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Toxicity can range from mild discomfort to life-threatening complications. Be aware of the warning signs, especially if mixing substances.
Common Serious Complications
1. Hyperthermia (Overheating) and heatstroke
MDMA increases body temperature, especially when combined with intense physical activity (like dancing for hours in a crowded, hot venue).
High temperatures can cause organ damage, muscle breakdown, or even death.
Signs include excessive sweating, dizziness, severe dehydration, confusion, seizures and collapse.
Take breaks, stay cool, and hydrate in moderation.
2. Serotonin Syndrome
Dangerous when MDMA is mixed with antidepressants, MAOIs, tramadol, or other stimulants.
Signs include high fever, muscle rigidity, confusion, agitation, fast heartbeat, seizures, and even unconsciousness.
Seek help immediately if someone is overheating, confused, or experiencing muscle rigidity.
3. Hyponatremia (Water Intoxication)
MDMA can increase the release of antidiuretic hormone (ADH), which makes the body retain water. Combined with excessive drinking (common at raves/clubs where people try to stay hydrated), this can dilute sodium levels in the blood, leading to brain swelling.
Symptoms start as headaches, nausea, confusion, but can quickly progress to seizures, coma, and death.
Sip slowly and include electrolytes (e.g., sports drinks) if sweating heavily. Seek help immediately if symptoms appear.
4. Heart Complications
High doses or combinations with stimulants increase risk of heart attacks, irregular heartbeat, or cardiac arrest; even in young, healthy individuals.
Call emergency services immediately if someone experiences these symptoms. Stay calm, cool the body, and avoid further stimulant intake.
5. Mental Health & Psychiatric Effects
High doses or frequent use couple with lack of sleep with or without pre-existing mental health condition can cause:
Panic attacks or intense fear
Paranoia or hallucinations
Lasting depression, anxiety, or emotional instability
Reassurance and a calm environment can help ease distress. If paranoia or hallucinations persist, professional mental health support may be needed.
6. Other complications:
Pulmonary harms: pneumothorax, pneumomediastenum
Intracranial haemorrhage
Liver failure
Diabetic ketoacidosis
