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.
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