the subjective effects of MDMA. Psychopharmacology (Berl) 2001a;154:161-8.
Liechti ME, Geyer MA, Hell D, Vollenweider FX. Effects of MDMA (ecstasy) on prepulse inhibition and habituation of startle in humans after pretreatment with citalopram, haloperidol, or
ketanserin. Neuropsychopharmacology 2001b; 24(3):240-52.
Liechti ME, Saur MR, Gamma A, Hell D, Vollenweider FX. Psychological and physiological effects of MDMA ("Ecstasy") after pretreatment with the 5-HT(2) antagonist ketanserin in healthy
humans. Neuropsychopharmacology 2000b; 23:396-404.
Liechti ME, Vollenweider FX. Acute psychological and physiological effects of MDMA ("Ecstasy") after haloperidol pretreatment in healthy humans. Eur Neuropsychopharmacol 2000a;10:289-95.
Liechti ME, Vollenweider FX. The serotonin uptake inhibitor citalopram reduces acute cardiovascular and vegetative effects of 3,4-methylenedioxymethamphetamine ('Ecstasy') in healthy
volunteers. J Psychopharmacol 2000b;14:269-74.
Liechti ME, Vollenweider FX. Wich receptor mediate subjective effects of MDMA in humans?. A summary of mechanistic studies. Hum Psychopharmacol Clin Exp 2001;16:589-98.
Mas M, Farré M, de la Torre R, Roset PN, Ortuño J, Segura J, Camí J.
Cardiovascular and neuroendocrine effects and pharmacokinetics of 3, 4-methylenedioxymethamphetamine in humans. J Pharmacol Exp
Ther 1999;290: 136-45.
Navarro M, Pichini S, Farre M, Ortuño J, Roset PN, Segura J, de la Torre R. Usefulness of saliva for measurement of 3,4- methylenedioxymethamphetamine and its metabolites: correlation with plasma drug concentrations and effect of salivary
pH. Clin Chem 2001;47:1788-95.
Pacifici R, Zuccaro P, Farré M, Pichini S, Di Carlo S, Roset PN, Hernández López C, Ortuno J, Segura J, Cami J, de la Torre R. Immunomodulating activity of MDMA Ann N Y Acad Sci 2000;914:215-24.
Pacifici R, Zuccaro P, Farré M, Pichini S, Di Carlo S, Roset PN, Ortuño J, Pujadas M, Bacosi A, Menoyo E, Segura J, de la Torre R. Effects of
repeated doses of MDMA ("ecstasy") on cellmediated immune response in humans. Life Sci 2001a;69:2931-41.
Pacifici R, Zuccaro P, Farré M, Pichini S, Di Carlo S, Roset PN, Ortuño J, Segura J, de la Torre R. Immunomodulating properties of MDMA alone and in combination with alcohol: a pilot study. Life Sci 1999;65:309-16.
Pacifici R, Zuccaro P, Farré M, Pichini S, Di Carlo S, Roset PN, Palmi I, Ortuño J, Menoyo E, Segura J, de la Torre R. Cell-mediated immune response in MDMA users after repeated dose administration: studies in controlled versus noncontrolled settings. Ann N Y Acad
Sci 2002;965:421-33.
Pacifici R, Zuccaro P, Hernández-López, Pichini S, di Carlo S, Farré M, Roset PN, Ortuño J, Segura J, de la Torre R. Acute effects of MDMA alone and in combination with ethanol on the immune system in humans. J Pharmacol Exp Ther 2001b;296:207-15.
Pichini S, Navarro M, Farré M, Ortuño J, Roset PN, Pacifici R, Zuccaro P, Segura J, de la Torre R. On-site testing of 3,4-methylenedioxymethamphetamine (ecstasy) in saliva with Drugwipe and Drugread: a controlled study in recreational users. Clin Chem 2002;48:174-6.
Pizarro N, de la Torre R, Farré M, Segura J, Llebaría A, Joglar J Synthesis and Capillary Electrophoresis Analysis of enantiomerically enriched reference standards of MDMA and its main metabolites Bioorganics and Medicinal Chemistry 2002a;10:1085-1092.
Pizarro N, Llebaría A, Cano S, Joglar J, Farré M, Segura J, de la Torre R. Stereochemical analysis of 3,4-methylenedioxymethamphetamine and its main metabolites by gas chromatography/ mass spectrometry. Rapid Commun Mass Spectrom. 2003;17:330-6.
Pizarro N, Ortuño J, Farré M, Hernández-López C, Pujadas M, Llebaría A, Joglar J, Roset PN, Mas M, Segura J, Cami J, de la Torre R. Determination of MDMA and its metabolites in blood and urine by gas chromatography-mass spectrometry and analysis of enantiomers by capillary electrophoresis. J Anal Toxicol 2002b;26:157-65.
Samyn N, De Boeck G, Wood M, Lamers CTJ, De Waard D, Brookhuis KA, Verstraete AG, Riedel WJ. Plasma, oral fluid and sweat ecstasy concentrations in controlled and real life conditions. Forensic Sci Int 2002;128:90-97.
Segura M, Ortuño J, Farré M, McLure JA, Pujadas M, Pizarro N, Llebaría A, Joglar J, Roset PN, Segura J, de La Torre R (2001) 3,4-Dihydroxymethamphetamine (HHMA). A Major in Vivo
,4- methylenedioxymethamphetamine (MDMA) Metabolite in Humans. Chem Res Toxicol 2001;14:1203-8.
Segura M, , Ortuño J, McLure JA, Pujades MA, Pizarro N, Farré M, Llebaria A, Joglar J, Segura J, de la Torre R. High-performance liquid chromatography with electrochemical detection applied to the analysis of 3,4-dihydroxymethamphetamine in human plasma and urine. J Chromatography B 2002;769:313-21.
Tancer ME, Johanson CE (2001) The subjective effects of MDMA and mCPP in moderate MDMA users. Drug Alcohol Depend 65: 97-101
Vollenweider FX, Gamma A, Liechti M, Huber T. Psychological and cardiovascular effects and short-term sequelae of MDMA ("ecstasy") in MDMA naive healthy volunteers. Neuropsychopharmacology
;19:241-51.
Vollenweider FX, Gucker P, Schönbächler R, Kamber E, Vollenweider-Scherpenhuyzen MFI, Schubiger G, Hell D. Effects of MDMA on 5-
HT uptake sites using PET and [11C]-McN5652 in humans. 2000. Data presented at 2000 conference of the German Society for Psychiatry, Psychotherapy and Neuromedicine [Deutsche Gesellschaft für psychiatrie, Psychotherapie und Nervenheilkunde].
Vollenweider FX, Ludewig S. Neurocognitive effects of MDMA: a summary of controlled human studies. Adiktologie 2002; 1 (suppl):47-52. 134
