Significant interactions with new antiretrovirals and psychotropic drugs

OBJECTIVE: To provide an update on relevant antiretroviral interactions and psychotropic medications for healthcare practitioners managing complex HIV-related pharmacotherapy. DATA SOURCES: Information was retrieved via a MEDLINE search (January 1966-September 1998) using MeSH headings human immunodeficiency virus, drug interactions, psychiatry, psychotropics, psychiatric illness, and names of medications commonly prescribed for the management of HIV infection. Abstracts of international and national conferences (until February 1999), review articles, textbooks, and references of all articles also were searched. STUDY SELECTION AND DATA EXTRACTION: Literature on pharmacokinetic interactions was considered for inclusion. Pertinent information was selected and summarized for discussion. In the absence of specific data, pharmacokinetic and pharmacodynamic properties were considered in order to predict the likelihood of potential drug interactions. DATA SYNTHESIS: All protease inhibitors and nonnucleoside reverse transcriptase inhibitors are substrates of the cytochrome P450 system and possess enzyme-inhibiting and/or -inducing properties. Psychotropic medications also possess similar metabolic characteristics and may interact with antiretrovirals. Modifications in drug selection, dose, or dosing regimen may be needed to ensure adequate antiretroviral concentrations and thus minimize the risk of incomplete viral suppression and/or development of drug resistance. In the absence of specific data, consideration of metabolic characteristics may assist practitioners in predicting the likelihood of possible interactions. RESULTS: The incidence and implications of antiretroviral drug interactions are reviewed. Practical management strategies are also discussed. Comprehensive tables on clinically significant interactions with antiretroviral combinations and with psychiatric medications are provided. CONCLUSIONS: Given the increasing use of multiple-drug therapy, the potential for drug interactions is extremely high. Drug interactions may lead to undesirable outcomes including subtherapeutic drug concentrations and risk of antiretroviral resistance. Practitioners need to consider pharmacokinetic, pharmacologic, therapeutic, and adherence factors when managing interactions with complex antiretroviral therapy.

This article has been cited by other articles:

				M. J. Repetto and J. M. Petitto Psychopharmacology in HIV-Infected Patients Psychosom Med, June 1, 2008; 70(5): 585 - 592. [Abstract] [Full Text] [PDF]

				A. I. Bhigjee and S. Rosemberg Optimizing therapy of seizures in patients with HIV and cysticercosis Neurology, December 26, 2006; 67(12_suppl_4): S19 - S22. [Abstract] [Full Text]

				D. Lin, M J. Tucker, and M. J Rieder Increased Adverse Drug Reactions to Antimicrobials and Anticonvulsants in Patients with HIV Infection Ann. Pharmacother., September 1, 2006; 40(9): 1594 - 1601. [Abstract] [Full Text] [PDF]

				N. L Sheehan, M.-J. Brouillette, M.-S. Delisle, and J. Allan Possible Interaction Between Lopinavir/Ritonavir and Valproic Acid Exacerbates Bipolar Disorder Ann. Pharmacother., January 1, 2006; 40(1): 147 - 150. [Abstract] [Full Text] [PDF]

				S. A. Krikorian and D. C. Rudorf Drug-Drug Interactions and HIV Therapy: What Should Pharmacists Know? Journal of Pharmacy Practice, August 1, 2005; 18(4): 278 - 294. [Abstract] [PDF]

				N. Turjanski and G. G. Lloyd Psychiatric side-effects of medications: recent developments Advan. Psychiatr. Treat., January 1, 2005; 11(1): 58 - 70. [Abstract] [Full Text] [PDF]

				J. Caballero and M. C Nahata Use of Selective Serotonin-Reuptake Inhibitors in the Treatment of Depression in Adults with HIV Ann. Pharmacother., January 1, 2005; 39(1): 141 - 145. [Abstract] [Full Text] [PDF]

				N. L Sheehan, D. V Kelly, A. L Tseng, R. P. van Heeswijk, L. C Beique, and C. A Hughes Evaluation of HIV Drug Interaction Web Sites Ann. Pharmacother., November 1, 2003; 37(11): 1577 - 1586. [Abstract] [Full Text] [PDF]

				D. J. Greenblatt, L. L. von Moltke, J. S. Harmatz, S. M. Fogelman, G. Chen, J. A. Graf, P. Mertzanis, S. Byron, K. E. Culm, B. W. Granda, et al. Short-Term Exposure to Low-Dose Ritonavir Impairs Clearance and Enhances Adverse Effects of Trazodone J. Clin. Pharmacol., April 1, 2003; 43(4): 414 - 422. [Abstract] [Full Text] [PDF]

				P. G Clay and M. M Adams Pseudo-Parkinson Disease Secondary to Ritonavir-Buspirone Interaction Ann. Pharmacother., February 1, 2003; 37(2): 202 - 205. [Abstract] [Full Text] [PDF]

				G. J. Treisman, A. F. Angelino, and H. E. Hutton Psychiatric Issues in the Management of Patients With HIV Infection JAMA, December 12, 2001; 286(22): 2857 - 2864. [Abstract] [Full Text] [PDF]

				J. M. Conry Significant Drug Interactions in the HIV Patient Journal of Pharmacy Practice, December 1, 2000; 13(6): 499 - 514. [Abstract] [PDF]

				F. Romanelli, H. R. Jennings, A. Nath, M. Ryan, and J. Berger Therapeutic dilemma: The use of anticonvulsants in HIV-positive individuals Neurology, April 11, 2000; 54(7): 1404 - 1407. [Abstract] [Full Text] [PDF]