[Solved] Can Losartan be taken with an MDMA session?

Losartan is an angiotensin II receptor blocker (ARB) that is prescribed for hypertension (high blood pressure) and certain heart conditions. MDMA (3,4-methylenedioxymethamphetamine) affects the cardiovascular system and can activate the renin-angiotensin system (RAS), which may interfere with the action of losartan. This can lead to unpredictable blood pressure fluctuations and increased renal strain. In general, MDMA increases blood pressure by an average of 10-40 mmHg systolic and 5-25 mmHg diastolic. If this is deemed problematic, MDMA use is advised against.

1. MDMA and the Renin-Angiotensin System (RAS)

MDMA increases blood pressure and heart rate by:

• Sympathetic stimulation: increased release of noradrenaline.
• Indirect activation of the RAS:
  • MDMA can cause kidney stress through dehydration and vasoconstriction of the renal vessels.
  • This can lead to increased production of renin and angiotensin II, causing blood pressure to rise further.

Conclusion: This suggests that MDMA can activate the RAS via a combination of sympathetic stimulation and hemodynamic changes, leading to a paradoxical effect on patients using ARBs.

2. MDMA and the Angiotensin II receptors (AT1 and AT2)

• AT1 receptor: Responsible for vasoconstriction and sodium retention → increases blood pressure.
• AT2 receptor: Causes vasodilation and has a blood pressure-lowering effect.

Losartan blocks the AT1 receptor, whereby the vasodilating effect of AT2 receptors increases relatively, resulting in a reduction in blood pressure.

Effect of MDMA when using losartan:

• MDMA can increase blood pressure via the RAS, causing extra angiotensin II to be released.
• This can partially counteract the effect of losartan, leading to an unpredictable blood pressure response.

3. Possible Risks With the Combination of MDMA and Losartan

1. Opposite effects:

   • Losartan lowers blood pressure, while MDMA increases it. This can reduce the effectiveness of losartan.

2. Increased risk of kidney stress:

   • MDMA causes fluid loss and can reduce renal blood flow.
   • ARBs such as losartan affect renal perfusion, which increases the risk of acute kidney injury.

3. Unpredictable blood pressure fluctuations:

   • Risk of hypertension in the early stages of MDMA use.
   • Chance of hypotension on execution, especially if losartan is still active.

4. How to Reduce Risks with Combined Use

Although the combination not recommended, certain precautions can help limit risks. In addition to starting with a low dose of 50 to 75 mg, these are general recommendations:

A. Electrolytes and Blood Pressure Regulation

Electrolytes (sodium, potassium, magnesium, calcium) play an important role in blood pressure regulation. In theory, it works to take an electrolyte drink containing calcium and magnesium at the beginning of the session and only add sodium later when blood pressure drops.

B. Practical advice

• Electrolyte drink (ORS or sports drink) with sodium and magnesium can help reduce extreme blood pressure fluctuations.
• Do not drink too much water (max. 250-500 ml per hour) to prevent water intoxication and hyponatremia.
• No extra potassium supplements take or consume foods high in potassium, since losartan already increases potassium levels.
• Use a blood pressure monitor to measure your blood pressure before, during and after use.
• Normal blood pressure: 120/80 mmHg - MDMA use is reasonably safe.
• Above 140/90 mmHg: Do not consider taking MDMA.
• Below 90/60 mmHg: Watch out for hypotension as MDMA effects wear off
• Take sodium on time:
  • In the early stages of MDMA use no extra sodium (blood pressure is already high by then).
  • When MDMA wears off extra sodium (blood pressure then drops).

C1. Alternative Strategy: Potassium-rich diet before use

A potassium-rich diet for several weeks prior to MDMA use can lower blood pressure and possibly reduce the need for losartan. NB: This should only be done under the supervision of a doctor, as excessive potassium can be dangerous when using losartan (you should therefore reduce the losartan dose if potassium intake increases).

Foods rich in potassium:

• Bananas, avocados, spinach, sweet potatoes, tomatoes.

C2. Optimizing General Health

• Improving cardiovascular health:
  Regular moderate physical activity (such as walking, cycling, or swimming) helps keep the heart and blood vessels in better condition.
• Reduce other risk factors:
  • Stop (or limit) smoking and alcohol (increases blood pressure and strains the heart).
  • Avoid energy drinks and caffeine, which increase blood pressure.

C3. Nutrition and supplements

• Nitrate-rich foodBeets, spinach, and arugula increase nitric oxide (NO), which helps with vasodilation and blood pressure regulation.
• Omega-3 fatty acidsFatty fish (salmon, mackerel), flaxseed, and walnuts can lower blood pressure and inflammation.
• Coenzyme Q10 (CoQ10): Supports heart function and blood pressure regulation.
• L-citrulline / L-arginine: Can increase NO production and improve vasodilation.

C4. Avoid Other Medicines or Drugs with Risks

• No MAO inhibitors (such as some antidepressants): Enhance the effects of MDMA and increase the risk of hypertensive crisis.
• No other sympathomimetics (such as amphetamines or cocaine)These enhance the blood pressure-raising effects of MDMA.

Conclusion

The combination of MDMA and losartan carries risks, including unpredictable blood pressure fluctuations and increased kidney strain. Although certain measures can help to limit these risks, they do not eliminate the danger completely. It is therefore advisable to avoid the use of MDMA in patients taking losartan or other ARBs, especially those with hypertension, heart or kidney problems.