title: Ergotism in Thailand caused by increased access to antiretroviral drugs: a global warning.
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).
authors: HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors: Anchalee
authors: A
authors: Avihingsanon
authors: HIV-NAT Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors: Reshmie A
authors: RA
authors: Ramautarsing
authors: Chulalongkorn University, Bangkok, Thailand.
authors: Gompol
authors: G
authors: Suwanpimolkul
authors: Khon Kaen University, Khon Kaen, Thailand.
authors: Ploenchan
authors: P
authors: Chetchotisakd
authors: Chonburi Hospital, Chonburi, Thailand.
authors: Chureeratana
authors: C
authors: Bowonwatanuwong
authors: Taksin Hospital, Bangkok, Thailand.
authors: Supunnee
authors: S
authors: Jirajariyavej
authors: Chiang Rai Hospital, Chiang Rai, Thailand.
authors: Patcharee
authors: P
authors: Kantipong
authors: Chonburi Hospital, Chonburi, Thailand.
authors: Hutsaya
authors: H
authors: Tantipong
authors: e HIV-NAT Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors: June Pirapon
authors: JP
authors: Ohata
authors: Chulalongkorn University, Bangkok, Thailand.
authors: Chusana
authors: C
authors: Suankratay
authors: HIV-NAT Research Collaboration, Thai Red Cross AIDS Research Center, Bangkok, Thailand.
authors: Kiat
authors: K
authors: Ruxrungtham
authors: Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors: David M
authors: DM
authors: Burger
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D004347:Drug Interactions; D004878:Ergotamine / Q000009:adverse effects* / Q000627:therapeutic use; D004881:Ergotism / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007866:Leg / Q000473:pathology; D008297:Male; D008875:Middle Aged; D013785:Thailand
chemical_list: D044966:Anti-Retroviral Agents; D017320:HIV Protease Inhibitors; D004878:Ergotamine