Indinavir Ergotamine

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Pregnancy (ergotamine s powerful uterine stimulant actions may cause fetal harm) hypersensitivity to ergot alkaloids peripheral vascular disease (eg, thromboangiitis obliterans, leutic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease) hepatic or renal impairment severe pruritus coronary artery disease hypertension sepsis. The use of potent CYP3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is contraindicated. 

Rosenthal E, Sala F, Chichmanian RM, Batt M, Cassuto JP. Ergotism related to concurrent administration of ergotamine tartrate and indinavir. JAMA 1999 281(11) 987. 

See (c) ritonavir below for details regarding a fatality involving indinavir, ritonavir and ergotamine. 

A fatality has been reported in a 49-year-old man taking ritonavir 200 mg twice daily and indinavir 800 mg twice daily in addition to stavu-dine and lamivudine. After taking three tablets of Cafergot (ergotamine tartrate 1 mg and caffeine 100 mg) his headache worsened, he developed progressive lower extremity weakness, severe peripheral vasoconstriction, labile hypertension and livedo reticularis (skin discolouration due to underlying capillary changes). He lapsed into coma and on day 5 was declared brain dead . ... 

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