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Paralytic ileus possibly associated with interaction between ritonavir/lopinavir and vincristine.

Author(s): Leveque D, Santucci R, Pavillet J, Herbrecht R, Bergerat JP

Affiliation(s): Department of Pharmacy Pharmacology, Hopital de Hautepierre, Strasbourg, France. dominique.leveque@chru-strasbourg.fr

Publication date & source: 2009-12, Pharm World Sci., 31(6):619-21. Epub 2009 Sep 10.

Publication type: Case Reports

CASE DESCRIPTION: A French Caucasian man aged 39 with HIV infection was treated with abacavir/lamivudine and ritonavir/lopinavir. The patient (normal renal and liver functions) was diagnosed with a Burkitt lymphoma for which he was treated with cyclophosphamide day 1 to 5; doxorubicin day 1; methotrexate day 10; and vincristine day 1 and 8. At day 12, he suffered from abdominal pain associated with constipation. Paralytic ileus was diagnosed by study imaging. Ileus lasted 10 days necessitating parenteral feeding. Later on, a further cycle of chemotherapy with etoposide replacing vincristine was given and was well tolerated. CONCLUSION: We speculate that an interaction between ritonavir/lopinavir and vincristine was responsible for this severe toxicity. Vincristine is transported by P-gp and is metabolized via CYP3A5. Ritonavir is a potent CYP3A5 isoenzyme and P-gp inhibitor. Lopinavir is also a P-gp inhibitor. Ritonavir and lopinavir might have delayed vincristine elimination. Clinicians should be aware of this possible interaction.

Page last updated: 2010-10-05

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