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Death Following Ingestion of MDMA (ecstasy) and Moclobemide

NCJ Number
Addiction Volume: 98 Issue: 3 Dated: March 2003 Pages: 365-368
Erkki Vuori; John A. Henry; Ilkka Ojanpera; Raija Nieminen; Taru Savolainen; Pia Wahlsten; Matti Jantti
Date Published
March 2003
4 pages
This article discusses four deaths following the ingestion of moclobemide and MDMA (ecstasy).
MDMA is a synthetic amphetamine derivative that is used widely as mood-modifying agent by young adults. Because it has minimal potential for addiction, MDMA is considered to be harmless but the effects may represent serotonergic neurotoxicity and lead to cognitive impairment. Moclobemide is a selective inhibitor of monoamine oxidase A (MAO A). Four cases of deaths due to a fatal interaction between MDMA and moclobemide that occurred during 2000 and 2001 in Finland were investigated. A detailed history was obtained, and a post-mortem examination was conducted on each case. Moclobemide had not been prescribed for any of the victims but was present at maximum therapeutic concentration in cases 1 and 2 and in moderate overdose in cases 3 and 4. It was not known why the victims combined these substances. The victims were likely to have been aware that this type of antidepressant drug could enhance the effect of ecstasy. The only known connection between the four cases was that all the cases were from the same part of the country and cases 1 and 2 occurred within a short time interval. Case 2 appeared to have been a polydrug user who had previously taken MDMA. Although the history and clinical observations were limited in most of these cases, the mode of death in each was consistent with a serotonin syndrome. MAO inhibitors are a potent group of drugs that affect serotonin turnover by inhibiting its breakdown by monoamine oxidase. A lay person could be confused by detailed pharmacological information and could seek to prolong the effect of ecstasy with the wrong drug. A number of sources available to the public now provide warnings about MDMA and its potential toxicity. Unfortunately, many of these minimize the risk of death from interactions or overdose. The risk of death is high if other drugs affecting serotonin release, especially a MAO inhibitor, and MDMA are simultaneously ingested. 25 references