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Quadricyclic Antidepressant Overdosage in a Patient With AIDS Under Mega–Highly Active Antiretroviral Therapy
Arch Intern Med. 2001;161:2260-2261.
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We describe a patient with acquired immunodeficiency syndrome (AIDS)
who experienced severe hypotension and cardiac conduction trouble due to maprotiline
hydrochloride (a quadricyclic antidepressant agent) overdosage within weeks
of beginning a new therapy with a combination of antiretroviral drugs: stavudine
(40 mg twice a day), ritonavir (400 mg twice a day), saquinavir mesylate (400
mg twice a day), indinavir sulfate (400 mg twice a day), and amprenavir (900
mg twice a day). We believe that the overdosage resulted from strong inhibition
of cytochrome P450 2D6 (CYP2D6) (the pathway of maprotiline hydroxylation)
by ritonavir and/or fluconazole.
Patients infected with multiresistant human immunodeficiency virus (HIV)
require multiple antiretroviral drugs, in particular, a combination of protease
inhibitors. In this setting, physicians should be aware of the high risk of
drug-drug interactions. Thus, monitoring coprescribed drugs may be required
for treatments with a low therapeutic-toxic index, such as therapy with antidepressants.
We report a . . . [Full Text of this Article] Report of a Case
Comment
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
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Psychiatric Issues in the Management of Patients With HIV Infection
Treisman et al.
JAMA 2001;286:2857-2864.
ABSTRACT
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