MDMA is likely to interact with many psychiatric medications (MAPS, 2021); however, MDMA may be used safely with some previously approved medications for post-traumatic stress disorder (PTSD), such as paroxetine (an SSRI antidepressant), though it may cause attenuation or reversion of certain subjective effects associated with MDMA administration (Segura et al., 2005).
Health professionals should be mindful of possible interactions and consult a physician or pharmacist on the possibility of interactions. Any change in medication should be overseen by a licensed medical provider. Use of psychedelic medicines other than ketamine in a clinical setting is very new and, has for many years, been limited to highly controlled clinical trials. Not all concomitant medications have been studied.
Contraindications
The following are contraindications for MDMA administration.
Additional Scenarios
In addition to the contraindications, if the client meets any of the following criteria, MDMA-assisted therapy is not recommended.
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Are not able to give adequate informed consent.
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Lack of fluency in the language of the treating health professionals.
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Lack of stable living situation or lack of supportive family/network.
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Have any current problem which, in the opinion of the health professionals or supervising physicians, might interfere with participation in treatment.
Concomitant Medications and Supplements
There are myriad more potential drug interactions between MDMA and other substances. The following are selected based upon commonality or potential for severe risks in combination.
Please ensure that you read through all items before proceeding by selecting each title.
References
Antoniou, T. and A.L. Tseng, Interactions between recreational drugs and antiretroviral agents. Ann Pharmacotherapy, 2002. 36(10): p. 1598-613.
Pilgrim, J.L., et al., Serotonin toxicity involving MDMA (ecstasy) and moclobemide. Forensic Sci Int, 2012. 215(1-3): p. 184-8.
Davies, N., W. English, and J. Grundlingh, MDMA toxicity: management of acute and lifethreatening presentations. Br J Nurs, 2018. 27(11): p. 616-622.
Vuori, E., et al., Death following ingestion of MDMA (ecstasy) and moclobemide. Addiction, 2003. 98(3): p. 365-8.
Cohen, I.V., Makunts, T., Abagyan, R. et al. Concomitant drugs associated with increased mortality for MDMA users reported in a drug safety surveillance database. Sci Rep 11, 5997 (2021). https://doi.org/10.1038/s41598-021-85389-x
Feduccia, A.A., et al., Discontinuation of medications classified as reuptake inhibitors affects treatment response of MDMA-assisted psychotherapy. Psychopharmacology, 2020.
MAPS. (2021). Multidisciplinary Association for Psychedelic Studies Investigator's Brochure. In (13 ed.). San Jose: MAPS.
Mohamed, W.M., et al., MDMA: interactions with other psychoactive drugs. Pharmacol Biochem Behav, 2011. 99(4): p. 759-74.
Nayak, S. M., Gukasyan, N., Barrett, F. S., Erowid, E., Erowid, F., Griffiths, R. R. (2021). Classic Psychedelic Coadministration with Lithium, but Not Lamotrigine, is Associated with Seizures: An Analysis of Online Psychedelic Experience Reports. Physicians Weekly. https://www.physiciansweekly.com/classic-psychedelic-coadministration-with-lithium-but-not-lamotrigine-is-associated-with-seizures-an-analysis-of-online-psychedelic-experience-reports
Schmid, Y., et al., Interactions between bupropion and 3,4-methylenedioxymethamphetamine in healthy subjects. J Pharmacol Exp Ther, 2015. 353(1): p. 102-11.
Segura, M., Farré, M., Pichini, S., Peiró, A. M., Roset, P. N., Ramírez, A., . . . de la Torre, R. (2005). Contribution of cytochrome P450 2D6 to 3,4-methylenedioxymethamphetamine disposition in humans: use of paroxetine as a metabolic inhibitor probe. Clin Pharmacokinet, 44(6), 649-660. https://doi.org/10.2165/00003088-200544060-00006