Ergotism in Thailand caused by increased access to antiretroviral drugs: a global warning
Anchalee Avihingsanon, Reshmie A Ramautarsing, Gompol Suwanpimolkul, Ploenchan Chetchotisakd, Chureeratana Bowonwatanuwong, Supunnee Jirajariyavej, Patcharee Kantipong, Hutsaya Tantipong, June Pirapon Ohata, Chusana Suankratay, Kiat Ruxrungtham, David M Burger, Anchalee Avihingsanon, Reshmie A Ramautarsing, Gompol Suwanpimolkul, Ploenchan Chetchotisakd, Chureeratana Bowonwatanuwong, Supunnee Jirajariyavej, Patcharee Kantipong, Hutsaya Tantipong, June Pirapon Ohata, Chusana Suankratay, Kiat Ruxrungtham, David M Burger
Abstract
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).
Conflict of interest statement
Financial Affiliations: Drs Avihingsanon, Ramautarsing, Suwanpimolkul, Chetchotisakd, Bowonwatanuwong, Jirajariyavej, Kantipong, Tantipong, Suankratay, and Burger and Miss Ohata have no relevant financial affiliations to disclose. Dr Ruxrungtham has received grants awarded to his institution from Merck & Co, Inc, and Tibotec and has received payment directly from Bristol-Meyers Squibb, Merck & Co, Inc, Roche, Janssen Cilag, GlaxoSmithKline, and The Government Phar maceutical Organization (GPO; Bangkok, Thailand) for lecture(s), including service on speakers bureaus.
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Source: PubMed