• Mechanism of action
  • ↑ Release and ↓ reuptake of serotonin, dopamine, and norepinephrine
    • Serotonin stimulation is more prominent
  • MDMA increases secretion of antidiuretic hormone (ADH) → thirst → increased water intake without electrolyte repletion → hyponatremia
• Clinical features
  • Clinical features of stimulant intoxication, e.g., sympathetic toxidrome, euphoria, agitation
  • Entactogen: social empathy (feeling of “oneness”), loss of anxiety, promotion of introspection and personal reflection
  • Hyponatremia: can manifest with seizures, cerebral and/or pulmonary edema
  • Features of serotonin syndrome (especially with concomitant use of an SSRI)
  • Other: grinding teeth (bruxism), trismus, distorted perceptions of sensation and time

Mnemonic

MDMA has street names like ecstasy, E, X, XTC. Remember X to bruxism.