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Fonseca DA, Ribeiro DM, Tapadas M, Cotrim MD. Ecstasy (3,4-methylenedioxymethamphetamine): Cardiovascular effects and mechanisms. Eur J Pharmacol 2021; 903:174156. [PMID: 33971177 DOI: 10.1016/j.ejphar.2021.174156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022]
Abstract
3,4-methylenedioxymethamphetamine or MDMA (known as "ecstasy") is a recreational drug of abuse, popular worldwide for its distinctive psychotropic effects. Currently, the therapeutic potential of MDMA in psychotherapy has attracted a lot of interest from the scientific community, despite the multitude of effects that this drug of abuse elicits on the human body. While neuronal effects have been the most studied, cardiovascular effects have also been described, as increased blood pressure and heart rate are the most recognizable. However, other effects have also been described at the cardiac (impaired cardiac contractile function, arrhythmias, myocardial necrosis and valvular heart disease) and vascular (vasoconstriction, disruption of vascular integrity and altered haemostasis) levels. Several mechanisms have been proposed, from the interaction with monoamine transporters and receptors to the promotion of oxidative stress or the activation of matrix metalloproteinases (MMPs). This review provides an overview of the cardiovascular implications of MDMA intake and underlying mechanisms, relevant when considering its consumption as drug of abuse but also when considering its therapeutic potential in psychiatry. Moreover, the risk/benefit ratio of the therapeutic use of MDMA remains to be fully elucidated from a cardiovascular standpoint, particularly in patients with underlying cardiovascular disease.
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Affiliation(s)
- Diogo A Fonseca
- Univ Coimbra, Faculty of Pharmacy, Laboratory of Pharmacology and Pharmaceutical Care, 3000-548, Coimbra, Portugal; Univ Coimbra, Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), 3000-548, Coimbra, Portugal; Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology, 3000-548, Coimbra, Portugal.
| | - Daniel M Ribeiro
- Univ Coimbra, Faculty of Pharmacy, Laboratory of Pharmacology and Pharmaceutical Care, 3000-548, Coimbra, Portugal
| | - Margarida Tapadas
- Univ Coimbra, Faculty of Pharmacy, Laboratory of Pharmacology and Pharmaceutical Care, 3000-548, Coimbra, Portugal
| | - Maria Dulce Cotrim
- Univ Coimbra, Faculty of Pharmacy, Laboratory of Pharmacology and Pharmaceutical Care, 3000-548, Coimbra, Portugal; Univ Coimbra, Faculty of Medicine, Coimbra Institute for Clinical and Biomedical Research (iCBR), 3000-548, Coimbra, Portugal; Univ Coimbra, Centre for Innovative Biomedicine and Biotechnology, 3000-548, Coimbra, Portugal
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Duflou J. Psychostimulant use disorder and the heart. Addiction 2020; 115:175-183. [PMID: 31321853 DOI: 10.1111/add.14713] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 05/08/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023]
Abstract
Psychostimulants are a diverse range of substances that encompass cocaine and the phenylethylamines, the latter including the amphetamines, cathinones and some 'novel psychoactive substances'. This paper examines the range of pathophysiological processes, clinical presentations and treatment options involving the heart and cardiovascular system both in the acute setting and where long-term effects of psychostimulant use have affected the cardiovascular system. A common feature of these drugs is their effect on the cardiovascular system, where their major action is that of sympathomimetic amines with short- and long-term stimulation of the adrenergic system and consequent effects on blood pressure, cardiac modelling, atherogenesis and cellular calcium signalling. Cocaine additionally exhibits a variety of prothrombotic effects, effects on inflammatory mediators and alterations in myocardial gene expression. Persistent psychostimulant use results in progressive cardiovascular pathology, largely in the form of accelerated atherosclerosis, hypertension and myocardial ischaemia. Abstinence results in at least partial reversal of pathology. To a large extent, an assumption is made that treatment protocols used for cocaine-associated cardiovascular pathology apply to the amphetamines and other phenylethylamines, but there appears to be little research in this area, despite acknowledgement that cocaine and the better-known amphetamines have different modes of action.
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Affiliation(s)
- Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
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