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  • Dangerous Interaction : MAOIs. Do not take MDMA if you are currently taking prescription MAOIs. MAOIs are most commonly found in the prescription anti-depressants Nardil (phenelzine), Parnate (tranylcypromine), Marplan (isocarboxazid), Eldepryl (l-deprenyl), and Aurorix / Manerix (moclobemide). Ayahuasca also contains MAOIs (harmine and harmaline). MDMA and MAOIs are a potentially dangerous combination.
  • Dangerous Interaction: Protease Inhibitors. Avoid taking MDMA if you are currently using the protease inhibitor Ritonavir. This may be a life-threatening combination. See Case Report: Interaction between MDMA and Ritonavir (Norvir).
  • Dangerous overheating. MDMA use can lead to hyperthermia (overheating) especially in those who are exerting themselves for long periods of time. It is important for users to pay attention to their bodies and make sure they aren't overheating. Take breaks from dancing. Step outside for a moment if the temperature in the room is high. Make sure to drink enough, but not too much, water.
  • Individual sensitivity varies widely. A small percentage of users seem to react with extreme sensitivity to MDMA and experience overly strong effects at normal doses, including hyponatremia, unconsciousness, seizures, and other serious medical problems.
  • Stimulant combinations can be dangerous. Avoid other strong stimulants in combination with MDMA, which can increase heart rate, blood pressure, and body temperature risks.
  • Water Poisoning. Some ecstasy users overreact to the overheating and dehydration issue by obsessively over-drinking. When drinking large amounts of water it's important to mix in sports drinks or salty snacks to avoid the very real dangers of water poisoning and hyponatremia (low salt), which can cause serious health problems including death. MDMA can cause changes in the body's antidiuretic hormone, leading to much higher susceptibility to hyponatremia. Drink water, but don't drink too much.
  • Seizures. A small number of MDMA users have reportedly had seizures after taking moderate amount of pure MDMA, more common in smaller women and with higher doses. See References Search: MDMA Seizure and Experience Search: MDMA & seizure.

  • Health Condition Contraindications. Individuals with a history of heart ailments, high blood pressure, aneurism or stroke, glaucoma, hepatic (liver) or renal (kidney) disorders, or hypoglycemia may be at higher risk.
  • Hyponatremia. Some users seem particularly sensitive to MDMA's effects on the antidiuretic hormone (ADH, aka Vasopressin) which can lead to serious or even fatal hyponatremia, even without ingesting too much water. See References Search: MDMA & hyponatremia.
  • Neurotoxicity Risk of long term changes to serotonin increases with dose and frequency of use. Though complex, people who use very high doses, re-dose repeatedly, or take MDMA frequently could experience mild, but persisting reductions in certain types of verbal memory or a mild increase in depressive symptoms. See MDMA Neurotoxicity.
  • May worsen depression. MDMA use can exacerbate depression in some users and cause depressions with heavy or frequent use.
  • MDMA & Erectile Dysfunction Drugs. Special consideration should be taken when combining MDMA & Viagra.
  • Crashing after peak. MDMA use can cause severe crashes after the peak effects wane, resulting in depressed mood, crying, and extreme lethargy in some users.
  • Hangover. MDMA can cause hangovers in some users lasting between 1 and 7 days.
  • Frequent use may worsen symptoms. Avoid high doses and frequent use. Over the last 15 years, many studies have shown that the higher the dose and more frequent the use, the worse the long term after-effects may be.

One of the primary problems with MDMA is the low quality of the material sold on the street to recreational users. Tablets of street "ecstasy" frequently contain an assortment of psychoactive substances, either mixed with MDMA, or in place of it, or may contain no active ingredients at all. Other substances found in street ecstasy include MDA, MDE, PMA, caffeine, ephedrine, amphetamines, DXM, and occasionally DOB.

Caffeine, ephedrine, and amphetamines will produce less empathic effects than MDMA with more stimulation and feelings of restlessness. MDA and MDE are both similar in effects to MDMA and it may be difficult for even experienced users to distinguish between them. MDE is slightly shorter in duration than MDMA and generally has a lower peak and less euphoria than MDMA. MDA lasts longer and generally produces more visuals and psychedelic effects than MDMA. The effects of DXM, which has become more common in street ecstasy, can be extremely unpleasant if you're not expecting them: strong disorientation, dizziness, nausea, grogginess or strong sedation, and at high enough doses, dissociation from the body.

For further information on the contents of laboratory tested Ecstasy pills...see or