Hard Boiled: Alcohol Use as a Risk Factor for MDMA-Induced Hyperthermia: a Systematic Review.
Jan Van Amsterdam, Tibor M Brunt, Mimi Pierce, Wim van den Brink
Neurotoxicity Research December 2021 DOI: 10.1007/s12640-021-00416-z (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Review Peer reviewed |
|---|---|
| Topics | MDMA |
| Keywords | Alcohol Fatalities Hyperthermia Hyponatremia Interaction Risk factor |
| Key findings | The authors argue that alcohol use interacts with most of the physiological drivers of MDMA-induced hyperthermia, dehydration, and hyponatremia, including poikilothermia, high ambient temperature exposure, vigorous dancing, vasoconstriction, dehydration, and delayed sweating and diuresis. They conclude that recreational and clinical MDMA users should refrain from concomitant alcohol use to reduce the risk of adverse health incidents. |
Abstract
Although MDMA (ecstasy) is a relatively safe recreational drug and is currently considered for therapeutic use for the treatment of posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD), recreational MDMA use occasionally elicits hyperthermia and hyponatremia, sometimes with a fatal outcome. Specific risk factors for both adverse effects are profuse sweating while vigorously dancing under unfavorable conditions such as high ambient temperatures and insufficient fluid suppletion which result in dehydration. Concomitant use of MDMA and alcohol is highly prevalent, but adds to the existing risk, because alcohol facilitates the emergence of MDMA-induced adverse events, like hyperthermia, dehydration, and hyponatremia. Because of potential health-related consequences of concomitant use of MDMA and alcohol, it is important to identify the mechanisms of the interactions between alcohol and MDMA. This review summarizes the main drivers of MDMA-induced hyperthermia, dehydration, and hyponatremia and the role of concomitant alcohol use. It is shown that alcohol use has a profound negative impact by its interaction with most of these drivers, including poikilothermia, exposure to high ambient temperatures, heavy exercise (vigorous dancing), vasoconstriction, dehydration, and delayed initiation of sweating and diuresis. It is concluded that recreational and clinical MDMA-users should refrain from concomitant drinking of alcoholic beverages to reduce the risk for adverse health incidents when using MDMA.
Comparable studies
Other narrative reviews on MDMA, most cited first.
| Study | Year | Design | Participants |
|---|---|---|---|
| Human Pharmacology of MDMA | 2004 | Review | |
| Human psychopharmacology of Ecstasy (MDMA): a review of 15 years of empirical research | 2001 | Review | |
| 3,4‐Methylenedioxymethamphetamine (MDMA, “Ecstasy”): pharmacology and toxicology in animals and humans | 1994 | Review | |
| (±)3,4-Methylenedioxymethamphetamine (‘Ecstasy’)-Induced Serotonin Neurotoxicity: Studies in Animals | 2000 | Review | |
| Amphetamine toxicities | 2010 | Review |
Citations in the library
Cited by 12
- Therapeutic role of psilocybin and 3,4-methylenedioxymethamphetamine in trauma: A literature review World Journal of Psychiatry May 19, 2023
- Harm reduction behaviours and harm experiences of people who use 3,4-methylenedioxymethamphetamine (MDMA) in Aotearoa New Zealand. Harm Reduction Journal March 21, 2024
- Trance, posture, and tobacco in the Casas Grandes shamanic tradition: Altered states of consciousness and the interaction effects of behavioral variables Anthropology of Consciousness November 8, 2023
- A thematic analysis of MDMA-related harm and harm reduction experiences and knowledge in Aotearoa New Zealand. Harm Reduction Journal May 23, 2024
- Rare but relevant: MDMA and hyponatraemia Addiction December 8, 2025
and 7 more in the library
Cites 58
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- Small Changes in Ambient Temperature Cause Large Changes in 3,4-Methylenedioxymethamphetamine (MDMA)-Induced Serotonin Neurotoxicity and Core Body Temperature in the Rat Journal of Neuroscience July 1, 1998
- 'Eve' and 'Ecstasy'. A report of five deaths associated with the use of MDEA and MDMA JAMA March 27, 1987
and 53 more in the library