PROTEASE INHIBITORS AND SSRIS
Fluoxetine modestly raises the levels of ritonavir. A few cases of serotonin syndrome have been attributed to the use of fluoxetine and ritonavir. Darunavir/ritonavir and fosamprenavir/ritonavir reduced paroxetine levels and darunavir/ritonavir reduced sertraline levels. Fluoxetine would be expected to be similarly affected. These reductions in SSRI levels are opposite to the effect originally predicted.
It would be prudent to anticipate some reduction in efficacy when starting these protease inhibitors (and probably any ritonavir-boosted protease inhibitors) in patients taking fluoxetine, sertraline or paroxetine. Monitor the clinical effect and increase the SSRI dose as necessary. The general relevance of the few cases of serotonin syndrome, is also uncertain.
It would be prudent to anticipate some reduction in efficacy when starting these protease inhibitors (and probably any ritonavir-boosted protease inhibitors) in patients taking fluoxetine, sertraline or paroxetine. Monitor the clinical effect and increase the SSRI dose as necessary. The general relevance of the few cases of serotonin syndrome, is also uncertain.