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When Ritonovir was brought to market the only form that had ever been seen was I. Years of laboratory research, testing, drug development and initial
use, and no one had ever seen form II. Then Ritonovir stopped working, it no longer dissolved, and form II was discovered.
Once form II (cis) appeared they could never get rid of it. Laboratory procedures that made form I years ago, now only made form II or at least form
II contaminated product. Plants in different parts of the world all began making form II. Samples in storage, once brought in to the lab turned into
form II. Once form II appeared on the planet it seemed to contaminate all the Ritonovir in the world.
(If you have ever read Vonnegut's novel "Cats Cradle" it is like fictional "Ice 9" that freezes the world catalytically.)
So they had to abandon using the drug in capsule or tablet form, only a suspension would work - and that now suddenly needed constant refrigeration to
prevent crystallization.
It is believed that the first bit of Form II was created in a fluke set of conditions (supersaturated solution, a degradation product providing a
suitable nucleation surface), but one it existed it contaminated the world.
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