Hi, It is not recommended to take MDMA (also known as ecstasy) while on azathioprine. Azathioprine is an immunosuppressant medication used to treat autoimmune disorders, and it can affect the liver s ability to break down certain drugs, including MDMA. This can lead to increased levels of MDMA in the body, which can be dangerous and increase the risk of side effects and toxicity. Additionally, MDMA can increase the activity of the immune system, which may counteract the effects of azathioprine and increase the risk of autoimmune reactions. It is important for your friend to talk to their healthcare provider about any planned recreational drug use and to follow their recommendations. It is also important to note that MDMA use can have significant risks and can cause a range of short- and long-term health effects, including increased heart rate, high blood pressure, dehydration, and damage to the brain and other organs. Take care. Hope I have answered your question. Let me know if I can assist you further. Regards, Dr. Priyanka, General & Family Physician