Role of dantrolene in the management of the acute toxic effects of Ecstasy (MDMA).

Editor—The use of dantrolene in the management of hyperthermia for acute ‘Ecstasy’ (3,4-methylenedioxymetamphetamine, MDMA) toxicity has been recently reviewed by Hall and Hendry. We would like to confirm the efficacy of dantrolene after a recent case that presented to our emergency department. A 21-yr-old male presented after collapse with, GCS 4/15, generalized rigidity, tachycardia (160 min), hypertension (170/120 mm Hg), tachypnoea (40 min), and hyperthermia 41.78C. The history confirmed Ecstasy ingestion. Initial treatment involved physical methods to cool the patient, such as cold i.v. fluids and ice packs. Diazepam 10 mg i.v. and acetaminophen 1 g p.r. were administered. For the following 45 min, the patient’s clinical state failed to improve. After this time, the anaesthetist present gave 1 mg kg dantrolene and almost immediately the patient’s rigidity reduced. Serial measurement of body temperature after dantrolene administration revealed a reduction in core temperature to 38.7 after 30 min and this continued to decrease until it was within normal limits at 90 min. The patient was subsequently transferred to ITU where he was treated supportively for 4 days. He was then discharged to the ward having made a full recovery. We concur with the recommendation that dantrolene is an effective treatment for hyperthermia due to MDMA ingestion. Its early use in our case appears to have been instrumental in controlling this patient’s hyperthermia.