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Taking MDMA With Liver Issues

llamalad

Greenlighter
Joined
May 11, 2014
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4
Hi everyone,
This is my first post - basically I'm eager to get some opinions on whether it would be wise to take MDMA again, given my current health condition.

I have autoimmune liver disease and significant scarring of the liver: a few months ago I took 1/8 of a gram of MDMA and proceeded to have the most indescribably incredible experience of my entire life to date.

Prior to this I had dredged up as much of the literature on harm reduction that I could find and took the appropriate measures to ensure I was safe (even including setting an hourly timer to measure fluid intake...).

The next day, though I felt fine, it transpired I had become extremely jaundiced (we're talking a lurid yellow) for about 4 hours after dropping; my pupils had dilated so far as to take over my entire eye and I may or may not have also temporarily passed out from the sheer pleasure on the come up (though this cannot be confirmed and I don't recall fainting). I buzzed intensely for 8 hours, even on this relatively low dose.

All this was very worrying BUT at my next regular blood test all the liver function tests were excellent and there appears to have been no permanent damage done.

My question is this: would it be incredibly stupid to take MD again given my reaction? Would taking two smaller doses over the course of a few hours be more sensible? Is the likelihood of an idiosyncratic reaction to MD less likely the second time? Are there any other recreational substances that may prove less hepatotoxic?

Thank you all for your time.
 
Hi llamalad,

If you became jaundiced the first time, why would you think you would not have a hepatotoxic reaction again a second time? If taking 0.125 gm of MDMA cause you to be jaundiced, then it likely means you don't have the hepatic reserve to tolerate MDMA, as even a small insult with MDMA caused sufficient amount of bilirubin to build up to cause noticable jaundice.

Just because your liver enzymes are now normal doesn't mean that damage was not caused to your liver. If we say that MDMA is truly hepatotoxic, then the damage caused to your hepatocytes by MDMA would transiently elevate your AST/ALT as these enzymes are released as the cell lyses. Once the MDMA is out of your system, your AST/ALT will return to baseline after some time, as there is no longer further ongoing damage. This is different than a chronic inflammation like hepatitis, where your liver enzymes are persisently elevated.

As far as taking taking multiple small doses over the course of a few hours, I am not sure if the hepatoxicity of MDMA is concentration dependent or more dependent on the AUC (area under the curve) of the concentration with respect to time, in which case you may not lessen the toxicity via this technique.

If you are really willing to take the risk again, try doing an even smaller dose, as your hepatic excretion mechanisms may be compromised due to your autoimmune disease, leading to higher plasma concentrations of MDMA.
 
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Thanks very much for your detailed reply. My liver problem is caused by chronic inflammation although this is tightly controlled by steroidal medications.
The interesting thing is that the blood tests were done the same week as the roll and were normal - this is often not the case when I consume small amounts of alcohol, so can MD really be that hepatotoxic?
All very confusing as significant jaundice should have showed up in the bloods - perhaps the drug caused my skin to become very pale, making my already slightly yellow hue much more noticeable? In any case, you are quite right that a minuscule dose would be sensible.
 
Thanks very much for your detailed reply. My liver problem is caused by chronic inflammation although this is tightly controlled by steroidal medications.
The interesting thing is that the blood tests were done the same week as the roll and were normal - this is often not the case when I consume small amounts of alcohol, so can MD really be that hepatotoxic?
All very confusing as significant jaundice should have showed up in the bloods - perhaps the drug caused my skin to become very pale, making my already slightly yellow hue much more noticeable? In any case, you are quite right that a minuscule dose would be sensible.

In comparison to alcohol, MDMA is not hepatoxic, but of course it does require the liver for metabolism. Alcohol is one of the most hepatoxic drugs out there, so despite it's legality, you should avoid that at all costs. Regarding MDMA, I don't feel like I understand your condition well enough to say you should do it again. Clearly something different happened, which I would imagine would've been a decreased breakdown of the MDMA as a result of your liver condition. It probably just potentiated the MDMA, hence why it was so powerful and long-lasting. For the sake of HR, you shouldn't really do it again. For the sake of HR you should avoid all drugs really, as they all require metabolism through the liver. Do you find caffeine is also extremely potentiated in it's dose-response?
 
In comparison to alcohol, MDMA is not hepatoxic, but of course it does require the liver for metabolism. Alcohol is one of the most hepatoxic drugs out there, so despite it's legality, you should avoid that at all costs. Regarding MDMA, I don't feel like I understand your condition well enough to say you should do it again. Clearly something different happened, which I would imagine would've been a decreased breakdown of the MDMA as a result of your liver condition. It probably just potentiated the MDMA, hence why it was so powerful and long-lasting. For the sake of HR, you shouldn't really do it again. For the sake of HR you should avoid all drugs really, as they all require metabolism through the liver. Do you find caffeine is also extremely potentiated in it's dose-response?

Thanks for your reply - I would agree that a decreased rate of drug metabolism is the most likely explanation for my prolonged and intense experience, as well as the jaundice. Avoiding all drugs is obviously the safest option and one which I should probably take - for me it's all about the risk:benefit ratio. Taking MDMA has been extremely therapeutic; I would even go as far to say life altering.
My response to caffeine is normal, though when drinking alcohol (from which I now completely abstain) I tended to get drunk more quickly.

What I'm trying to establish is how likely I am to go into fulminant liver failure on MDMA - with just 1/16 of a gram I wouldn't think it possible, though of course idiosyncratic reactions do occur. As far as I'm aware, intermittent ketamine use is not particularly hepatotoxic, though this isn't something I would touch again. Would a tiny amount of LSD be more safe?
 
Avoiding all drugs is obviously the safest option and one which I should probably take - for me it's all about the risk:benefit ratio. Taking MDMA has been extremely therapeutic; I would even go as far to say life altering.

Yeah I completely understand, I don't believe in prohibition. I just don't want to advise you do something that is potentially dangerous. I don't know about the risk:benefit ratio on this because I don't really know much about the liver, and it's deficiencies, so I can't properly help.

My response to caffeine is normal, though when drinking alcohol (from which I now completely abstain) I tended to get drunk more quickly.

Ok, do you have any atypical responses to different stimulants (adderall, vyvanse, ritalin, concerta etc)? I'm surprised your response to caffeine is normal, but once again I don't really understand your condition.

What I'm trying to establish is how likely I am to go into fulminant liver failure on MDMA - with just 1/16 of a gram I wouldn't think it possible, though of course idiosyncratic reactions do occur.

I'm not sure. If I was to guess, I'd agree with you and say it's highly unlikely to occur. Some key things which you quite simple must do is test everything you take and keep doses well down the lower end of the spectrum. 80-100mg would probably be fine. But exercise caution.

As far as I'm aware, intermittent ketamine use is not particularly hepatotoxic, though this isn't something I would touch again. Would a tiny amount of LSD be more safe?

LSD would probably be more safe yeah. If I remember correctly, LSD is the least hepatoxic recreational drug available, but it may also be strongly potentiated, which with LSD might end with an overpowering and uncomfortable trip. So once again, keep doses low and know for 100% what drug you are actually taking.
 
In comparison to alcohol, MDMA is not hepatoxic, but of course it does require the liver for metabolism. Alcohol is one of the most hepatoxic drugs out there, so despite it's legality, you should avoid that at all costs. Regarding MDMA, I don't feel like I understand your condition well enough to say you should do it again. Clearly something different happened, which I would imagine would've been a decreased breakdown of the MDMA as a result of your liver condition. It probably just potentiated the MDMA, hence why it was so powerful and long-lasting. For the sake of HR, you shouldn't really do it again. For the sake of HR you should avoid all drugs really, as they all require metabolism through the liver. Do you find caffeine is also extremely potentiated in it's dose-response?

I don't know if we can say that MDMA is not hepatotoxic. There are a lot of reports out there documenting the acute and chronic effects of MDMA on the liver. Some patients have even gone on to require liver transplantation after fulminant liver failure after ingestion of MDMA. However, I don't think the exact mechanism behind this hepatotoxicity is completely known.

http://www.ingentaconnect.com/content/ben/cpb/2010/00000011/00000005/art00009

But you are totally right JWills: we cannot really know the risk vs benefit ratio. The OP probably should not use MDMA again, but if he absolutely feels he wants to take the risk he should stay well below 100mg.
 
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