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Ritonavir & MDMA :(

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happykitty

Bluelighter
Joined
Mar 28, 2009
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I wasn't sure where to put this - So, i've just had to start taking the protease inhibitor, Ritonavir, and am dismayed to read that I can never take MDMA again :! :( My question is: is this absolutely set in stone, not even smaller amounts? Is there any alternative? (are any of the other protease inhibitors ok?) I guess I'm not super fussed - just human nature to dislike finality!
 
I don't really know but from what I have read...maybe Ritonavir inhidits the enzymes needed to metabolize MDMA and that is the cause. Concidering what the durg is used for I would say you should worry more about getting healthy before thinking about rolling. But you last comment seems to imply a rather bleak out look for your situation.

If you are set on rolling again the only thing you can do is talk with your doctor and see if there is another drug that is just as effective as Ritonavir but may still allow you to feel the effects of MDMA.
 
Oh my, I think you've got me all wrong here - I look after myself (and am in fact quite healthy otherwise - no coinfections etc. - not so sure what you were implying there?) No bleak outlook - I'm fortunate enough to have a wonderful fiancee, and a lovely, supportive family. And given that my current regime is working, I think changing it for the sake of being able to take MDMA would be very silly :) I've been reading more and more about Retonavir - and there are a lot of things that you can't take with it (due to it inhibiting CYP3A4) - guess I've just answered my own question!
 
I didn't mean to sound like and ass or anything :)

But the last line of your post made it sound like you weren't in very good shape...I am glad to hear your are in good health. You are most deffinately right, If your regimine is working you should stick with it. But really the only thing you can do is have a frank conversation about it with your doctor.

Who knows, you may be in a situation somewhere down the line where stopping or switching meds so that you could experience E again is possible.
 
Hey no probs :)

Sounds like there are some interesting/promising things in the pipeline, but being a scientist, I have my skeptic's hat on!
 
Because the ritonavir inhibits one of the enzymes that breaks down MDMA, it can increase the potency of the MDMA, which can increase the risk of overdose.

This isn't an insurmountable problem. As long as you are cautious in the dosage of MDMA that you take, it should be possible to safely use while on this medication. (So, start with a small dose and see how things go if you're determined to try it.)

One of the unknowns that I think deserves mention is that MDMA is hard on your immune system. Even with medication, you are partly relying on the health of your immune system to keep the HIV virus in check, so it may be possible that using MDMA (or any other drug use that stresses the system) could reduce your resistance to the HIV infection getting worse.

If you really want to try it, I think it can be done with reasonable safety, but don't make a habit of it and keep dosages reasonably low.
 
OK...so feeling the effects of MDMA on Ritonavir is possible but the danger comes in the potentiating effects and the fact that it will take longer to be metabolized?

I guess I never really thought of it from that angle...I am so used to people taking meds that limit the effects of MDMA it never occured to me that it may be the other way around.
 
The fact that it will take longer to be metabolized is what potentiates the effects, in this case to potentially overdose levels. This isn't really something to kid around with, as there have been reported deaths from naively combining Ritonavir and MDMA: Erowid: Interaction between MDMA and Ritonavir (Norvir).

Like TheDEA said, it *may* be possible to use MDMA on Ritonavir, but you'd have to be *extremely* careful with the dosage. Off the top of my head, I believe something like 60% of the initial dose is metabolized by CYP3A4, with the rest being metabolized by CYP2D-family enzymes and COMT. In people with a genetic CYP2D6 deficiency this balance will weigh even more heavily in the direction of CYP3A4, and this isn't even considering that Ritonavir is a mild CYP2D6 inhibitor in its own right.

Personally, I wouldn't risk it -- there's just too much to lose for too little gain. If you still feel strongly about it, I would start with a sub-threshold dose and work your way up to a maximum of 30mg over the course of a few sessions (basing this off a compromise between the 2-3/5-10 fold potentiation mentioned in the Erowid article, depending on genetic CYP2D6 deficiency). Don't redose in a single session -- MDMA inhibits the enzymes that metabolize it, so redosing always leads to a larger effective dose than you'd expect.

Good luck, take care, and tread extremely carefully if you do decide to go through with this. :\
 
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Thanks, guys! (I actually work in a science-based area - some years back I did work on cytochrome P450s - so I had done a little reading into the mechanisms) I had decided not to risk it anyway, not really worth it, and a month into starting meds, I feel better than I have in years :)
 
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