How do antidepressants and protease inhibitors (PIs) interact?

Updated: Jan 15, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michelle R Salvaggio, MD, FACP  more...
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Answer

Answer

Antidepressants include drugs such as bupropion, paroxetine, sertraline, trazodone, and various tricyclic antidepressants (amitriptyline, desipramine, imipramine, nortriptyline).

Bupropion in combination with either LPV/RTV or TPV/RTV will lead to decreased bupropion drug concentrations.

Paroxetine in combination with DRV/RTV or FPV/RTV will lead to decreased paroxetine drug levels.

Sertraline in combination with DRV/RTV will lead to decreased sertraline drug levels.

Give lowest dose of trazodone, and monitor for central nervous system and cardiovascular adverse effects when trazodone is used in combination with ATV +/- RTV, DRV/RTV, FPV +/- RTV, LPV/ RTV, or TPV/ RTV.

SQV/RTV in combination with trazodone is contraindicated.

RTV-boosted PIs in combination with tricyclic antidepressants (amitriptyline, desipramine, imipramine, nortriptyline) will cause an increase in tricyclic antidepressant drug levels; use the lowest possible dose, and titrate as needed.

Dose adjustments of aripiprazole, brexpiprazole, cariprazine, and pimavanserin may be needed with certain PIs.


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