Ergotism in Thailand caused by increased access to antiretroviral drugs: a global warning

• Published in: Topics in antiviral medicine Vol. 21; no. 5; pp. 165 - 168
• Main Authors: Avihingsanon, Anchalee, Ramautarsing, Reshmie A, Suwanpimolkul, Gompol, Chetchotisakd, Ploenchan, Bowonwatanuwong, Chureeratana, Jirajariyavej, Supunnee, Kantipong, Patcharee, Tantipong, Hutsaya, Ohata, June Pirapon, Suankratay, Chusana, Ruxrungtham, Kiat, Burger, David M
• Format: Journal Article
• Language: English
• Published: United States IAS-USA 2014
• Subjects: Adult; Anti-Retroviral Agents - adverse effects; Anti-Retroviral Agents - therapeutic use; Cases From the Field; Drug Interactions; Ergotamine - adverse effects; Ergotamine - therapeutic use; Ergotism - diagnosis; Ergotism - pathology; Female; HIV Infections - complications; HIV Infections - drug therapy; HIV Protease Inhibitors - adverse effects; HIV Protease Inhibitors - therapeutic use; Humans; Leg - pathology; Male; Middle Aged; Thailand; Thailand
• ISSN: 2161-5861; 2161-5853

Ergotism is a toxic condition resulting from overexposure to the ergot compounds produced by various fungi of the genus Claviceps. Traditionally, such exposure was due to ingestion of infected grains, but long-term or excessive use of medications containing ergot derivatives or drug-drug interactions between these medications can result in ergotism. Ergotamine, typically used to treat migraine, has less than 5% bioavailability due to extensive first-pass metabolism by cytochrome P450 3A4 (CYP3A4). Concurrent intake of ergotamine and strong CYP3A4 inhibitors, such as the HIV protease inhibitors (PIs), can lead to clinical ergotism. A total of 13 cases of clinical ergotism in HIV-infected patients has been published since 1997 (most recently reviewed by Frohlich et al).