Review article: mechanisms and management of hepatotoxicity in ecstasy (MDMA) and amphetamine intoxications

Recreational use of ecstasy (MDMA) and amphetamines, often considered safe, can cause serious liver damage, including hepatitis and acute liver failure, especially in young people. The patterns of injury and possible mechanisms are described. Diagnosing the cause requires high clinical suspicion. Treatment options, including the debated use of liver transplantation for severe cases, are reviewed.

Study at a glance

Abstract

The social use of ecstasy (methylenedioxymethampheta‐mine, MDMA) and amphetamines is widespread in the UK and Europe, and they are popularly considered as ‘safe’. However, deaths have occurred and hepatotox‐icity has featured in many cases of intoxication with amphetamine or its methylenedioxy analogues such as ecstasy. Recreational use of these drugs presents an important but often concealed cause of hepatitis or acute liver failure, particularly in young people. The patterns of liver damage and multiple putative mechanisms of injury are discussed. Recognition of the aetiological agent requires a high index of suspicion. Optimum management of the resultant liver damage, including the controversial role of liver transplantation for fulminant hepatic failure, is also discussed.