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Appendix XIII: Interactions Between HIV-Related Medications and Psychotropic Medications

Updated April 2010

Table 1: Significant Interactions Between Antiretroviral Therapy and Psychotropic Medications: Contraindicated Combinations and Agents to Be Used With Caution*
Medication Contraindicated Use With Caution Comments
Atazanavir
(Reyataz)
Midazolam
Triazolam
Pimozide
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam and triazolam levels may be significantly increased with concurrent PI use.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Darunavir
(Prezista)
Midazolam
Triazolam
Pimozide
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam and triazolam levels may be significantly increased with concurrent PI use.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of CYP450 system; consider alternative anticonvulsant.
Delavirdine
(Rescriptor)
Midazolam
Triazolam
Pimozide
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam and triazolam levels may be significantly increased with concurrent use; avoid combination.
Efavirenz
(Sustiva)
Midazolam
Triazolam
Pimozide
Carbamazepine
Phenobarbital
Phenytoin
• Based on in vitro data, midazolam and triazolam concentrations may be significantly increased with co-administration, but in vivo, a reduction in midazolam is expected; avoid combination.
• Efavirenz may increase pimozide levels; monitor closely for toxicity.
• Carbamazepine, phenobarbital, and phenytoin may reduce EFV drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Etravirine
(Intelence)
Carbamazepine
Phenobarbital
Phenytoin
  • Carbamazepine, phenobarbital, and phenytoin may significantly reduce ETR drug concentrations due to induction of the CYP450 system; do not use.
Fosamprenavir
(Lexiva)
Midazolam
Triazolam
Pimozide
Tricyclic
antidepressants
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam, triazolam, and pimozide levels may be significantly increased with concurrent PI use.
• Monitor tricyclic antidepressant therapy closely for toxicity.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Indinavir
(Crixivan)
Midazolam
Triazolam
Pimozide
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam, triazolam, and pimozide levels may be significantly increased with concurrent PI use.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Lopinavir/
ritonavir
(Kaletra)
Midazolam
Triazolam
Pimozide
Carbamazepine
Olanzapine
Phenobarbital
Phenytoin
• Midazolam, triazolam, and pimozide levels may be significantly increased with concurrent PI use.
• Lopinavir/ritonavir may reduce olanzapine levels.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Maraviroc
(Selzentry)
None Carbamazepine
Phenobarbital
Phenytoin
• Carbamazepine and phenobarbital may increase maraviroc metabolism, leading to loss of virologic response, and possible resistance to maraviroc. Increase maraviroc dose to 600 mg twice daily with co-administration.
Nelfinavir
(Viracept)
Midazolam
Triazolam
Pimozide
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam and triazolam levels may be significantly increased with concurrent PI use.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Nevirapine
(Viramune)
None Carbamazepine
Phenobarbital
Phenytoin
• Potential for interaction with carbamazepine is unknown. Use with caution and consider monitoring carbamazepine levels.
Raltegravir
(Isentress)
None Phenobarbital
Phenytoin
• Phenobarbital and phenytoin co-administration may significantly decrease raltegravir serum concentrations.
Ritonavir
(Norvir)
Midazolam
Triazolam
Pimozide
Alprazolam,
carbamazepine,
clorazepate,
diazepam, estazolam,
flurazepam,
methamphetamine,
nefazodone,
olanzapine,
perphenazine,
phenobarbital,
phenytoin,
risperidone,
trazadone, selective
serotonin re-uptake
inhibitors (SSRIs),
thioridazine,
zolpidem
• Midazolam, triazolam, and pimozide levels may be significantly increased with concurrent PI use.
• Due to the complex nature of ritonavir metabolism, increased or decreased levels of psychotropic agents may occur. Monitor patients closely when changing psychotropic agents or adding ritonavir.
• Monitor desipramine levels when used with ritonavir.
• Ritonavir may reduce olanzapine levels.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Saquinavir
(Invirase)
Midazolam
Triazolam
Pimozide
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam and triazolam levels may be significantly increased with concurrent PI use.
• Carbamazepine, phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
Tipranavir
(Aptivus)
Midazolam
Triazolam
Pimozide
Olanzaping
Mirtazapine
Nefazadone
Carbamazepine
Phenobarbital
Phenytoin
• Midazolam and triazolam levels may be significantly increased with concurrent PI use.
• Carbamazepine phenobarbital, and phenytoin may reduce PI drug concentrations due to induction of the CYP450 system; consider alternative anticonvulsant.
* Tricyclic antidepressants should be used with caution with all boosted PIs.