Serotonin syndrome in HIV-infected individuals receiving antiretroviral therapy and fluoxetine

AIDS. 2001 Jul 6;15(10):1281-5. doi: 10.1097/00002030-200107060-00010.


Objective: To describe HIV-infected individuals taking antidepressants who developed the serotonin syndrome due to drug--drug or drug--food interactions.

Design and setting: Case studies carried out at the HIV Outpatient Clinic, Atlanta Veterans Affairs Medical Center.

Participants and interventions: HIV-positive patients who were receiving antiretroviral and antidepressant therapies and presented with symptoms consistent with the serotonin syndrome. Their antidepressants were discontinued or the doses reduced in order to resolve the symptoms.

Results: Five cases of serotonin syndrome developed after patients who were taking antidepressants ingested P450 inhibitors.

Conclusions: Serotonin syndrome should be suspected in patients on serotonergic medications who present with mental status change, autonomic dysfunction, and neuromuscular abnormalities. Suspicion should be heightened in those who are ingesting substances known to inhibit P450 enzymes, such as protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and grapefruit juice.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anti-HIV Agents / adverse effects*
  • Anti-HIV Agents / therapeutic use
  • Antidepressive Agents, Second-Generation / adverse effects*
  • Antidepressive Agents, Second-Generation / pharmacokinetics
  • Antidepressive Agents, Second-Generation / therapeutic use
  • Cytochrome P-450 Enzyme System / metabolism
  • Depression / complications
  • Depression / drug therapy*
  • Drug Interactions
  • Female
  • Fluoxetine / adverse effects
  • Fluoxetine / pharmacokinetics
  • Fluoxetine / therapeutic use
  • Food-Drug Interactions
  • HIV Infections / complications
  • HIV Infections / drug therapy*
  • Humans
  • Male
  • Middle Aged
  • Selective Serotonin Reuptake Inhibitors / adverse effects*
  • Selective Serotonin Reuptake Inhibitors / pharmacokinetics
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Serotonin Syndrome / chemically induced*


  • Anti-HIV Agents
  • Antidepressive Agents, Second-Generation
  • Serotonin Uptake Inhibitors
  • Fluoxetine
  • Cytochrome P-450 Enzyme System