Serotonin syndrome in HIV-infected individuals receiving antiretroviral therapy and fluoxetine.
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.
DeSilva
K E
KE
Atlanta Veterans Affairs Medical Center, Decatur, Georgia, USA.
Le Flore
D B
DB
Marston
B J
BJ
Rimland
D
D
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
D019380:Anti-HIV Agents; D018687:Antidepressive Agents, Second-Generation; D003577:Cytochrome P-450 Enzyme System; D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors