Info

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

c) Delirious syndrome when fast dose increase

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).

Table 3: Other antidepressants

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

Was this article helpful?

0 0

Post a comment