c) Selected side effects
Amitriptyline
Initially 2-3 x 25 mg a) Lopinavir/r, ritonavir increase amitriptyline levels
Amitriptyline
(e. g. Saroten™, Laroxyl™, Novoprotect™, Amineurin™)
Initially 2-3 x 25 mg a) Lopinavir/r, ritonavir increase amitriptyline levels usual therapeutic dose 3 x 50 mg or 2 x 75 mg b) Promotes sleep. Weight gain, constipation - might be desired side effects
|
Clomipramine (Anafranil™, Hydiphen™) |
2-3 x 25 mg for three days usual therapeutic dose 3 x 50 mg or 3 x 75 mg |
a) Lopinavir/r, ritonavir increase clomipramine levels b) Initially possible agitation, combination with benzodiazepine possible, also see above c) Effective in chronic pain |
|
Doxepin (Aponal™, Sinquan™) |
Initially 3 x 25 mg usual therapeutic dose 3 x 50 mg or 3 x 75 mg |
a) Lopinavir/r, ritonavir increase doxepin levels b) see above c) Often orthostasis |
|
Imipramine (Tofranil™, Pryleugan™) |
2-3 x 25 mg for three days usual therapeutic dose 3 x 50 mg or 3 x 75 mg |
a) Lopinavir/r, ritonavir increase imipramine levels b) see above c) Especially at the start of therapy anticholin-ergic adverse effects |
For further reading see Angelino 2001, Benkert 2001, Einsiedel 2001
For further reading see Angelino 2001, Benkert 2001, Einsiedel 2001
Other drugs / therapies
There are numerous other antidepressants but at the time being there is not much data on their use in HIV-infected patients. These include the noradrenergic and se-rotonergic drug mirtazapine (unlike SSRIs and tricyclic agents, there are so far no reports on sexual dysfunction with this drug) and the combined serotonin-noradrenaline re-uptake inhibitor venlafaxine. The selective noradrenaline re-uptake inhibitor reboxetine seems to be interesting in the therapy of HIV-infected patients since it is not metabolized via cytochrome P450 (CYP450) (Carvalhal 2003).
|
Drug (Trade name) |
Dosage/day |
a) Interactions with HAART b) Evaluation / comments c) Selected side effects |
|
Mirtazapine (Remeron™ ) |
Initially 15 mg at bedtime usual therapeutic dose 30-45 mg |
a) not known b) Sedating, promotes sleep, weight gain no sexual dysfunction c) Cave!: not in leukopenia! |
|
Reboxetine |
Initially 2 to 4 mg |
a) not known |
|
(Edronax™) |
maintenance therapy 8 mg to 12 mg |
b) not sedating c) Dry mouth, insomnia, sweating, tremor and urinary retention. Cave!: Dose reduction (2 x 2 mg) in renal or hepatic insufficiency |
|
Venlafaxine (Trevilor™) |
Initially 37.5 mg in the morning administer twice daily maintenance therapy 75 to 375 mg/day |
a) Lopinavir-ritonavir, ritonavir increase ven-lafaxine levels b) Extended release formulation with lesser side effects. Effective in anxiety |
|
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