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Pharmacy World & Science

, 31:619 | Cite as

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

  • Dominique LevêqueEmail author
  • Raoul Santucci
  • Julien Pavillet
  • Raoul Herbrecht
  • Jean Pierre Bergerat
Case Report

Abstract

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.

Keywords

Drug–drug interaction Paralytic ileus Ritonavir/lopinavir Vincristine 

Notes

Funding

None.

Conflict of interest statement

None.

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Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Dominique Levêque
    • 1
    Email author
  • Raoul Santucci
    • 1
  • Julien Pavillet
    • 2
  • Raoul Herbrecht
    • 2
  • Jean Pierre Bergerat
    • 2
  1. 1.Department of Pharmacy PharmacologyHôpital de HautepierreStrasbourgFrance
  2. 2.Department of Oncology HematologyHôpital de HautepierreStrasbourgFrance

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