Antiretrovirals and Psychotropics: Drug Interactions and Complications

The development of much of modern psychopharmacology has occurred during the era of the HIV/AIDS epidemic, with greater understanding of drug-drug interactions, pharmacokinetics, and pharmacodynamics, and has led to improved treatment of HIV and comorbid neuropsychiatric disorders, with fewer medication-related complications than in the early years of the epidemic. The authors present a comprehensive review of the literature on the interactions among psychotropic medications and antiretroviral medications, with a pragmatic focus on side effect management, therapeutic drug monitoring, and the specific challenges of mastering complicated medication regimens. Brief case vignettes and suggested treatment approaches are presented for most common presentations of persons living with HIV and psychiatric comorbidities. A series of comprehensive tables are provided as a summary of the various clinical drug interactions to assist in informed, evidence-based clinical decisional support.