Survival after massive ecstasy overdose

Introduction: The toxicity profile of the amphetamine derivative 3,4-methyl enedioxymethamphetamine (MDMA, "Ecstasy") is well known. This designer drug is usually taken at "house parties" and may cause severe complications, so metimes leading to death, even when taken in relatively small units (1 or 2 tablets). Up to now, only a few cases of survival after ingestion of an ov erdose of Ecstasy have been described. In most cases the users developed hy perthermia, disseminated intravascular coagulation, rhabdomyolysis, and ren al failure. Case Report: We describe a man who, after ingesting 50 tablets of Ecstasy (in combination with oxazepam and alcohol) at home, recovered wi thin 2 days. Presenting features were unconsciousness, apnea, and convulsio ns. It is suggested that in most cases severe 3,4-methylenedioxymethampheta mine toxicity results from an interaction between direct pharmacological ef fects of the drug and the prevailing environmental conditions (high ambient temperature, dancing in trance, little fluid intake).