A Case of 3,4-Dimethoxyamphetamine (3,4-DMA) and 3,4-Methylenedioxymethamphetamine (MDMA) Toxicity with Possible Metabolic Interaction

  • J Psychoactive Drugs. 2016 Nov-Dec;48(5):351-354. doi: 10.1080/02791072.2016.1225324.
Michael A Darracq  1 ,  Stephen L Thornton  2 ,  Alicia B Minns  3 ,  Roy R Gerona  4
Affiliations
  • 1. a Assistant Professor, Fresno Medical Education Program, Department of Emergency Medicine, Division of Medical Toxicology , University of California San Francisco , Fresno , CA , USA.
  • 2. b Assistant Professor, Department of Emergency Medicine, Kansas Poison Control System , University of Kansas Medical Center , Kansas City , KS , USA.
  • 3. c Assistant Professor, Department of Emergency Medicine, Division of Toxicology , University of California San Diego , San Diego , CA , USA.
  • 4. d Assistant Professor, Department of Laboratory Medicine , University of California San Francisco , San Francisco , CA , USA.
PMID: 27636207 DOI: 10.1080/02791072.2016.1225324
Abstract

We present a case of "ecstasy" ingestion revealing 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-dimethoxyamphetamine (3,4-DMA) and absence of Cytochrome P450 (CYP)-2D6 MDMA metabolites.

Case report: A 19-year-old presented following a seizure. Initial vital signs were normal. Laboratories were normal with the exception of sodium 127 mEq/L and urine drugs of abuse screen positive for amphetamines. Twelve hours later, serum sodium was 114 mEq/L and a second seizure occurred. After receiving hypertonic saline (3%), the patient had improvement in mental status and admitted to taking "ecstasy" at a rave prior to her initial presentation. Liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS) of serum and urine revealed MDMA, 3,4-DMA, and the CYP-2B6 MDMA metabolites 3,4-methylendioxyamphetamine (MDA) and 4-hydroxy-3-methoxyamphetamine (HMA). The CYP2D6 metabolites of MDMA, 3,4-dihydromethamphetamine (HHMA) and 4-hydroxy-3-methoxymethamphetamine (HMMA), were detected at very low levels.

Conclusion: This case highlights the polypharmacy which may exist among users of psychoactive illicit substances and demonstrates that concurrent use of MDMA and 3,4-DMA may predispose patients to severe toxicity. Toxicologists and Other healthcare providers should be aware of this potential toxicity.

Keywords
3,4 dimethoxyamphetamine (DMA); 3,4-methylenedioxymethamphetamine; liquid chromatography-time-of-flight mass spectrometry (LC-TOF/MS); pharmacokinetics.
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