Drug Interactions of Psychiatric and COVID-19 Medications

Mohebbi, Niayesh; Talebi, Ali; Moghadamnia, Marjan; Nazari Taloki, Zahra; Shakiba, Alia

doi:10.32598/bcn.11.covid19.2500.1

Volume 11, Issue 2 (March & April - Special Issue on COVID-19 2020) BCN 2020, 11(2): 185-200 | Back to browse issues page

‎ 10.32598/bcn.11.covid19.2500.1

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Mohebbi N, Talebi A, Moghadamnia M, Nazari Taloki Z, Shakiba A. Drug Interactions of Psychiatric and COVID-19 Medications. BCN 2020; 11 (2) :185-200
URL: http://bcn.iums.ac.ir/article-1-1750-en.html

Drug Interactions of Psychiatric and COVID-19 Medications

Niayesh Mohebbi ^*

¹, Ali Talebi²

, Marjan Moghadamnia²

, Zahra Nazari Taloki²

, Alia Shakiba³

1- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran; Research Center for Rational Use of Drugs; Tehran University of Medical Sciences,Tehran, Iran.
2- Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
3- Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Abstract:

^{Introduction:}^{Coronavirus disease 2019 (COVID-19) has become a pandemic with 1771514 cases identified in the world and 70029 cases in Iran until April 12, 2020. The co-prescription of psychotropics with COVID-19 medication is not uncommon. Healthcare providers should be familiar with many Potential Drug-Drug Interactions (DDIs) between COVID-19 therapeutic agents and psychotropic drugs based on cytochrome P450 metabolism. This review comprehensively summarizes the current literature on DDIs between antiretroviral drugs and chloroquine/hydroxychloroquine, and psychotropics, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics.}

^Methods:^{Medical databases, including Google Scholar, PubMed, Web of Science, and Scopus were searched to identify studies in English with keywords related to psychiatric disorders, medications used in the treatment of psychiatric disorders and COVID-19 medications.}

^Results:^{There is a great potential for DDIs between psychiatric and COVID-19 medications ranging from interactions that are not clinically apparent (minor) to those that produce life-threatening adverse drug reactions, or loss of treatment efficacy. The majority of interactions are pharmacokinetic interactions via the cytochrome P450 enzyme system.}

^Conclusion:^{DDIs are a major concern in the comorbidity of psychiatric disorders and COVID-19 infection resulting in the alteration of expected therapeutic outcomes. The risk of toxicity or lack of efficacy may occur due to a higher or lower plasma concentration of medications. However, psychiatric medication can be safely used in combination with COVID-19 pharmacotherapy with either a wise selection of medication with the least possibility of interaction or careful patient monitoring and management.}

Keywords: COVID-19, Drug Interaction, antidepressants, antipsychotics, anxiolytics, Chloroquine

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●^{Drug interactions are major challenge in comorbidity of psychiatric disorders and COVID-19 infection}

●^{QTc prolongation is a major concern while using antiviral medications and/or Chloroquine/hydroxychloroquine in combination with many psychotropics. Cardiac monitoring especially in high risk patients is highly recommended.}

●^{concomitant use of SSRIs with antiviral medications and/or Chloroquine/hydroxychloroquine increase the risk of hypoglycemia.}

●^{concomitant use of pimozide or midazolam with antiviral medications is contraindicated.}

^{Plain Language Summary}

^{In December 2019, the reports of coronavirus disease 2019 (COVID-19) were documented in Wuhan, China. This condition is caused by a novel beta-coronavirus, called as Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Nowadays, the Coronavirus Disease 2019 (COVID-19) has become a global pandemic; with more than hundred thousand cases have been identified in Iran. COVID-19 affects people's mental health and quality of life. The COVID-19 causes panic, anxiety, depression and insomnia, especially in patients and health care professionals. There is a possibility of starting psychiatric drugs in patients with COVID-19. Also, some patients with COVID-19 have been taking psychiatric drugs due to various problems. As a result of this, the likelihood of drug- drug interaction (DDI) between psychiatric drugs and drugs used to treat COVID-19 can be a concern. Many psychiatric drugs are metabolized via the cytochrome P450 system. Therefore, their hepatic metabolism and ability to alter activity of cytochrome P450 can lead to pharmacokinetic interactions when they are used with medications in COVID-19 treatment. Risk of toxicity or lack of efficacy may occur due to higher or lower plasma concentration of medications. Moreover intensification of similar adverse effects might lead to patients harm. Psychiatric medication can be safe in combination with COVID-19 pharmacotherapy with close attention to selection of medication with the least possibility of interaction and also careful monitoring.}

Type of Study: Review | Subject: Clinical Neuroscience
Received: 2020/04/16 | Accepted: 2020/05/16 | Published: 2020/07/1

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