Alexander T. Gallo MPharm, PhD, Paul B. Fitzgerald MBBS, MPM, PhD, FRANZCP
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引用次数: 0
Abstract
Purpose of Review
On 1 July 2023, the Therapeutic Goods Administration approved 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for the treatment of post-traumatic stress disorder (PTSD). Accordingly, the purpose of this review is to provide an overview of MDMA and what pharmacists should know as this treatment emerges.
Sources of Information
EMBASE, MEDLINE, and CINAHL databases were searched to provide an overview narrative synthesis of the literature on MDMA, relevant to pharmacists.
Key Findings
Cytochrome P450 2D6 is involved in the metabolic pathway of MDMA, an enzyme inhibited by a number of drugs used in the pharmacological management of PTSD (e.g. selective serotonin reuptake inhibitors). Co-administration of these drugs with MDMA can lead to increases in plasma MDMA concentrations. Additionally, inhibition of the serotonin transporter can inhibit the uptake of MDMA into the presynaptic terminal, dampening the effects of MDMA and potentially, limiting the effectiveness of MDMA-assisted psychotherapy. Accordingly, these drugs are typically withdrawn prior to treatment with MDMA. While selective serotonin reuptake inhibitor/serotonin noradrenaline reuptake inhibitor drugs with MDMA are unlikely to cause serotonin toxicity, monoamine oxidase inhibitors can. Other drugs, such as caffeine, alcohol, over-the-counter medicines, and complimentary/alternative medicines, can also interact with MDMA.
Conclusion
With a detailed knowledge of the pharmacology of MDMA, pharmacists may play a role in MDMA-assisted psychotherapy by collecting a detailed medication history and assisting clinicians in the withdrawal of interacting medicines.
期刊介绍:
The purpose of this document is to describe the structure, function and operations of the Journal of Pharmacy Practice and Research, the official journal of the Society of Hospital Pharmacists of Australia (SHPA). It is owned, published by and copyrighted to SHPA. However, the Journal is to some extent unique within SHPA in that it ‘…has complete editorial freedom in terms of content and is not under the direction of the Society or its Council in such matters…’. This statement, originally based on a Role Statement for the Editor-in-Chief 1993, is also based on the definition of ‘editorial independence’ from the World Association of Medical Editors and adopted by the International Committee of Medical Journal Editors.