Dantrolene Administration in the Management of the Prehospital Patient with Methylenedioxymethamphetamine Overdose: A Case Series and Literature Review.
Kia Nikoomanesh, Alexander T Phan, Julian Choi, Sarkis Arabian, Michael M Neeki
Case Reports in Critical Care August 27, 2022 DOI: 10.1155/2022/5346792 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case series Case report Peer reviewed |
|---|---|
| Sample size | 9 |
| Population | Patients who presented after ingesting various forms of MDMA at rave music events |
| Interventions | Dantrolene cooling measures |
| Topics | MDMA |
| Key findings | Among nine patients with MDMA-induced hyperpyrexia, cooling measures and dantrolene lowered body temperature by hospital arrival, but nearly all still had laboratory abnormalities indicating end-organ damage. The authors report that the degree and severity of organ damage appeared to track with initial core body temperature, and that dantrolene with cooling appeared to have no effect on reducing the risk of end-organ damage in this population. |
Abstract
Methylenedioxymethamphetamine (MDMA) is a psychoactive substance that is used commonly as a recreational drug at rave music festivals. MDMA intoxication can cause a myriad of symptoms and side effects including the manifestation of hyperpyrexia in patients. Hyperpyrexia can mimic a heat stroke and ultimately lead to various forms of end-organ damage. The most common methods used in treating MDMA-induced hyperpyrexia focus on the rapid reduction of core body temperature. Various off-label medications have also been used in combating MDMA-induced hyperpyrexia. Dantrolene is one such medication, although its role in the treatment of MDMA intoxication remains uncertain. This case series preliminarily examines the efficacy of dantrolene in mitigating MDMA-induced hyperpyrexia and potentially reducing the risk of end-organ damage in patients suffering from MDMA overdose. This study focuses on nine patients who presented after ingesting various forms of MDMA at "rave" music events. All patients were found to be hyperthermic in the field with a maximum core body temperature of 109 degrees Fahrenheit. All patients were immediately managed by cooling measures, and seven patients additionally received dantrolene in the field before being transferred to Arrowhead Regional Medical Center. Upon arrival to the hospital, nearly every patient was found to have significantly decreased body temperatures when compared to previously measured body temperatures out in the field. However, nearly all patients in the study were also noted to have laboratory abnormalities consistent with various forms of end-organ damage. The degree and severity of end-organ damage observed in MDMA-induced hyperpyrexia seem to be a function of initial core body temperature. Higher core body temperature tends to correlate with more forms of end-organ damage and a higher severity of end-organ damage. Intervention with dantrolene and cooling measures appeared to have no effect on reducing the risk of developing end-organ damage in this patient population.
Comparable studies
Other case reports and case series on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| 'Eve' and 'Ecstasy'. A report of five deaths associated with the use of MDEA and MDMA Individuals whose deaths were associated with MDMA or MDEA use | 1987 | Case series | n = 5 |
| Pathology of deaths associated with "ecstasy" and "eve" misuse. Young white men aged 20 to 25 who died after using ring-substituted amphetamines (MDMA... | 1996 | Case series | n = 7 |
| 'Eve' and 'Ecstasy' Individuals who died after using MDMA or MDEA | 1987 | Case series | n = 5 |
| A Method of Conducting Therapeutic Sessions with MDMA Clients with clear therapeutic purpose, excluding those with serious functional... | 1998 | Case study | n = 2 |
| Diversity of Psychopathology Associated with use of 3,4-Methylenedioxymethamphetamine (‘Ecstasy’) Psychiatric patients presenting between 1990 and 1992 whose symptoms developed in the... | 1994 | Case series | n = 13 |
Citations in the library
Cites 9
- Effects of MDMA on body temperature in humans Temperature October 31, 2014
- Morbidity associated with MDMA (ecstasy) abuse: A survey of emergency department admissions Human & Experimental Toxicology May 20, 2010
- Critical Role of Peripheral Vasoconstriction in Fatal Brain Hyperthermia Induced by MDMA (Ecstasy) under Conditions That Mimic Human Drug Use Journal of Neuroscience June 4, 2014
- A Case Series of Life-Threatening MDMA Poisoning in An Electronic Dance Music Party in Hong Kong Asia Pacific Journal of Medical Toxicology January 5, 2019
- Dantrolene in the treatment of MDMA-related hyperpyrexia: a systematic review. CJEM September 2010
and 4 more in the library