Ergotism is an uncommon cause of peripheral vasoconstriction that manifests differently depending on the arteries involved. Coronary vasospasm is an uncommon and possibly dangerous symptom of ergotism. Ergot alkaloids and their derivatives are metabolized by the cytochrome P-450 isoenzyme CYP3A; consequently, taking ergotamine and a CYP3A inhibitor at the same time considerably raises the risk of ergotism. Darunavir, when combined with cobicistat, effectively suppresses CYP3A. When ergotamine is used with enhanced human immunodeficiency virus protease inhibitors, a few negative interactions have been reported in the literature. For a study, researchers presented a case of a patient who arrived at the emergency department with severe coronary vasospasm caused by the combination of ergotamine with darunavir and cobicistat. Coronary angiography performed in an emergency found no significant atherosclerotic stenosis, but it did demonstrate persistent coronary artery spasm.
The patient recovered completely and was released after immediate cardiac resuscitation, intravenous vasodilator therapy, and 14 days of extracorporeal membrane oxygenation. Concurrent usage of ergot alkaloids and their derivatives might be fatal for individuals receiving cobicistat-boosted darunavir. The conventional treatment for human immunodeficiency virus (HIV) is highly aggressive antiretroviral therapy, and severe medication responses are occasionally recorded.
Reference:journals.sagepub.com/doi/full/10.1177/13596535211068957
