What is the clinically relevant metabolic pathway of the toxin produced by Claviceps Purpurae?
Ergotamines are CYP3A4 substrates. In combination with inhibitors of CYP3A4, such as antiretrovirals used to treat HIV, life and limb threatening vasospasm can result.
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Petit E, Schoonheydt K, Meert P, Van Laer M. Drug-Drug Interaction of Ergotamine with a Combination of Darunavir, Abacavir, and Lamivudine Causing a Fatal Vasospastic Ischemia. Case Rep Emerg Med. 2018 Dec 19;2018:4107450. doi: 10.1155/2018/4107450. PMID: 30662776; PMCID: PMC6313968.