Baggott Matthew J, Garrison Kathleen J, Coyle Jeremy R, Galloway Gantt P, Barnes Allan J, Huestis Marilyn A, Mendelson John E
Addiction and Pharmacology Research Laboratory, Friends Research Institute, Baltimore, MD 21201, USA.
Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
Adv Pharmacol Sci. 2016;2016:2175896. doi: 10.1155/2016/2175896. Epub 2016 Jun 14.
Hyponatremia is a serious complication of 3,4-methylenedioxymethamphetamine (MDMA) use. We investigated potential mechanisms in two double-blind, placebo-controlled studies. In Study 1, healthy drug-experienced volunteers received MDMA or placebo alone and in combination with the alpha-1 adrenergic inverse agonist prazosin, used as a positive control to release antidiuretic hormone (ADH). In Study 2, volunteers received MDMA or placebo followed by standardized water intake. MDMA lowered serum sodium but did not increase ADH or copeptin, although the control prazosin did increase ADH. Water loading reduced serum sodium more after MDMA than after placebo. There was a trend for women to have lower baseline serum sodium than men, but there were no significant interactions with drug condition. Combining studies, MDMA potentiated the ability of water to lower serum sodium. Thus, hyponatremia appears to be a significant risk when hypotonic fluids are consumed during MDMA use. Clinical trials and events where MDMA use is common should anticipate and mitigate this risk.
低钠血症是使用3,4-亚甲基二氧甲基苯丙胺（摇头丸）的一种严重并发症。我们在两项双盲、安慰剂对照研究中调查了其潜在机制。在研究1中，有药物使用经验的健康志愿者单独接受摇头丸或安慰剂，并与α-1肾上腺素能反向激动剂哌唑嗪联合使用，哌唑嗪用作释放抗利尿激素（ADH）的阳性对照。在研究2中，志愿者接受摇头丸或安慰剂，随后进行标准化饮水。摇头丸降低了血清钠水平，但未增加ADH或 copeptin，尽管对照药物哌唑嗪确实增加了ADH。与安慰剂相比，摇头丸后饮水负荷导致血清钠降低更多。女性的基线血清钠水平有低于男性的趋势，但与药物情况无显著相互作用。综合两项研究，摇头丸增强了水降低血清钠的能力。因此，在使用摇头丸期间饮用低渗液体时，低钠血症似乎是一个重大风险。在摇头丸使用普遍的临床试验和活动中应预见并减轻这种风险。
