My boyfriend has never taken MDMA and is interested in doing it with me. He has HIV and is taking Reyataz, Truvada, and Norvir. I have read some studies from around 2002 - 2003 suggesting there is a potentially fatal interaction between MDMA and Norvir because of over-saturation of the CYP2D6 metabolic pathway. However, I also found a paper on Erowid from the same period that suggests that this is not the case. I also have not found any research on this after 2003, and I know *many* people who are on anti-retrovirals and take MDMA with no ill effects, so I suspect that the two reported cases of lethal ARV and MDMA interaction were actually caused by something else. However, before my boyfriend takes any risk, I would like to know for sure. I would especially like to hear from any medical professionals who have experience in the area of treating HIV, and I think solid information on this question would be of value to a very large community.
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MDMA &
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MDMA and Anti-Retrovirals (Norvir, Retinovir, etc.)
- Thread starter KaiDog
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Folley
Bluelighter
Check this out:
MDMA, also known as ecstasy, XTC, Adam, and Essence, is a commonly used substance at all-night dance parties known as raves and is also increasingly being used recreationally by young professionals. When MDMA is taken orally as a capsule or tablet at average doses of 75-100 mg,20 users cite enhanced feelings of empathy for others, anxiolysis, and strong feelings of euphoria. MDMA is an amphetamine-like compound that undergoes demethylenation principally by CYP2D6.21-23 Concomitant administration with CYP2D6 inhibitors could lead to significant increases in MDMA exposure with potentially dangerous and even fatal consequences, as illustrated by a case report.18 Within a few hours of taking 180 mg of MDMA, a 32-year-old man with AIDS experienced symptoms suggestive of a heightened serotonergic state including tachypnea, tachycardia, cyanosis, and profuse sweating. He then experienced an apparent tonic-clonic seizure, tachypnea, and tachycardia (carotid pulse 200 beats/min), and subsequently died from cardiorespiratory arrest. This patient had previously taken similar amounts of MDMA on several occasions without adverse effects, but this was the first time he had taken MDMA since adding ritonavir 600 mg twice daily to his antiretroviral regimen. At autopsy, the patient's blood concentrations of MDMA were approximately tenfold higher than expected given the amount ingested. Since ritonavir is a well-known potent inhibitor of many hepatic isoenzymes including CYP2D6, the clinicians concluded that the patient likely experienced a fatal serotonergic reaction to MDMA as a result of an interaction with ritonavir.
The danger associated with this interaction may be magnified due to the large variability in the actual amount of MDMA between tablets and the presence of other chemicals (e.g., amphetamines, ephedrine) in some MDMA tablets whose metabolism can also be inhibited by ritonavir, leading to a life-threatening consequence.24 Thus, the combination of MDMA and ritonavir should be avoided. Other isoforms of the CYP450 system may also be involved in the metabolism of MDMA, notably 1A2, 2B6, and 3A4.23 All PIs can inhibit CYP3A4 activity to varying degrees, and ritonavir, nelfinavir, and the NNRTI efavirenz also demonstrate inhibitory activity against 2B625 ; therefore, individuals using MDMA should be warned about the potential for an interaction with these agents and advised to take appropriate precautions (e.g., use 25% of the usual amount of MDMA, take breaks from dancing, ensure rave or party has medical team on site, maintain adequate hydration by avoiding alcohol and replenishing fluids regularly).
You should probably read over this whole article:
http://www.natap.org/2003/Jan/010703_3.htm
MDMA, also known as ecstasy, XTC, Adam, and Essence, is a commonly used substance at all-night dance parties known as raves and is also increasingly being used recreationally by young professionals. When MDMA is taken orally as a capsule or tablet at average doses of 75-100 mg,20 users cite enhanced feelings of empathy for others, anxiolysis, and strong feelings of euphoria. MDMA is an amphetamine-like compound that undergoes demethylenation principally by CYP2D6.21-23 Concomitant administration with CYP2D6 inhibitors could lead to significant increases in MDMA exposure with potentially dangerous and even fatal consequences, as illustrated by a case report.18 Within a few hours of taking 180 mg of MDMA, a 32-year-old man with AIDS experienced symptoms suggestive of a heightened serotonergic state including tachypnea, tachycardia, cyanosis, and profuse sweating. He then experienced an apparent tonic-clonic seizure, tachypnea, and tachycardia (carotid pulse 200 beats/min), and subsequently died from cardiorespiratory arrest. This patient had previously taken similar amounts of MDMA on several occasions without adverse effects, but this was the first time he had taken MDMA since adding ritonavir 600 mg twice daily to his antiretroviral regimen. At autopsy, the patient's blood concentrations of MDMA were approximately tenfold higher than expected given the amount ingested. Since ritonavir is a well-known potent inhibitor of many hepatic isoenzymes including CYP2D6, the clinicians concluded that the patient likely experienced a fatal serotonergic reaction to MDMA as a result of an interaction with ritonavir.
The danger associated with this interaction may be magnified due to the large variability in the actual amount of MDMA between tablets and the presence of other chemicals (e.g., amphetamines, ephedrine) in some MDMA tablets whose metabolism can also be inhibited by ritonavir, leading to a life-threatening consequence.24 Thus, the combination of MDMA and ritonavir should be avoided. Other isoforms of the CYP450 system may also be involved in the metabolism of MDMA, notably 1A2, 2B6, and 3A4.23 All PIs can inhibit CYP3A4 activity to varying degrees, and ritonavir, nelfinavir, and the NNRTI efavirenz also demonstrate inhibitory activity against 2B625 ; therefore, individuals using MDMA should be warned about the potential for an interaction with these agents and advised to take appropriate precautions (e.g., use 25% of the usual amount of MDMA, take breaks from dancing, ensure rave or party has medical team on site, maintain adequate hydration by avoiding alcohol and replenishing fluids regularly).
You should probably read over this whole article:
http://www.natap.org/2003/Jan/010703_3.htm
severely etarded
Bluelight Crew
If your boyfriend doesn't want his HIV to become AIDS, he ought NOT to try MDMA. HIV in it's early stages is actually treatable and can go into remission. Once it crosses over a certain point it is no longer treatable. Would you like to cross the threshold?
This article is from 2002 and relies on the CYP2D6 theory to explain the interaction. However, that interaction is what the paper I found on Erowid throws into doubt. Also, I live in the Castro in San Francisco, and if there was a deadly interaction between anti-retrovirals and MDMA, I think it would be a matter of public knowledge, as guys would be dropping dead left and right. So, the reason I'm looking for more current studies or information.
severely etarded
Bluelight Crew
All I'm saying is that a night of staying up and partying will give the opposite effect of any anti-virals. I understand where you're coming from, and how lovely of a drug MDMA is but I just can't condone taking it when the immune system is in such a vulnerable state. Your bf needs plenty of rest, fluids, regular mild exercise (walking a few miles every day at least), healthy diet and NO DRUGS OR ALCOHOL, NO CIGARETTES. That is the fast track to potential recovery.
I'm still not sure what you mean by "recovery." I have many friends who have lived with HIV for decades, and it's not something like the cold that you get over with rest, a healthy lifestyle, and plenty of fluids. Once you have HIV, you have HIV, and the main goal is impairing replication of the virus. If your T-cell count falls below a certain level, it's true that you become more susceptible to illness, which can become much more serious than normal because of the compromised immune system. In fact, AIDS is distinguished from HIV based purely on the number of t-cells.
Living a healthy lifestyle is important, but most important is staying on one's meds. I have friends who party like rock stars, and have for years, and are perfectly healthy because they've stayed on their meds. There is some clinical evidence that suggests you shouldn't drink, shouldn't smoke, etc., but these are about the same suggestions for anyone else.
I don't seriously think that occasionally getting stoned, or having a roll on a rare occasion, will do my boyfriend's immune system any significant damage that could send him into AIDS on its own. I do think that missing his meds to roll, or having a serious interaction with his meds, is far riskier than the roll itself, which is the reason why I'm looking into this.
Living a healthy lifestyle is important, but most important is staying on one's meds. I have friends who party like rock stars, and have for years, and are perfectly healthy because they've stayed on their meds. There is some clinical evidence that suggests you shouldn't drink, shouldn't smoke, etc., but these are about the same suggestions for anyone else.
I don't seriously think that occasionally getting stoned, or having a roll on a rare occasion, will do my boyfriend's immune system any significant damage that could send him into AIDS on its own. I do think that missing his meds to roll, or having a serious interaction with his meds, is far riskier than the roll itself, which is the reason why I'm looking into this.
severely etarded
Bluelight Crew
^ you realize people have actually gotten rid of HIV. Depending on the strain it can go away with a healthy lifestyle, even better chance with meds.
Once it turns into AIDS the immune system is compromised and you can forget it ever going away.
Just because a few people you know "party lik a rockstar" with HIV doesn't make it a wise choice. Immunodeficiency virus is serious. Not all strains are the same.
If it were me I'd try to test negative someday but hey to each his own.
The best thing one can do is protect the immune system. That wil go a long way to keep the virus in check...
Once it turns into AIDS the immune system is compromised and you can forget it ever going away.
Just because a few people you know "party lik a rockstar" with HIV doesn't make it a wise choice. Immunodeficiency virus is serious. Not all strains are the same.
If it were me I'd try to test negative someday but hey to each his own.
The best thing one can do is protect the immune system. That wil go a long way to keep the virus in check...
cj
Bluelight Crew
Right.... you got a source for that? I bet your b/f would be fine to roll but there is an elevated risk of drug interaction problems.
severely etarded
Bluelight Crew
Yeah Google it dude I'm not going to waste my time for your laziness it's happened quite a few times in the last 20 years
questforstarfish
Bluelighter
I'm not sure how much research can be done on this subject, unfortunately, as I imagine it's considered unethical for researchers to give MDMA to people with HIV in order to test it. They can only theorize. It sounds like you've found the info that is available, and I'm so sorry that there's not more out there!
Basically, the effect a night on MDMA has on the immune system is comparable to a night of drinking. It does NOT act in any way, to my knowledge, to suppress it, except perhaps because he might miss a night of sleep. I can not say that anecdotal evidence is reliable but I do know of people who are positive who roll on MDMA. If you guys decide to, keep the dose fairly small (take half a pill to start, then if that's not enough finish the pill, and do not re-dose after that) and take all the regular precautions. Do it at home in a relaxed and safe environment, with access to a phone if necessary just in case. Ensure he stays self aware in the days afterwards, monitor for any changes he feels. I don't think there's a way to know for sure and it's totally up to you guys, but I don't know of any drugs that are known to interact with MDMA aside from MAOIs and SSRIs, and maybe drugs that inhibit liver enzymes like CYP may allow the MDMA to stay in the body for a longer period of time.
Sorry I can't be of more help!
Basically, the effect a night on MDMA has on the immune system is comparable to a night of drinking. It does NOT act in any way, to my knowledge, to suppress it, except perhaps because he might miss a night of sleep. I can not say that anecdotal evidence is reliable but I do know of people who are positive who roll on MDMA. If you guys decide to, keep the dose fairly small (take half a pill to start, then if that's not enough finish the pill, and do not re-dose after that) and take all the regular precautions. Do it at home in a relaxed and safe environment, with access to a phone if necessary just in case. Ensure he stays self aware in the days afterwards, monitor for any changes he feels. I don't think there's a way to know for sure and it's totally up to you guys, but I don't know of any drugs that are known to interact with MDMA aside from MAOIs and SSRIs, and maybe drugs that inhibit liver enzymes like CYP may allow the MDMA to stay in the body for a longer period of time.
Sorry I can't be of more help!
Thanks, that's actually quite helpful to at least hear that you know other folks in our situation who roll. I'm really not concerned about the affect to his immune system - his viral load is undetectable, and, despite other opinions here, we are both quite certain that rest and fluids won't make his HIV go away. I'm actually much more concerned about the potential CYP interaction from what I've found in the few papers on the topic. However, it seems to me that if this was a serious interaction, I'd have heard more about it by now.
We are considering small dosing, and some more info on this would be helpful as well. He weighs ~130 lbs (~59 kilos). I am assuming an effective does of 2mg/kilo, so about 120mgs. I can control the size of the dose to about a hundredth of a gram. I was thinking that 60 mg to start would be good, but then I saw an "estimate" that Norvir could have a multiplying effect of 10x, which would be a 600mg dose. The largest dose I have ever known someone (who weighed more like 150lbs) to take *at once* is about 320mg with no ill effects except some short term memory loss of the event. A 600mg effect seems like it would be a really bad thing. Can anyone advise on this? I also don't want him to take such a small dose that it does nothing, or just makes him feel speedy.
This week I am going to see if he will go to Magnet, our local HiV information and testing center in the Castro, and find out if there's anyone there who can counsel him. If he goes and gets any solid information, I will be sure to pass it on.
questforstarfish
Bluelighter
Did you get the multiplying effect estimate from the Lancet article "Fatal interaction between ritonavir and MDMA?" I just found this. It seems suspicious to me that they place blame on an interaction between the two drugs, when they also state that the patient who died had severely impaired liver function. It seems to me that the reason he died after taking nearly 3 pills (as well as alcohol) was more likely caused by his liver's inability to metabolize such a high dose of MDMA. The alcohol he took at the time could only have made things worse. He couldn't break it all down and it continued to accumulate throughout the night. Those are my thoughts on the whole thing.
Of course it's definitely a good idea to smart with a much smaller dose than usual. It does say in the article that it's possible that the medication can inhibit liver enzymes responsible for the breakdown of MDMA. Go see your doc, like you said- I would expect that HIV centers have staff that are fairly well-educated on this type of subject, since HIV can unfortunately be closely linked with the "party and drugs" scene! Good luck!
Of course it's definitely a good idea to smart with a much smaller dose than usual. It does say in the article that it's possible that the medication can inhibit liver enzymes responsible for the breakdown of MDMA. Go see your doc, like you said- I would expect that HIV centers have staff that are fairly well-educated on this type of subject, since HIV can unfortunately be closely linked with the "party and drugs" scene! Good luck!
That is indeed one of the two articles I found. I hadn't noticed the bit about severely impaired liver function. Fortunately, my boyfriend is in excellent shape, doesn't smoke or drink, and only very occasionally will have a toke. He sees a doctor regularly, and we know all systems are go. So far everything points to low dosing (especially since he has a virgin nervous system), but I will report back any findings either way.
questforstarfish
Bluelighter
That would be cool if you did report back, I keep checking this post hoping someone will have an answer for you because a) I'd like you guys to get some helpful info and b) I'm very curious now, myself! To me, it seems like they wrote that Lancet article out of a call to get more research on the POSSIBLE interactions of the ARV, rather than any actual evidence that it having an interaction. More to cover all the bases than a suspected interaction...again, I'm not an expert but liver function basically determines everything when it comes to drugs, alcohol and medications. They seemed to stress in the article that his liver was at the end of its rope (no matter what his HIV status), and being on ARVs, alcohol, a high dose of MDMA and probably a number of other medications likely way overloaded his liver!
Anyway. Your man is healthy...not at all the situation described above! It's great to see you being as safe as possible about it and I wish you the best of luck
(And no, I have not heard of a healthy lifestyle completely eliminating HIV from the body either. How lovely the world would be if this were the situation, eh!)
Anyway. Your man is healthy...not at all the situation described above! It's great to see you being as safe as possible about it and I wish you the best of luck
(And no, I have not heard of a healthy lifestyle completely eliminating HIV from the body either. How lovely the world would be if this were the situation, eh!)