A An HIV-positive man taking
ritonavir and saquinavir died after also taking
metamfetamine and amyl nitrate. Toxicology reported extremely high metamfeta- mine levels, which were attributed to an interaction with
ritonavir. A reaction similar to the
serotonin syndrome and haemolytic
anaemia has also been reported in patients taking ecstasy with
ritonavir and metamfetamine with indinavir, respectively.
Patients should be made aware of the additional potential risks of using
amfetamines with
ritonavir. Appropriate precautions, apart from avoidance, include a reduction of the usual dose of ecstasy to about 25%, taking breaks from dancing, checking that a medical team are on site, maintaining adequate hydration by avoiding
alcohol, and replenishing fluids regularly.