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de la Torre R, Ortuno J, Mas M, Farre M, Segura J. 
“Fatal MDMA intoxication”. 
Lancet. 1999 Feb 13;353(9152):593.
Sir--J A Henry and I R Hill (Nov 28, 1751) report a fatal interaction between ritonavir and 3,4-methylenedioxymethamphetamine (MDMA, 'Ecstasy'). MDMA plasma concentrations measured in their patient largely exceeded those expected after ingestion of 180 mg MDMA. They argue that concomitant treatment with ritonavir could be responsible for a metabolic interaction between both drugs, leading to toxic concentrations of MDMA, and that CYP2D6 (a polymorphic isoenzyme of cytochrome P450) would be involved in such interaction. Ritonavir is mainly a CYP3A substrate and secondarily a CYP2D6 and CYP2C9 substrate. Clinical interactions reported until now with CYP2D6 substrates seem less relevant than those associated with CYP3A...
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