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Drug–drug interactions and clinical considerations with co-administration of antiretrovirals and psychotropic drugs

Published online by Cambridge University Press:  08 October 2018

Kellie J. Goodlet Open the ORCID record for Kellie J. Goodlet [Opens in a new window] ,
Monika T. Zmarlicka  and
Alyssa M. Peckham
Kellie J. Goodlet*
Affiliation:
Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, Arizona, USA
Monika T. Zmarlicka
Affiliation:
Department of Pharmacy, Maricopa Medical Center, Phoenix, Arizona, USA
Alyssa M. Peckham
Affiliation:
School of Pharmacy, Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts, USA Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts, USA
*
*Address for correspondence: Kellie J. Goodlet, PharmD, 19555 N 59th Ave, Glendale, AZ 85308, USA. (Email: [email protected])
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Abstract

Psychotropic medications are frequently co-prescribed with antiretroviral therapy (ART), owing to a high prevalence of psychiatric illness within the population living with HIV, as well as a 7-fold increased risk of HIV infection among patients with psychiatric illness. While ART has been notoriously associated with a multitude of pharmacokinetic drug interactions involving the cytochrome P450 enzyme system, the magnitude and clinical impact of these interactions with psychotropics may range from negligible effects on plasma concentrations to life-threatening torsades de pointes or respiratory depression. This comprehensive review summarizes the currently available information regarding drug–drug interactions between antiretrovirals and pharmacologic agents utilized in the treatment of psychiatric disorders—antidepressants, stimulants, antipsychotics, anxiolytics, mood stabilizers, and treatments for opioid use disorder and alcohol use disorder—and provides recommendations for their management. Additionally, overlapping toxicities between antiretrovirals and the psychotropic classes are highlighted. Knowledge of the interaction and adverse effect potential of specific antiretrovirals and psychotropics will allow clinicians to make informed prescribing decisions to better promote the health and wellness of this high-risk population.

Keywords

AIDSantidepressantsantipsychoticsantiretroviral therapyanxiolyticsdrug interactionsHIV
Type
Review
Information
CNS Spectrums , Volume 24 , Issue 3 , June 2019 , pp. 287 - 312
Copyright
© Cambridge University Press 2018 

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