Sex Differences in the Effects of MDMA (Ecstasy) on Plasma Copeptin in Healthy Subjects

• Published in: The journal of clinical endocrinology and metabolism Vol. 96; no. 9; pp. 2844 - 2850
• Main Authors: Simmler, Linda D., Hysek, Cédric M., Liechti, Matthias E.
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Oxford University Press 01.09.2011; Copyright by The Endocrine Society; Endocrine Society
• Subjects: Adult; Arginine Vasopressin - blood; Argipressin; Biological and medical sciences; Cross-Over Studies; Drug abuse; Duloxetine; Duloxetine Hydrochloride; Ecstasy; Endocrinopathies; Feeding. Feeding behavior; Female; Females; Fundamental and applied biological sciences. Psychology; Gender differences; Glycopeptides - blood; Humans; Hyponatremia; Kidney; Male; MDMA; Medical sciences; N-Methyl-3,4-methylenedioxyamphetamine - pharmacology; Norepinephrine; Norepinephrine transporter; Osmolar Concentration; Placebos; Plasma; Secretion; Serotonin; Serotonin Agents - pharmacology; Serotonin transporter; Serotonin Uptake Inhibitors - pharmacology; Sex Characteristics; Sex differences; Sodium; Thiophenes - pharmacology; Urine; Vasopressin; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Human; Obesity; Healthy subject; Nutrition; Nutrition disorder; Sex; Metabolic diseases; Male; Blood plasma; Copeptin; Female; Drug of abuse; Endocrinology; Nutritional status; Comparative study; Recreational drug
• ISSN: 0021-972X; 1945-7197; 1945-7197
• DOI: 10.1210/jc.2011-1143

Background:3,4-Methylenedioxymethamphetamine (MDMA, ecstasy) misuse is associated with hyponatremia particularly in women. Hyponatremia is possibly due to inappropriate secretion of plasma arginine vasopressin (AVP).Objective:To assess whether MDMA increases plasma AVP and copeptin in healthy male and female subjects and whether effects depend on MDMA-induced release of serotonin and norepinephrine. Copeptin, the C-terminal part of the AVP precursor preprovasopressin, is cosecreted with AVP and can be determined more reliably.Methods:We used a randomized placebo-controlled crossover design. Plasma and urine osmolalities as well as AVP and copeptin levels were measured in 16 healthy subjects (eight female, eight male) at baseline and after MDMA (125 mg) administration. In addition, we tested whether effects of MDMA on AVP and copeptin secretion can be prevented by pretreatment with the serotonin and norepinephrine transporter inhibitor duloxetine (120 mg), which blocks MDMA-induced transporter-mediated release of serotonin and norepinephrine.Results:MDMA significantly elevated plasma copeptin levels at 60 min and at 120 min compared with placebo in women but not in men. The copeptin response to MDMA in women was prevented by duloxetine. MDMA also nonsignificantly increased plasma AVP levels in women, and the effect was prevented by duloxetine. Although subjects drank more water after MDMA compared with placebo administration, MDMA tended to increase urine sodium levels and urine osmolality compared with placebo, indicating increased renal water retention.Conclusion:MDMA increased plasma copeptin, a marker for AVP secretion, in women but not in men. This sex difference in MDMA-induced AVP secretion may explain why hyponatremia is typically reported in female ecstasy users. The copeptin response to MDMA is likely mediated via MDMA-induced release of serotonin and/or norepinephrine because it was prevented by duloxetine, which blocks the interaction of MDMA with the serotonergic and noradrenergic system.