Ecstasy is an illegal drug whose chemical name is 3,4-methylenedioxymethamphetamine (MDMA). It is an artificial derivative of amphetamine, having first been manufactured in 1912.

Ecstasy induces a sense of euphoria, well-being, openness, empathy and energy in users, with the effects generally lasting for two to three hours. It works by preventing the re-uptake of the brain chemical 5-hydroxytryptamine, as well as dopamine and noradrenaline in the brain, resulting in increased activity of the brain regions that respond to these chemicals.

Clinical trials into the use of ecstasy in patients with post-traumatic stress disorder are underway in the United States. The drug may enable these patients to examine their thought processes with less fear. Before being made illegal, ecstasy was often used in psychotherapy.

Side-effects of ecstasy include teeth grinding and jaw clenching, as well as high heart rate, blood pressure and temperature. Serious medical consequences of ecstasy use are rare, but include the breakdown of muscle tissue and low blood sodium levels. The latter has caused coma and death in a few cases, but it is uncertain to what extent this was caused by the drug, or by drinking too much water.

Ecstasy is not considered an addictive drug, but its long-term consequences are uncertain.

In 1996, a man taking antiretroviral therapy died after taking a small dose of ecstasy. Post-mortem examination revealed that the man had extremely high levels of ecstasy in his blood.1 This was put down to ritonavir (Norvir) preventing the breakdown of ecstasy in the man’s liver, as was seemingly confirmed in a second case of high blood levels and prolonged effects of the drug published in 1999.2

While these cases have led to fears that protease inhibitors may cause dangerous increases in ecstasy levels, many people manage to take these drugs together with few adverse effects. However, patients taking protease inhibitors should use ecstasy with caution.

There is no evidence of an interaction between ecstasy and non-nucleoside reverse transcriptase inhibitors (NNRTIs), including no evidence of increased central nervous system side-effects in patients taking efavirenz (Sustiva).3


  1. Henry JA et al. Fatal interaction between ritonavir and MDMA. Lancet 352: 1751-1752, 1998
  2. Harrington RD et al. Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma hydroxybuytrate. Arch Intern Med 159: 2221-2224, 1999
  3. Faggian F et al. Recreational substance use and tolerance of efavirenz in HIV-1 infected patients. AIDS Care 17: 908-910, 2005


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