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antidepressants
Mar 14, 2003

how many anti-depressants are there that react to hiv drugs and what are they?

Response from Dr. Horwath

The most commonly used antidepressants, the SSRI's, are quite safe when used in combination with antiretroviral drugs. The SSRI's include sertraline (Zoloft), fluoxetine (Prozac), paroxetine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). Among these antidepressants, studies show that the lowest risk for drug interaction occurs with sertraline, citalopram, and escitalopram.

Problematic interactions have been described between the protease inhibitors (especially ritonavir) and the tricyclic antidepressants. The most commonly used drugs in this category are imipramine, desipramine, amitriptyline, doxepin, and nortriptyline. Ritonavir may elevate the blood levels of these medications, which may create a risk of cardiac arhythmia and dizziness (due to orthostatic hypotension [lowered blood pressure on standing up]).

This is not a problem when these drugs are used in low doses. For example, amitriptyline (Elavil) is often used at low doses (50 mg) to treat peripheral neuropathy and other pain syndromes. This is not likely to pose a problem in combination with ritonavir. However, the dosages used to treat depression are often much higher (150-250 mg) and present a risk for serious adverse effects when used in combination with ritonavir.

This dose not mean that the tricyclic antidepressants cannot be used to treat patients on ritonavir. Sometimes they are indicated in this situation. However, they need to used with close monitoring of the dose, blood levels, and EKG's.



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