Brown Medical School
HIV 101: Psychiatric and HIV Medication Interactions

January 2005

See Also
More on HIV Drug Interactions
CategoryNNRTIsNRTIsPIs
SSRIsProzac increases levels of Rescriptor 50%NPD*Prozac may lead to increased effects of Norvir, but no dose adjustment of Norvir is needed when used in combination. Norvir increases levels of Prozac, Luvox, Paxil, and Zoloft.
TCAsNPDNPDNorvir decreases Norpramin clearance by 50%, causing higher than anticipated blood levels; may increase levels of Elavil, Sinequan, Tofranil, Depakote. When used in combination with Norvir, caution is required. It is recommended to use lower doses, and regularly monitor EKG and serum TCA levels.
Other: WellbutrinSustiva may increase wellbutrin levels.NPDViracept and Norvir may increase wellbutrin levels, increasing risk of drug-induced seizures.
Other: SerzoneNPDNPDCaution advised; combination of PIs and Serzone may increase levels of both drugs.
SNRIsNPDNPDEffexor may decrease Crixivan levels.
Other: DesyrelNPDNPDPotential for drug interactions when Desyrel is co-administered. Adverse effects including nausea, hypotension, and syncope were observed when Norvir and Desyrel were co-administered. It is likely that Nizoral, Crixivan, and other CYP34A inhibitors may lead to increases in Desyrel plasma concentrations with potential for adverse effects. If Desyrel is used with a potent CYP34A inhibitor, a lower dose of Desyrel should be considered.
BenzodiazepinesNPDNPDKaletra and Halcion may have possible interactions; Halcion and other antipsychotics from this class are contraindicated in combination with PIs due to the potential for serious and life-threatening reactions such as prolonged or severe sedation or respiratory depression. Xanax, Dalmane, Klonopin, and Valium should be used in caution with PIs due to the potential for serious reactions such as prolonged or severe sedation or respiratory depression. Ativan, Restoril, and Tranxene are free of the serious interactions with PIs found with other benzodiazepines.
Non-Benzodiazepine Sedative/HypnoticsNPDNPDAmbien and Sonata should be used with caution in combination with PIs due to the potential for serious reactions such as prolonged or severe sedation or respiratory depression.
Lithium CarbonateNPDNPDNPD
AnticonvulsantsTegretol and Dilantin may decrease levels of PIs and NNRTIs.Long term clinical implications not known; monitor for Retrovir toxicity.Tegretol may decrease levels of PIs and NNRTIs. Known to decrease Crixivan levels with loss of viral suppression. Tegretol levels increased by Norvir. Dilantin: co-administered with Kaletra results in decreased concentrations of both Dilantin and Kaletra.
First Generation -- TypicalNPDNPDOrap is contraindicated in combination with PIs due to potential for serious and life-threatening reactions, such as cardiac arrhythmia. Norvir may increase levels of antipsychotics.
Second Generation -- AtypicalNPDNPDPIs may increase plasma levels of Clozaril and increase the risk for seizures and orthostatic hypotension. Geodon: caution is indicated when Geodon is co-administered with Norvir.
Third GenerationNPDNPDNPD
St. John's WortMay reduce blood levels of NNRTIs. Induces metabolism of Viramune; increased clearance ~35%.NPDMay reduce blood levels of PIs.
This table has been adapted from "Psychiatric Medications and HIV Antiretrovirals: A Guide to Interactions for Clinicians." NY/NJ AIDS Education and Training Center.

* No Published Data about drug interactions specific to this combination.

This article was provided by Brown Medical School, and is a part of the publication Infectious Diseases in Corrections Report.


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