Ecstasy-induced rhabdomyolysis and its role in the development of acute renal failure

Acute poisoning involving the pyrrolidinophenone-type designer drug 4′-methyl-alpha-pyrrolidinohexanophenone (MPHP)

“…Toxic liver damage and rhabdomyolysis have been reported for related stimulant drugs [26][27][28][29][30]. Hence it seems likely, that these toxic effects were caused by MPHP.…”

Carvedilol reverses hyperthermia and attenuates rhabdomyolysis induced by 3,4-methylenedioxymethamphetamine (MDMA, Ecstasy) in an animal model*

“…Neither controlled trials in humans nor studies using animal models have confirmed that dantrolene can reverse established hyperthermia following MDMA exposure. Rhabdomyolysis, which is commonly linked to MDMA-induced death, is precipitated under conditions of extreme hyperthermia (12). Factors that may contribute to MDMA-induced myolysis include hyperthermia, vasoconstriction, and activation of UCP-3, which diverts energy stored in the mitochondrial electrochemical gradient away from adenosine triphosphate production to be used for the generation heat.…”

“…These findings suggest that drugs which can inhibit the activation of UCP-3 in skeletal muscle may also inhibit the thermogenic response to MDMA and related sympathomimetic agents, as well as other chemically unrelated psychostimulants such as cocaine. Because excessive activation of UCP-3 can significantly reduce mitochondrial adenosine triphosphate synthesis for the sake of heat generation, agents that activate skeletal muscle UCP-3 may induce adenosine triphosphate depletion in myocytes and ultimately may contribute to muscle cell breakdown and rhabdomyolysis, a common finding in patients presenting with MDMA toxicity (5,11,12). The sympathetic nervous system regulates the expression and activity of skeletal muscle UCP-3 by the activation of ␤ 3 -adrenergic receptors (␤ 3 -ARs) (13).…”

Rhabdomyolysis

“…The medical literature is filled with case reports of rhabdomyolysis resulting from snake and spider bites [10][11][12] to drugs like cocaine [13][14][15][16][17] and ecstasy [18,19] to keyboard overuse [20]. While the exact mechanisms responsible for all causes of rhabdomyolysis are not fully understood, it is clear that that muscle damage can occur from direct muscle injury or by metabolic inequalities between energy consumption and energy production [1].…”