MDMA Interactions

A

  • Amitriptyline - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

B

  • Bupropion - reduction in norepinephrine and heart rate elevation; significantly prolonged positive mood effects; increase in MDMA levels and reduction in primary metabolites; increased bupropion levels; potential increased risk of seizure, stimulant toxicity, and serotonin syndrome; consider tapering and discontinuing at least 2 weeks prior or a 25% reduced dose of MDMA

  • Buspirone - loss of psychedelic effect; consider tapering and discontinuing at least 5 days prior

C

  • Carvedilol - reduction in cardiostimulant and hyperthermic effects despite increasing circulating epinephrine and norepinephrine

  • Chlorpheniramine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Citalopram - reduced subjective effects by 30-80%; reduced physiological effects by 6-14%; loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Clomipramine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Clonidine - reduced elevation in circulating norepinephrine and blood pressure

D

  • Desipramine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Desvenlafaxine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Doxazosin - reduced increases in mean arterial pressure despite enhancing tachycardia; weakened heightened mood ratings; moderately weakened increased body temperature

  • Duloxetine - reduced circulating norepinephrine; reduced MDMA-induced increases in heart rate and blood pressure; near-complete elimination of MDMA’s effects on pupillary light reflex; reduced MDMA-induced elevations in copeptin in females; significantly reduced subjective effects such as well-being, extroversion, closeness, openness, and alterations in consciousness; fewer acute and subacute subjective complaints; increased plasma MDMA despite attenuated effects; loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

E

  • Escitalopram - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

F

  • Fluoxetine - reduced subjective effects by 30-80%; reduced physiological effects by 6-14%; increased plasma MDMA despite attenuated effects; loss of psychedelic effect; consider tapering and discontinuing at least 6 weeks prior

  • Fluvoxamine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

H

  • Haloperidol - reduced well-being, reduced “oceanic boundlessness,” higher rate of state anxiety; dysphoric state

I

  • Imipramine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Isocarboxazid - potential risk of serotonin syndrome and/or hypertensive crisis; consider tapering and discontinuing at least 2 weeks prior

L

  • Levomilnacipran - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • LSD - higher plasma concentrations and extended plasma elimination half-life for LSD with longer psychedelic experiences, and increased blood pressure and heart rate compared to LSD alone

M

  • Memantine - no effect on MDMA-induced acute memory impairment or effects on mood

  • Methylphenidate - delayed time for MDMA to reach maximum concentration; increased circulating epinephrine, heart rate, and rate pressure; decreased “happy” affect recognition; increased mental concentration; increased acute and subacute subjective complaints

  • Mirtazapine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Moclobemide - potential risk of serotonin syndrome and/or hypertensive crisis; consider tapering and discontinuing at least 2 weeks prior

N

  • Nortriptyline - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

P

  • Paroxetine - reduced subjective effects by 30-80%; reduced physiological effects by 40-60%; increased plasma MDMA despite attenuated effects; blunted MDMA-induced immunosuppression especially cytokine release; loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Pindolol - pretreatment reduced “positive basic mood,” “mania-like experience,” and “dreaminess”; pretreatment reduced increases in peak heart rate

  • Phenelzine - potential risk of serotonin syndrome and/or hypertensive crisis; consider tapering and discontinuing at least 2 weeks prior

R

  • Reboxetine - reduced circulating norepinephrine and reduced cardiovascular stimulant effects; reduced psychostimulant properties such as emotional excitation, feeling “stimulated,” state anxiety, and blissful feelings such as closeness and boundlessness; reduced acute and subacute complaints such as tremor and restlessness; increased plasma MDMA despite attenuated effects

S

  • Selegiline - intensified effects, potential risk of serotonin syndrome; consider tapering and discontinuing at least 2 weeks prior

  • Sertraline - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

T

  • Tranylcypromine - potential risk of serotonin syndrome and/or hypertensive crisis; consider tapering and discontinuing at least 2 weeks prior

  • Trazodone - loss of psychedelic effect; consider tapering and discontinuing at least 5 days prior

V

  • Venlafaxine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Vilazodone - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

  • Vortioxetine - loss of psychedelic effect; consider tapering and discontinuing at least 2 weeks prior

LSD

DMT