From the Guidelines
MDMA overdose is a life-threatening condition that requires immediate medical attention, and treatment typically involves supportive care, including IV fluids, cooling measures, and medications to control blood pressure, heart rate, and seizures if needed. The symptoms of MDMA overdose include hyperthermia, severe hypertension, rapid heart rate, seizures, confusion, and loss of consciousness 1. While waiting for help, it is essential to move the person to a cool area, remove excess clothing, and apply cool (not cold) compresses to help reduce body temperature. Ensuring they have an open airway and placing them in the recovery position if unconscious but breathing is also crucial.
Key Considerations
- Hyperthermia is a significant concern in MDMA overdose, and cooling measures should be implemented promptly 1.
- Benzodiazepines like diazepam may be administered to reduce agitation and seizures 1.
- IV fluids and medications to control blood pressure and heart rate may be necessary to prevent organ failure and brain damage 1.
- There is no specific antidote for MDMA toxicity, making prevention and prompt treatment crucial 1.
Treatment Approach
- Discontinue the precipitating agent and provide supportive care, including treatment of agitation (eg, benzodiazepines), amelioration of hyperthermia, and management of autonomic instability (eg, IV fluids and other agents to address abnormal vital signs) 1.
- In severe cases, emergency sedation, neuromuscular paralysis, and intubation may be considered, especially if the patient has severe serotonin syndrome (eg, temperature >41.1°C) 1.
- Cyproheptadine, a serotonin2A antagonist, may be considered in adult patients with severe serotonin syndrome, typically starting with 12 mg, followed by 2 mg every 2 hours for continuing symptoms, and a maintenance dose of 8 mg every 6 hours, given orally 1.
From the Research
Symptoms of MDMA Overdose
- Hyperthermia, with body temperatures reaching as high as 109 degrees Fahrenheit 2
- Seizures 2
- Altered mental status 2
- Multiorgan failure, including cerebrovascular ischemia and coagulopathy 2
- Acute hypoxemic respiratory failure 2
- Hepatotoxicity and hyponatremia 3, 4
- Neurologic effects, including destruction of serotonergic neurons and potential long-term neurologic sequelae 3, 4
- Cardiovascular effects, including hyperpyrexia and multi-organ failure 5
Treatment of MDMA Overdose
- Prompt medical management, including rapid intubation and cooling measures such as ice baths 2
- Continuous renal replacement therapy for patients with multiorgan failure 2
- Intubation for acute hypoxemic respiratory failure 2
- Close monitoring in the intensive care unit (ICU) for patients with severe symptoms 2
- Hemodialysis for patients with renal failure 2
- Treatment of hyperthermia, coagulopathy, rhabdomyolysis, and renal failure 6