Life-threatening interactions between HIV-1 protease inhibitors and the illicit drugs MDMA and gamma-hydroxybutyrate

Arch Intern Med. 1999 Oct 11;159(18):2221-4. doi: 10.1001/archinte.159.18.2221.


Human immunodeficiency virus 1 (HIV-1) protease inhibitors have dramatically reduced the morbidity and mortality due to HIV-1 infection. However, most of these antiretrovirals are also potent inhibitors (and occasionally inducers) of hepatic and intestinal cytochrome P450 systems and, therefore, have the potential to alter the elimination of any substance that utilizes these metabolic pathways. We describe a patient infected with HIV-1 who was treated with ritonavir and saquinavir and then experienced a prolonged effect from a small dose of methylenedioxymetamphetamine (MDMA or ecstacy) and a nearly fatal reaction from a small dose of gamma-hydroxybutyrate (GHB). We also discuss the potential for HIV-1 protease inhibitors to alter the metabolism of other abusable prescribed and illicit substances.

Publication types

  • Case Reports

MeSH terms

  • Acquired Immunodeficiency Syndrome / drug therapy*
  • Adrenergic Uptake Inhibitors / adverse effects*
  • Adult
  • Anesthetics / adverse effects*
  • Drug Synergism
  • HIV Protease Inhibitors / pharmacology*
  • Hallucinogens / adverse effects*
  • Humans
  • Male
  • N-Methyl-3,4-methylenedioxyamphetamine / adverse effects*
  • Ritonavir / pharmacology*
  • Saquinavir / pharmacology*
  • Sodium Oxybate / adverse effects*


  • Adrenergic Uptake Inhibitors
  • Anesthetics
  • HIV Protease Inhibitors
  • Hallucinogens
  • Sodium Oxybate
  • N-Methyl-3,4-methylenedioxyamphetamine
  • Saquinavir
  • Ritonavir