MDMA

• Mechanism of action
  • ↑ Release and ↓ reuptake of serotonin, dopamine, and norepinephrine
    • Serotonin stimulation is more prominent
  • MDMA increases secretion of antidiuretic hormone (ADH) → thirst → increased water intake without electrolyte repletion → hyponatremia
• Clinical features
  • Neuropsychiatric: Euphoria, increased sociability/empathy, disinhibition, agitation, paranoia, hallucinations, bruxism (teeth grinding).
  • Sympathomimetic: Hyperthermia, tachycardia, HTN, diaphoresis, mydriasis (pupillary dilation).
  • Serotonergic: Tremor, hyperreflexia, spontaneous/inducible clonus, shivering.
  • Fluid/Metabolic Disturbance: Profuse thirst, polydipsia leading to fluid overload symptoms (headache, nausea, AMS, seizures).

Mnemonic

MDMA has street names like ecstasy, E, X, XTC. Remember X to bruxism.