Nirmatrelvir and Dihydroergotamine Injection: Interaction Details

a) A 34-year-old HIV positive woman presented to the emergency room with dizziness, loss of vision, headache, vomiting, diarrhea, and feeling of cold in her left foot after receiving ergotamine tartrate and ritonavir. Her current drug regimen included ritonavir, lamivudine and stavudine, which she had been taking for the past 3 years to treat HIV infection. She had taken three ergotamine tartrate tablets during the 4 days preceding the onset of signs and symptoms. Physical exam revealed an arterial blood pressure of 160/60 mm Hg, a heart rate of 80 beats/min, the absence of peripheral pulses in all 4 extremities, and acral cyanosis. The patient went in and out of consciousness throughout her stay in the emergency room. She was admitted to the ICU and 24 hours later had a decrease in level of consciousness, as well as arterial hypotension, and orotracheal intubation was necessary. Systemic arteriography demonstrated signs of stenosis and vasospasm in medium and large vessels that diffusely affected the mesenteric, renal, femoral, humeral, and internal carotid arteries, with cerebral hypoperfusion. There was no response to intra-arterial infusion of nimodipine. Treatment with a perfusate containing dobutamine, corticosteroids, and heparin was initiated, but there was no response to treatment. Alprostadil was added to the perfusate for 7 days, but there was no response to treatment. The patient's neurological state deteriorated and she remained in coma vigil. Multiple subcortical infarcts were revealed on a cranial CT scan. Arteriography performed one month after the onset of symptoms revealed vasospasm to have disappeared from all previously involved arteries. Two years after the diagnosis was made there was no change in the patient's neurological state (coma vigil) ¹.