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[Ergotism and HIV].

Bárbara C Finn1, Sabrina Vadalá, Ana Meraldi

  • 1Servicio de Clínica Médica, Hospital Británico de Buenos Aires, Buenos Aires, Argentina.

Medicina
|August 9, 2013
PubMed
Summary
This summary is machine-generated.

Ergotism, a vascular condition, can occur when HIV patients take ergotamine with protease inhibitors. Discontinuing these drugs and using other treatments improved patient symptoms.

Keywords:
ergotamineergotismmigraineritonavir

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Area of Science:

  • Pharmacology
  • Cardiology
  • Infectious Diseases

Background:

  • Ergotism is a serious complication of ergot derivative intoxication.
  • It manifests as a vasomotor syndrome leading to peripheral vascular disease, often affecting extremities.

Observation:

  • Four HIV-1 infected patients on antiretroviral therapy, including boosted-protease inhibitors, self-treated with ergotamine.
  • These patients presented with symptoms of peripheral vascular disease, including diminished or absent pulses.
  • Arterial Doppler studies revealed diffused arterial spasm in two patients.

Findings:

  • A diagnosis of ergotism was made due to the association of ergotamine and protease inhibitors.
  • Treatment involved drug discontinuation (protease inhibitors and ergotamine), calcium channel blockers, enoxaparin for antithrombotic prophylaxis, and acetylsalicylic acid for antiplatelet therapy.
  • One patient also received pentoxifylline and vasodilator prostaglandins, leading to symptom improvement.

Implications:

  • This case series highlights a significant drug interaction between ergotamine and boosted-protease inhibitors.
  • Early diagnosis of this drug interaction is crucial and requires a high index of clinical suspicion.
  • Managing ergotism in this context involves a multi-faceted approach including drug cessation and supportive therapies.