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Benign SVT on MDMA medication.SIDE EFFECTS of MDMA?

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Hello!

I am a 20 year old male. I have been diagnosed with SVT. I have had SVT my entire life. Generally I would have an episode once every few months. The episode would result in my heart beating approx 180-250 times a minute. Sometimes I would be able to terminate the episode by holding my breath, although other times I would just have to wait it out for about 10 minutes or so for it to stop on its own. After a particularly bad episode where my heart started beating 300 times a minute and would not stop on its own ever after 25 minutes (had to call the paramedics to stop it with Adenosine), I went through a cardiac ablation, and it was considered a partial success, as my SVT episodes, although happening more often (once or twice a month), are always able to be stopped 100% of the time within a few seconds, by holding my breath. My cardiologist has told me that the type of SVT I have is benign, more of an annoyance, but carries no serious risks.

I am taking 25 mg Metoprolol to further help control the SVT. My question is regarding the substance MDMA. I completely understand that you must advise against the use of any illicit substance as such. I am also very aware of all the potential risks of the substance as well as ways to minimize risks. I have used MDMA before multiple times with no adverse effects, although it was before I started taking Metoprolol. My question is, could there be any possible dangerous interaction between pure, MDMA and 25 mg Metoprolol, and if so, what could the interaction be, and what risks could it carry? I came across this study that seemed to indicate that using Pindolol with MDMA actually helped prevent increases in heart rate, which would indicate to me that using the two together is not a problem, however the beta blocker that was studied is a different one than the one I use. I'm assuming that the mechanism of action could be different for different beta blockers, so I wanted to ask to make sure I checked about it. http://www.ncbi.nlm.nih.gov/pubmed/20378736

My second question is, is there any significant chance that a person with benign SVT, using MDMA, could be more at risk for adverse effects, than someone with no heart conditions? And if so, are we talking, a slight increase in risk, or significant increase?

Thank you for your time!

Category: Cardiologist

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Category: Cardiologist
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Hello,
Thank you for your query at DoctorSpring com

All beta blockers have class effect. So pindolol effects are similar to metoprolol. Both are cardioselecticve. Tge study says beta blockers only protect against the heart rate rise of mdma but the hypertensive response continues despite beta blockers. So there is no guarantee that using a beta blocker protects you from the ill effects of mdma.

Mdma effect lasts for 8 hours. If you had taken the drug previously and now stopoed it and taking metoprolol then a significant interaction is unlikely unless you are taking them simultaneously.
MDMA can be very dangerous in a patient with DVT specially because it leads to sympathetic overactivity and you had some episodes of 300 pm before ablation. We dont want a repeat of that
So it is advisable that you totally abstain from mdma and continue your beta blockers,

Regards
Dr Vivek Mahajan
DM Cardiology


Patient replied :

Thank you for your response!
Just wanted to see if you could elaborate on a couple of your points.
If the Metoprolol was taken with MDMA or around the same time (within an hour or two) could there be a significant risk of any dangerous interaction with the beta blocker, and if so, what kind of interaction would be possible?
Also, when you say it is very dangerous in an SVT patient, what type of risks would it carry? Is it more likely to lead to serious cardiovascular complications (heart attack, hypertensive crisis, etc) than in people with normal functioning hearts, or does it only increase the risk of having an SVT episode?

Thank you!


Hello
Taken simultaneously metoprolol would block the tachycardia due to mdma. It wouldn't block the hypertensive response of mdma. But some theoretical speculations are that hypertensive response maybe aggravated as the alpha blockade by beta blockers would aggravate the vasoconstrictor effect of mdma. However metoprolol has no significant alpha blockade. So the point is metoprolol would block the harmful tachycardia due to mdma but not the hypertensive response. The study didn't show that hypertensive response is worsened but there are some people who fear that hypertensive response may be aggravated. So as far as evidence is concerned beta blockers are partially protective against mdma. Whether it is harmful in other ways like hypertension and specially qith metoprolol is yet unknown. Though we can take the results of pindolol for metoprolol in a broad sense till a study with metoprolol is not available still there may be small difference in the response. So as of now beta blockers only partially protect against mdma effect and whether some harmful aspects are aggravated is unknown
Mdma will aggravate the sympathetic activity and lead to worsening of svt in svt
patients. That is the risk. The risk of heart attacks and strokes will be similar to general population if you are are not a patient of cerebro cardiovascular disease.

Regards
Dr Vivek Mahajan


Dr. Vivek Mahajan
Category: Cardiologist
Experience: 
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
Dr. Vivek Mahajan and 4 other Medical Specialists are ready to help you

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