A 45 year-old HIV positive male is brought to the emergency room for confusion, disorientation, slow speech, chest tightness, labored breathing, shortness of breath, abdominal pain and severe constipation. Physical examination is significant for low blood pressure, a weak pulse, blue lips, constricted pupils, slow respirations. He reports that he has been taking methadone for the last 6 years for opioid addiction with ‘no issues’. Two weeks ago he was started on ibuprofen 800 mg three times a day for his knee pains and a week ago he was started on fluconazole 200 mg on the first day, followed by 100 mg once daily for oropharyngeal candidiasis. What is the most likely reason for this patient’s current distress?
