Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review.
Brian E Grunau, Matthew O Wiens, Jeffrey R Brubacher
CJEM September 2010 DOI: 10.1017/s1481803500012598 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Systematic review Randomized Peer reviewed |
|---|---|
| Sample size | 71 |
| Population | Human cases of MDMA-induced hyperpyrexia reported in case reports |
| Intervention | Dantrolene |
| Topics | MDMA |
| Key findings | Dantrolene was associated with higher survival (21/26) compared to no dantrolene (25/45), especially in extreme (≥42°C) and severe (≥40°C) fever, with survival rates of 8/13 and 10/10 versus 0/4 and 15/27, respectively. No adverse events were attributed to dantrolene except possible transient hypoglycemia. |
Abstract
The use of dantrolene in the treatment of hyperpyrexia related to MDMA (3,4-methylenedioxymethamphetamine) is controversial, with little data available to guide clinical decision-making. Although the treatment is recommended by several poison control centres, published data are primarily in the form of case reports and animal and in vitro experiments. We conducted a systematic review to investigate the published evidence regarding the safety and benefits of dantrolene for MDMA-related hyperpyrexia in humans. A systematic search of Embase and MEDLINE was conducted from the earliest possible date to November 2008. All human trials and case reports of MDMA related hyperpyrexia were considered. Data were abstracted systematically and characteristics including use of dantrolene, adverse reactions attributed to dantrolene, peak temperature, complications from MDMA-related hyperpyrexia and survival were recorded. Our search yielded 668 articles of which 53, reporting 71 cases of MDMA-induced hyperpyrexia, met our inclusion criteria. No clinical trials, randomized controlled trials, observational studies or meta-analyses were identified. Dantrolene was used in 26 cases. Patient characteristics were similar in the dantrolene and no dantrolene groups. The proportion of survivors was higher in the dantrolene group (21/26) than in the no dantrolene group (25/45). This difference was especially pronounced in those with extreme (≥ 42°C) and severe (≥ 40°C) fever, with a survival rate of 8 of 13 and 10 of 10, respectively, in the dantrolene group compared with 0 of 4 and 15 of 27 in the no dantrolene group. There were no reports of adverse events attributable to dantrolene with the exception of a possible association with an episode of transient hypoglycemia. Our systematic review suggests that dantrolene is safe for patients with MDMA-related hyperpyrexia. Dantrolene may also be associated with improved survival and reduced complications, especially in patients with extreme (≥ 42°C) or severe (≥ 40°C) hyperpyrexia, although this conclusion must be interpreted with caution given the risk of reporting or publication bias.
Comparable studies
Other systematic reviews and meta-analyses on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| A review of the acute subjective effects of MDMA/ecstasy | 2006 | Systematic review | |
| Adverse events in clinical treatments with serotonergic psychedelics and MDMA: A mixed-methods systematic review Patients in clinical trials with MDMA or serotonergic psychedelics | 2022 | Systematic review | n = 598 |
| Treating posttraumatic stress disorder with MDMA-assisted psychotherapy: A preliminary meta-analysis and comparison to prolonged exposure therapy Patients with PTSD | 2016 | Meta-analysis | |
| The neuropsychology of ecstasy (MDMA) use: a quantitative review MDMA users | 2007 | Meta-analysis | |
| Drug-drug interactions between psychiatric medications and MDMA or psilocybin: a systematic review | 2022 | Systematic review |
Citations in the library
Cited by 19
- Safety pharmacology of acute MDMA administration in healthy subjects Journal of Psychopharmacology February 21, 2017
- Serotonin toxicity of serotonergic psychedelics Psychopharmacology July 12, 2021
- Carvedilol inhibits the cardiostimulant and thermogenic effects of MDMA in humans British Journal of Pharmacology March 8, 2012
- Effects of MDMA on body temperature in humans Temperature October 31, 2014
- Safety pharmacology of acute LSD administration in healthy subjects Psychopharmacology September 13, 2021
and 14 more in the library
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and 16 more in the library