olanzapine and HIV-Infections

Patients with schizophrenia are eight times more likely than healthy individuals to become infected with the human immunodeficiency virus (hiv). Although in vitro studies provide some data on the interaction between antipsychotics and retroviral agents, there is a lack of in vitro data on this subject. We describe the case of a 35-year-old patient who suffered from schizophrenia, polydrug abuse and an hiv infection and who also had treatment-resistant psychosis. An interaction between the antiretroviral drug ritonavir and the antipsychotic olanzapine turned out to be the cause of the treatment resistance. As far as we know, this is the first report of such a clinically relevant interaction. We present a review of the current literature on this type of interaction.

Topics: Adult; Anti-Retroviral Agents; Antipsychotic Agents; Benzodiazepines; Drug Interactions; HIV Infections; Humans; Male; Olanzapine; Psychoses, Substance-Induced; Ritonavir; Schizophrenia

Neuroleptic sensitivity presents a considerable problem for the treatment of psychosis in the acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV)-positive patient population. As yet, there are few data on the response of these patients to newer atypical antipsychotic medications.. We present the detailed medication history of a 33-year-old man with AIDS, who had a prior history of extrapyramidal symptoms (EPS) with both typical antipsychotics and risperidone, and was treated with olanzapine for major depression with psychotic features.. The patient developed akathisia in a dose-dependent manner at dosages between 10 and 15 mg daily of olanzapine, but no EPS. Akathisia responded to dose reduction and use of beta-adrenergic blockade.. The AIDS patient may exhibit sensitivity even to newer atypical antipsychotics. The lack of EPS and response to a beta-blocker underscore the different mechanisms causing akathisia and EPS.

Topics: Adult; Akathisia, Drug-Induced; Antipsychotic Agents; Benzodiazepines; Dose-Response Relationship, Drug; HIV Infections; Humans; Male; Olanzapine; Pirenzepine; Risperidone