Important note: Information in this article was accurate in January 1999. The state of the art may have changed since the publication date.AIDSWEEKLY Plus; Monday, January 11, 1999
Daniel J. DeNoon, Senior Editor
An AIDS patient taking ritonavir died after ingesting the illicit drug known as Ecstasy (3,4-methylenedioxymethamphetamine or MDMA).
U.K. physicians reporting the case suggest that all amphetamine derivatives may be dangerous in people taking ritonavir, which inhibits the CYP2D6 liver enzyme responsible for demethylenation.
"Ritonavir could interact with many drugs that are metabolized by CYP2D6, including amphetamine derivatives," warned J.A. Henry and I.R. Hill of St. Mary's Hospital, London, in the journal The Lancet ("Fatal Interaction Between Ritonavir and MDMA," Lancet, 1998;352:1751-2). "Manufacturers' instructions should contain the appropriate warnings of the danger of interactions with illicit drugs."
The patient was a 35-year-old man diagnosed with AIDS in 1995. He had a prior history of heavy alcohol use and abnormal liver function. He had recently reduced his alcohol intake and his liver function improved but aspartate transaminase levels remained very high (173 IU/L, normal range 11-55 IU/L).
Within four hours of taking an estimated MDMA dose of 180 mg, the patient became ill and was assessed by a nurse as hypertonic, profusely sweating, tachycardic, and cyanosed. He was able to give a history to physicians, but 25 minutes after presentation he had an apparent tonic-clonic convulsion. Soon afterwards he died of a cardiorespiratory arrest.
Upon autopsy, the toxicology report showed a blood level of 4.56 mg/L MDMA, 3,4-methylenedioxyamphetamine of 0.36 mg/L, and ethanol of 0.24 g/L.
Henry and Hill advise that patients with severe MDMA reactions should immediately be transferred to hospital.
The corresponding author for this report is J.A. Henry, Academic Department of Accident and Emergency Medicine, Imperial College School of Medicine, St. Mary's Hospital, London W2 1NY, U.K. Email: <j.a.henry@ic.ac.uk>.
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