Question
Shall I avoid ritonavir because of interactions with other meds?
2 July 2008. Related: All topics, Changing treatment, Drug interactions, Side effects.
I am a 39 years old woman – on a healthy diet and a healthy weight. I have been taking ritonavir 100mg, Invirase (saquinavir) and Truvida (tenofovir+FTC) for 10 months.
This causes a rash for which I take anti-histamin.
I take Cilest (ethinylestradiol and norgestimate) as a hormone replacement because 2 years ago my pituitary gland has stopped producing estrogen.
Two months after starting antivirals, I had to stop fluoxetine 10mg (Prozac), due to an interaction with ritonavir that caused hairloss. Prior to HIV treatment I was fine with fluoxetine 10mg and 20mg for over a year. (You helped me find the cause of the hair loss).
Needing an anti depressant again I started on Citalopram 5 weeks ago – less than 10mg due to possible boosting interaction with ritonavir – around 6mg daily.
2 years ago I took Citalopram for 5 months and then stopped due to slowly increasing forgetfulness as a side effect.
This time it went well for 2 weeks but then I seemed to get the full list of side effects for Citalopram – vivid nightmares, tiredness, dry eyes, feeling aggressive and restless, painful stomach, wind, diarrhoea – all getting worse with time. Further my rash exploded into yellow oozing and hurting wounds – previously my rash was managable….
Now the QUESTION:
Would avoiding ritonavir solve my problem – preferably I would like to tollerate fluoxetin again?
Could I get raltegravir to use with my Truvada – would this solve my problem?
Or would I be more likely to get nelfinavir?
You have helped me with expert advise in the past and I would like to use your expertise as a second oppinion when I next see my doctor on Thursday.
Thanks
Answer
Thank you for the nice words – and I’m sorry to hear you are having such a rough time.
The medications that you mentioned are used for management of changes in mood, and in particular when somebody is ‘low’. Both fluoxetine and citalopram are from the SSRI (Selective Serotonin Reuptake Inhibitors) family.
Before trying to switch ritonavir, why don’t you discuss the possibility of switching your SSRI to some other drug from the family with your doctor? Sometimes it takes some ‘experimenting’ before the person finds the SSRI that ‘fits’ him/her.
Other possible options are paroxetine (Seroxat) and sertraline (Lustral) for instance. Paroxetine has nausea as a possible side effect though and perhaps it should be a second option if you have that from the antiretrovirals.
Again with both of these you will have to check with your doctor for interactions and change the dosage accordingly if necessary.
If this still doesn’t work then looking for an HIV combination that has less drug interactions may be another alternative.
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