Drug interactions
Methadone + Methylenedioxymethamphetamine
Severity: Major
Methadone and Methylenedioxymethamphetamine: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
MDMA is a serotonin-releasing stimulant and methadone has weak serotonergic activity, so the combination may raise the risk of serotonin toxicity. MDMA can also cause tachycardia, hyperthermia and arrhythmia, while methadone prolongs the QT interval, and the stimulant effects may mask opioid sedation, leading to overdose risk.
What this interaction means in plain words
Methadone and Methylenedioxymethamphetamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Additive serotonergic and cardiovascular effects, with possible CYP2D6 inhibition by MDMA altering methadone exposure.
What to do
Advise patients to avoid MDMA while on methadone. If exposure occurs, monitor for hyperthermia, agitation, clonus and ECG changes.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Methadone
- Alvimopan + Methadone Contraindicated
- Calcium / magnesium / potassium / sodium oxybates + Methadone Contraindicated
- Droperidol + Methadone Contraindicated
- Ibutilide + Methadone Contraindicated
- Isocarboxazid + Methadone Contraindicated
- Lefamulin + Methadone Contraindicated
Frequently asked questions
Can I take Methadone with Methylenedioxymethamphetamine?
MediHelp rates the interaction as major. Methadone and Methylenedioxymethamphetamine can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. MDMA is a serotonin-releasing stimulant and methadone has weak serotonergic activity, so the combination may raise the risk of serotonin toxicity. MDMA can also cause tachycardia, hyperthermia and arrhythmia, while methadone prolongs the QT interval, and the stimulant effects may mask opioid sedation, leading to overdose risk.
How serious is the interaction between Methadone and Methylenedioxymethamphetamine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Advise patients to avoid MDMA while on methadone. If exposure occurs, monitor for hyperthermia, agitation, clonus and ECG changes.
What other medicines interact with Methadone?
MediHelp also lists interactions of Methadone with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Droperidol. The full list is on the Methadone page.
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