MDMA in Subjects With Moderate Hepatic Impairment and Subjects With Normal Hepatic Function

  • End date
    Dec 28, 2021
  • participants needed
  • sponsor
    Multidisciplinary Association for Psychedelic Studies
Updated on 28 February 2021
drugs of abuse
alcohol test
12 lead ECG
moderate hepatic insufficiency


This study is an open-label, single dose study evaluating the effect of moderate hepatic impairment in the pharmacokinetics of MDMA and its active metabolite, 3,4-methylene-dioxyamphetamine (MDA) in order to decide whether an adjustment to the dosage would be need for individuals with moderate hepatic function in comparison to individuals with normal liver function. Eight participants with moderate hepatic impairment and eight matched participants with normal hepatic function will take part in this study. All patients will be evaluated to see if they meet criteria for study participation, with screening including a physical examination including a 12-lead electrocardiogram (ECG) and questions about mental and physical health. Participants who meet study criteria will stay at the study site for three days. On Day 1, they will receive a single dose of 80 mg MDMA. For the next seven to eight hours, participants will have blood collected and will rate their mood and other experiences. They will stay at the study sight for two more days. Blood will be drawn twice on the second day and once on the third day, and they will have their heart function measured with ECG. Blood will be collected periodically during a 12-hour interval on the day of drug administration. Blood will also be drawn 24, 36, 48, 72 and 96 hours after MDMA administration. Participant mood and feelings or experiences on-drug (subjective effects) will be measured a half-hour, one, two, four, six, and seven hours after receiving MDMA. ECG will be performed every day at the same time upon enrollment (Day -4 or -3) and from the Day 1 (day of drug administration) to Day 5. Blood pressure, heart rate and body temperature on Day 1 through 5. Blood samples will be used to compute the peak or maximum amount of MDMA and MDA in blood (Cmax), the time until reaching peak MDMA or MDA (Tmax) and the area under curve (AUC), or actual degree of exposure to drug. The primary outcome measure will be AUC for MDMA. Finding out if there are differences in drug metabolism between people with normally functioning livers and people whose livers do not function normally will help researchers performing MDMA-assisted psychotherapy.


PTSD is a serious debilitating disorder that negatively impacts a person's daily life. 3,4-methylenedioxymethamphetamine (MDMA) is a ring-substituted phenylisopropylamine derivative that releases serotonin, norepinephrine and dopamine. MDMA has been shown to reduce defenses and fear of emotional injury, enhance communication, and increase empathy, creating productive psychological state that enhances the therapeutic process for the treatment of PTSD and other anxiety disorders. This is supported by data from an international series of Phase 2 pilot studies of MDMA-assisted psychotherapy conducted by the sponsor that provide preliminary evidence that chronic PTSD, independent of cause, is treatable with two to three sessions of MDMA-assisted psychotherapy and associated non-drug preparatory and integrative psychotherapy. The results from multiple independent studies in Phase 2 efficacy analyses demonstrate superiority of MDMA-assisted psychotherapy over psychotherapy with placebo and low dose MDMA.

This protocol is for a Phase 1, open-label study with a primary purpose of evaluating the effect of moderate hepatic impairment in the pharmacokinetics of MDMA and its active metabolite, 3,4-methylene-dioxyamphetamine (MDA), and determining whether an adjustment to the dosage would be indicated in this group of patients in comparison to patients with normal liver function. Because people with moderate hepatic impairment may experience greater exposure to drug than people without it, the secondary purpose of this study is to evaluate the effect of moderate hepatic impairment on the safety and tolerability of oral MDMA, with special attention to ECG data. The study will enroll eight participants, ages 18 to 65 years old, with moderate hepatic impairment, and eight healthy controls with normal hepatic function who are matched with participants with moderate impaired hepatic function on the basis of age, weight and gender.

Participants who give their written informed consent will be screened for study participation that will include a physical examination, assessing current and prior medical and physical health, and a baseline electrocardiogram (ECG) reading. If applicable, they may begin tapering off any contraindicated psychiatric medication. Participants who meet study criteria will receive a single dose of 80 mg MDMA on the first day of a three-day stay at the study site. Blood will be collected periodically in order to calculate pharmacokinetics of MDMA and its active metabolite methylenedioxyamphetamine (MDA). Blood will be collected ten times on Day 1 (-5 min, 0 hours (drug administration), 0.5 h, 1, 2, 4, 6, 7, 10 and 12 hours), starting five minutes before drug administration. Subjective effects of MDMA will be assessed through 15 visual analog scales at similar time points to blood collection, at 0.5, 1, 2, 4, 6 and 7 hours post-drug. There will be six 12-lead ECG measurements on Day 1. Participants will remain at the study site for two more days. Drug safety will be assessed by measuring blood pressure, heart rate and body temperature after MDMA administrations, collecting adverse events throughout the study and measuring suicidal thoughts or behaviors with the Columbia Suicide Severity Rating Scale (C-SSRS). Blood will be collected 24 and 36 hours after drug administration, and ECG will be performed on Day 2, and a single ECG and blood draw will occur on Day 3, 4 and 5. Participants will return for eight and 15 days after drug administration. They will have a single blood draw on each day. The study ends 15 days after drug administration, approximately one month after screening.

The primary outcome measure will be area under the curve from dosing to last dose (AUC) of MDMA and MDA. AUC will be computed from plasma collected multiple times after a single dose of MDMA, twice on the day following the day of drug administration, and once daily for three more days. Other pharmacokinetic measures will be maximal values of MDMA and MDA (Cmax), and time to reach maximum MDMA and MDA levels (Tmax). Safety measures will also include a comparison of subjective effects across groups, ECG readings, number of adverse events, and suicidal ideation or behavior as measured via C-SSRS during the study.

Condition Pharmacokinetics, Pharmacokinetic aspects, Hepatic Impairment
Treatment MDMA
Clinical Study IdentifierNCT03606538
SponsorMultidisciplinary Association for Psychedelic Studies
Last Modified on28 February 2021


Yes No Not Sure

Inclusion Criteria

Is your age between 18 yrs and 65 yrs?
Gender: Male or Female
Do you have any of these conditions: Pharmacokinetic aspects or Pharmacokinetics or Hepatic Impairment?
Do you have any of these conditions: Hepatic Impairment or Pharmacokinetic aspects or Pharmacokinetics?
Do you have any of these conditions: Pharmacokinetics or Pharmacokinetic aspects or Hepatic Impairment?
Do you have any of these conditions: Hepatic Impairment or Pharmacokinetic aspects or Pharmacokinetics?
Do you have any of these conditions: Hepatic Impairment or Pharmacokinetic aspects or Pharmacokinetics?
Do you have any of these conditions: Pharmacokinetic aspects or Hepatic Impairment or Pharmacokinetics?
Participants with moderate hepatic impairment (class B according to Child- Pugh's criteria)
Participants with normal hepatic function: no clinically significant findings from medical history, physical examination, laboratory values within protocol defined parameters
Age 18 to 65 years
Weight > 45 kg
Negative Carbohydrate Deficient Transferrin blood test at Screening and negative breathalyzer alcohol test prior to trial drug administration
Negative urine test for drugs of abuse at Screening and prior to trial drug administration
Able to comprehend and willing to sign an informed consent form

Exclusion Criteria

Have a current psychiatric diagnosis
Are pregnant or nursing, or are women of child bearing potential who are not practicing an effective means of birth control
Have acute or exacerbating hepatitis, fluctuating or rapidly deteriorating hepatic function as indicated by widely varying or worsening of clinical and/or laboratory signs of hepatic impairment within 2 weeks
Have autoimmune liver disease; esophageal variceal bleeding within 6 months prior to screening, unless successfully treated with banding, or gastric varices
Have spontaneous bacterial peritonitis within 3 months prior to screening
Have a portosystemic shunt, organ transplant, Wilson's disease, cholestatic liver disease (e g, primary biliary cirrhosis or primary sclerosing cholangitis)
Evidence or history of significant hematological, endocrine, cerebrovascular, cardiovascular (including controlled hyper-tension), coronary, pulmonary, renal, gastrointestinal, immunocompromising, or neurological disease, including seizure disorder, or any other medical disorder judged by the investigator to significantly increase the risk of MDMA administration
For moderate hepatic impairment participants: have clinically significant laboratory findings except as related to hepatic impairment
For control participants only: have clinically significant laboratory results outside the normal limits, including AST >48 U/L, ALT > 55 U/L, GGT > 48 U/L, bilirubin > 1.2 mg/dL or hemoglobin < 12 g/dL
Have a history of any illness that, in the opinion of the Investigator, might confound the results of the trial or pose risk in administering the trial drug to the subject
Have any positive test for drugs of abuse and /or alcohol at screening
Have a history or presence of clinically significant abnormal 12-lead ECG or an ECG with QTc by Bazett's correction of > 450 ms in men, > 470 ms in women on the screening ECG
Have a PR interval > 240 ms, QRS > 110 ms or a history of prolongation of QT interval
Have mental incapacity, unwillingness or language barriers precluding adequate understanding or subject co-operation
Are unwilling to stay in the clinical unit for the required duration as per the protocol
Have a history of multiple and/or severe allergies to drugs or foods or a history of severe anaphylactic reaction
Have a known or suspected allergy to trial product or related products
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