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Pharmacological Interaction Between 3,4 Methylenedioxymethamphetamine (MDMA, Ecstasy) and Paroxetine

Pharmacological Interaction Between 3,4 Methylenedioxymethamphetamine (MDMA, Ecstasy) and Paroxetine

  1. Jatelka
    Journal of Pharmacology and Experimental Therapeutics 2007,323(3):954-962

    Farre M, Abanades S, Roset PN, Peiro AM, Torrens M, O' Mathuna B, Segura M, de la Torre R

    3,4-Methylenedioxymethamphetamine (MDMA, 'ecstasy') is increasingly used by young people for its euphoric and empathic effects. MDMA can be used in combination with other drugs such as SSRIs. A clinical trial was designed where subjects pre-treated with paroxetine, one of the most potent inhibitors of both 5-HT reuptake and CYP2D6 activity, were challenged with a single dose of MDMA. The aim of the study was to evaluate the pharmacodynamic and pharmacokinetic interaction between paroxetine and MDMA in humans. A randomized, double-blind, cross-over, placebo controlled trial was conducted in 12 healthy male subjects. Variables included physiological parameters, psychomotor performance, subjective effects, and pharmacokinetics. Subjects received 20 mg/day of paroxetine (or placebo) orally for the three days before MDMA challenge (100 mg oral). MDMA alone produced the prototypical effects of the drug. Pretreatment with paroxetine was associated with marked decreases of both physiological and subjective effects of MDMA, despite a 30% increase in MDMA plasma concentrations. The decreases of HMMA plasma concentrations suggest a metabolic interaction of paroxetine and MDMA. These data shows that pretreatment with paroxetine significantly attenuates MDMA-related physiological and psychological effects. It seems that paroxetine could interact with MDMA at pharmacodynamic (serotonin transporter) and pharmacokinetic (CYP2D6 metabolism) levels. Marked decrease in the effects of MDMA could lead users to take higher doses of MDMA and to produce potential life-threatening toxic effects