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British Journal of Anaesthesia 2007 98(1):148-149; doi:10.1093/bja/ael329
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Role of dantrolene in treatment of heat stroke associated with Ecstasy ingestion

Editor—In their recent review Hall and Hendry1 advocate the use of dantrolene in the management of hyperthermia in acute MDMA (3,4-methylene-dioxy-meth-amphetamine, ‘Ecstasy’) toxicity. MDMA and other amphetamine analogues may present with the syndrome identical to exercise induced heatstroke, a multisystem disorder which has been reviewed by Bouchama and Knochel.2 One of these authors also carried out a randomized controlled trial of the use of dantrolene (2 mg kg–1) in heat stroke and found no difference between the treatment and placebo group in terms of cooling time, complications, or length of stay.3 A recent meta analysis concluded that there is no place for the use of dantrolene in heat stroke.4 In addition, each 20 mg vial of dantrolene contains 3 g of mannitol and is reconstituted in solution of pH 9.5 which alkalinizes the urine, thereby reducing the clearance of amphetamine like drugs such as MDMA.

We would recommend that heatstroke of whatever aetiology is treated as a multisystem disorder resembling severe sepsis with appropriate invasive monitoring and organ support including cooling, but not dantrolene. The danger of insidious late development of organ impairment or failure sometime after admission must not be overlooked and will not be prevented by early administration of dantrolene.

M. R. Duffy* and C. Ferguson

Plymouth, UK

*E-mail: mike_r_duffy{at}hotmail.com

References

1 Hall AP and Hendry JA. Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: overview of pathophysiology and clinical management. Br J Anaesth 2006; 96:678–85[Abstract/Free Full Text]

2 Bouchama A and Knochel JP. Heat stroke. N Eng J Med 2002; 346:1978–88[Free Full Text]

3 Bouchama A, Cefege A, Devol EB, Labdi O, El-Assil K, Seraj M. Ineffectiveness of dantrolene sodium in the treatment of heat stroke. Crit Care Med 1991; 19:176–80[ISI][Medline]

4 Smith JE. Cooling methods used in the treatment of exertional heat illness. Br J Sports Med 2005; 39:503–7[Abstract/Free Full Text]


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Ecstasy toxicity and the cooling factor
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