3,4‐methylenedioxymethamphetamine (MDMA)‐assisted psychotherapy: what the pharmacist needs to know
Alexander T. Gallo, Paul B. Fitzgerald
Journal of Pharmacy Practice and Research June 1, 2024 DOI: 10.1002/jppr.1921 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | MDMA Psychedelic-assisted therapy |
| Key findings | The review explains that MDMA is metabolized via cytochrome P450 2D6, which many PTSD medications inhibit, potentially raising MDMA plasma levels, while serotonin transporter inhibition may dampen MDMA's effects and limit psychotherapy effectiveness. The authors state that interacting drugs, including SSRIs, SNRIs, and monoamine oxidase inhibitors, are typically withdrawn before MDMA treatment, and they argue pharmacists can contribute by collecting medication histories and helping manage these withdrawals. |
Abstract
AbstractPurpose of ReviewOn 1 July 2023, the Therapeutic Goods Administration approved 3,4‐methylenedioxymethamphetamine (MDMA)‐assisted psychotherapy for the treatment of post‐traumatic stress disorder (PTSD). Accordingly, the purpose of this review is to provide an overview of MDMA and what pharmacists should know as this treatment emerges.Sources of InformationEMBASE, MEDLINE, and CINAHL databases were searched to provide an overview narrative synthesis of the literature on MDMA, relevant to pharmacists.Key FindingsCytochrome P450 2D6 is involved in the metabolic pathway of MDMA, an enzyme inhibited by a number of drugs used in the pharmacological management of PTSD (e.g. selective serotonin reuptake inhibitors). Co‐administration of these drugs with MDMA can lead to increases in plasma MDMA concentrations. Additionally, inhibition of the serotonin transporter can inhibit the uptake of MDMA into the presynaptic terminal, dampening the effects of MDMA and potentially, limiting the effectiveness of MDMA‐assisted psychotherapy. Accordingly, these drugs are typically withdrawn prior to treatment with MDMA. While selective serotonin reuptake inhibitor/serotonin noradrenaline reuptake inhibitor drugs with MDMA are unlikely to cause serotonin toxicity, monoamine oxidase inhibitors can. Other drugs, such as caffeine, alcohol, over‐the‐counter medicines, and complimentary/alternative medicines, can also interact with MDMA.ConclusionWith a detailed knowledge of the pharmacology of MDMA, pharmacists may play a role in MDMA‐assisted psychotherapy by collecting a detailed medication history and assisting clinicians in the withdrawal of interacting medicines.
Comparable studies
Other narrative reviews on MDMA and psychedelic-assisted therapy, most cited first.
Citations in the library
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