title: Serotonin syndrome in HIV-infected individuals receiving antiretroviral therapy and fluoxetine.
abstract: OBJECTIVE
  To describe HIV-infected individuals taking antidepressants who developed the serotonin syndrome due to drug--drug or drug--food interactions.
  
  
  METHODS
  Case studies carried out at the HIV Outpatient Clinic, Atlanta Veterans Affairs Medical Center.
  
  
  METHODS
  HIV-positive patients who were receiving antiretroviral and antidepressant therapies and presented with symptoms consistent with the serotonin syndrome. Their antidepressants were discontinued or the doses reduced in order to resolve the symptoms.
  
  
  RESULTS
  Five cases of serotonin syndrome developed after patients who were taking antidepressants ingested P450 inhibitors.
  
  
  CONCLUSIONS
  Serotonin syndrome should be suspected in patients on serotonergic medications who present with mental status change, autonomic dysfunction, and neuromuscular abnormalities. Suspicion should be heightened in those who are ingesting substances known to inhibit P450 enzymes, such as protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and grapefruit juice.
authors: Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
authors: K E
authors: KE
authors: DeSilva
authors: D B
authors: DB
authors: Le Flore
authors: B J
authors: BJ
authors: Marston
authors: D
authors: D
authors: Rimland
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D003863:Depression / Q000150:complications / Q000188:drug therapy*; D004347:Drug Interactions; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D018565:Food-Drug Interactions; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020230:Serotonin Syndrome / Q000139:chemically induced*; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D018687:Antidepressive Agents, Second-Generation; D003577:Cytochrome P-450 Enzyme System; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors