Interactions between ergotamine-tartrate(ergotamine) and Atazanavir (atazanavir)
ergotamine and atazanavir (Major Drug-Drug)
CONTRAINDICATED: Coadministration with protease inhibitors (PIs), particularly ritonavir, may significantly increase the plasma concentrations of ergot derivatives. The mechanism is PI inhibition of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of ergotamine and related drugs. Clinical ergotism, occasionally resulting in surgical amputation or death, has been reported in patients receiving ergotamine tartrate with ritonavir, indinavir, and/or nelfinavir. Even small, single doses of ergotamine have been involved in clinically significant interactions.
MANAGEMENT: Given the potential for ergot toxicity characterized by peripheral vasospasm, ischemia, thrombosis, tachycardia and hypertension, concomitant use of ergot derivatives with protease inhibitors is considered contraindicated.
