MDMA for Health & Longevity - Quick Reference Sheet
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MDMA for Health & Longevity

Created on 09/12/2026 – Quick Reference based on Evidence Review created using AI4L / Opus 5 – Audit

MDMA floods the brain with serotonin and oxytocin, producing hours of warmth, openness and a marked drop in fear. The strongest benefit evidence is lasting reduction in trauma symptoms, with weaker signals for sleep, heavy drinking, disordered eating and social anxiety in autistic adults. Severe harms track dose, setting and contaminated illicit material. Both promise and doubt remain unresolved. (Full Review)

Protocol

Dose
80 or 120 mg
MDMA hydrochloride, with an optional supplemental 40 mg or 60 mg at 90 to 120 minutes; session total 80–180 mg. Weight-adjusted dosing was not used.
Standard supervised regimen
3 sessions, 3–5 weeks apart
Eight-hour dosing sessions, each preceded and followed by non-drug therapy — three preparatory and three integrative sessions — with two therapists present throughout.
Time of day
9 to 10 am
Morning dosing, so the acute phase ends by late afternoon and sleep onset is not displaced. Later dosing regularly produces a sleepless night.
Time to effect
Post-traumatic stress symptoms
1–2 months
Therapeutic change is measured one to two months after the final session, not after the first.
Social closeness and emotional openness
30–60 minutes
Subjective effects begin 30 to 60 minutes after an oral dose and last four to six hours.
Sleep quality
By treatment exit
Measured sleep quality improved by treatment exit, with a further gain between exit and 12-month follow-up.

Benefits

Contraindications
  • Monoamine oxidase inhibitors (phenelzine, tranylcypromine, selegiline, moclobemide, linezolid), or within 2 weeks of stopping one
  • Ritonavir-boosted antiretroviral regimens
  • Coronary artery disease, myocardial infarction within 6 months, uncontrolled arrhythmia, or corrected QT interval above 450 ms in men or 470 ms in women
  • Uncontrolled hypertension (above 140/90 mmHg on repeated measurement)
  • Heart failure of New York Heart Association class III or IV, or known valvular heart disease
  • Liver impairment of Child-Pugh class B or C, or active hepatitis with transaminases above three times the upper reference limit
  • Kidney impairment with estimated glomerular filtration rate below 60 mL/min/1.73 m², or a history of hyponatraemia
  • Psychotic disorders, bipolar I disorder, or a first-degree family history of psychosis
  • Pregnancy and breastfeeding
  • Uncontrolled diabetes
    •
Key Interactions
  • Serotonin reuptake inhibitors (fluoxetine, sertraline, paroxetine, citalopram, venlafaxine, duloxetine)
  • CYP2D6 inhibitors (paroxetine, fluoxetine, bupropion, quinidine, ritonavir, terbinafine)
  • Over-the-counter dextromethorphan-containing cough preparations, and diphenhydramine
  • Over-the-counter pseudoephedrine and phenylephrine decongestants
  • St John's wort, 5-HTP (5-hydroxytryptophan), L-Tryptophan and Syrian rue extracts
  • Supplements with additive cardiovascular or thermogenic effects (yohimbine, synephrine, high-dose caffeine, ephedra-containing products)
  • Alcohol, cocaine, amphetamines and cannabis
    •

Risk & Side Effects

  • High: Acute rise in blood pressure and heart rate; acute hyponatraemia; acute hyperthermia; short-term physical side effects
    •
  • Medium: Neurocognitive impairment with repeated heavy use; post-dose low mood; fatal acute toxicity outside controlled settings; contaminated or misidentified illicit supply
    •
  • Low: Acute liver injury; serotonin toxicity with serotonergic medication; compulsive use and dependence; emergent suicidal ideation during treatment; developmental neurotoxicity in pregnancy
    •
  • Speculative: Cardiac valve thickening from repeated exposure
    •

Monitoring

Marker Target Why
Serum sodium 138–142 mEq/L Detects the sodium fall MDMA causes
Home blood pressure Below 120/80 mmHg seated at rest Establishes headroom for the acute sympathomimetic surge
Resting heart rate 50–70 beats per minute Baseline for the 20–40 beat rise MDMA produces
Core body temperature 36.5–37.2 °C Hyperthermia is the dominant fatal mechanism
ALT and AST 10–26 U/L each Screens for the hepatotoxicity seen in case reports
eGFR Above 90 mL/min/1.73 m² Impaired clearance compounds hyponatraemia and toxicity risk
Corrected QT interval on electrocardiogram Below 440 ms in men, below 460 ms in women Identifies arrhythmia risk before a sympathomimetic challenge
PCL-5 Below 31 points The primary outcome any course is judged against
PSQI 5 or below Sleep is the most persistent residual symptom after trauma
CYP2D6 genotype No established target; normal metaboliser status is the reference Poor metabolisers reach higher exposures from the same dose

Cadence: Full baseline panel before any exposure. Vital signs at baseline and hourly for six hours during each dosing session. Sodium, liver enzymes and kidney function one week after each session; symptom and sleep scores at one and two months after the final session; full panel plus electrocardiogram at 6 and 12 months.

Qualitative Assessment

  • Emotional range and the ability to recall difficult events without physical panic
  • Nightmare frequency and time to fall asleep
  • Willingness to enter social situations previously avoided
  • Startle response and baseline irritability
  • Alcohol and other substance use in the weeks after each session
  • Cognitive clarity, word-finding and short-term memory in the fortnight after dosing
  • Jaw soreness, tooth sensitivity and appetite recovery in the days after dosing
Not medical advice. Educational distillation of a single evidence review. Confirm any decision with a qualified clinician, especially in the presence of prescription drugs or chronic conditions.