Methylenedioxymethamphetamine (MDMA)

Methylenedioxymethamphetamine (MDMA) is a phenylethylamine structurally related to amphetamine and mescaline. Considered a drug of abuse with toxicity similar to that of dexamphetamine. It has no medical use. Oral or inhaled administration.

At the date of the last update, there was no published data available on its excretion in human milk or on the possible effects on infants of mothers who take MDMA during breastfeeding.

Its pharmacokinetic data (low molecular weight and low protein binding) make it likely to pass into the mothers’ milk in an amount that could be significant.

There is little information on the impact of maternal amphetamine abuse on the development and health of infants ^{(Oei, 2012)}, but it is known that they are more exposed to social problems, domestic violence and lower rates of breastfeeding. ^{(Oei, 2010)}

MDMA has psychedelic, dissociative, stimulating and hallucinogenic effects, is energizing, distorts sensory and temporal perception, emotions and sexual behavior, causes mydriasis, hypertension, tachycardia, and dizziness. ^{(NIH 2020 and 2017)}

It can lead to increased body temperature with malignant hyperthermia ^{(Parrott 2012)}, dehydration with hyponatraemia ^{(Dijken 2013, Moritz 2013)}, kidney failure, liver failure ^{(Cajanding 2017)}, panic, seizures and cerebral edema ^{(Baumann 2016)}, especially in women. ^{(NIH 2020 and 2017)}

MDMA causes increases in cortisol, prolactin, oxytocin, and dehydroepiandrosterone or DHEA ^{(Dolder 2018, Harris 2012, de la Torre 2000)}. It can cause lowered immune defenses. ^{(Connor 2004)}

Habitual use has been associated with sleep problems, loss of appetite, difficulty concentrating, illogical and disorganized thinking, depression, impaired memory and attention, anxiety, aggressiveness, irritability, arrhythmias, heart disease, impulsivity, and decreased cognitive function. ^{(NIH 2020 and 2017)}

The drug can be consumed with alcohol, cannabis, or other drugs and be adulterated with other substances such as methamphetamine, caffeine, ephedrine, cocaine, ketamine, dextromethorphan, mephedrone, and methylone, a synthetic stimulant found in bath salts ^{(Miner 2017)}, which increases neurotoxicity. ^{(NIH 2020 and 2017)}

To minimize the risk, after the last MDMA consumption, it is advisable to wait 75 hours, = 3 days (5T½, which eliminates 97% of the substance) before breastfeeding again. Meanwhile, express and discard milk regularly.

Psychotropic drugs of abuse disable the mother from being able to care for her child, endangering the lives and health of both.

Bed-sharing with the baby is not recommended if this drug is being used due to increased risk of suffocation or sudden infant death. ^{(UNICEF 2018, 2017, 2014 and 2013, Landa 2012, ABM 2008, UNICEF 2006)}

There is no scientific evidence on the benefits and risks of psychedelic drug microdosing. ^{(Kaypak 2022, de Wit 2022, Szigeti 2021, Lea 2020, Kuypers 2019)}

See below the information of these related products:

• Amfetamine (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)
• Dexamfetamine Sulfate (Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.)