Ergotamine/Lopinavir/ritonavir interaction
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Ergotamine/Lopinavir/ritonavir interaction Ergotism: case report
A 24-year-old woman developed ergotism following concurrent administration of ergotamine and lopinavir/ritonavir [routes and not all dose stated]. The women presented to a hospital with two day history of severe burning leg pain. She had significant history of congenital HIV infection and was receiving treatment with emtricitabine, tenofovir, and lopinavir/ritonavir. Four days prior to the presentation, she had a migraine headache and started receiving ergotamine twice daily. The pain was extended from toe to the midthigh along with discoloration. She also experienced walking difficulty. Examination of both legs revealed dorsalis pedis pulses, cold, and nonpalpable popliteal. Her CT angiography showed symmetric, diffuse, and luminal narrowing of the arteries in both legs. Ergotamine induced ergotism was suspected. Also, study revealed that ritonavir inhibits CYP3A4 enzyme which increased ergotamine concentration in serum leading to vasospastic limb ischemia. Based on these findings ergotism was confirmed. The women started receiving treatment with heparin and prostaglandin leading to gradual improvement in her symptoms. However, she developed gangrene on her left second toe that required amputation. Two weeks later, on follow-up examination no recurrence was observed and her CT angiography revealed improved perfusion on both legs. Reghukumar A, et al. Burning Pain in the Legs. New England Journal of Medicine 383: e18, No. 4, 23 Jul 2020. Available from: URL: http://doi.org/10.1056/ NEJMicm1911089
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Reactions 29 Aug 2020 No. 1819
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