Drug Interactions of Psychiatric and COVID-19 Medications

Overview

Journal Basic Clin Neurosci

Specialty Neurology

Date 2020 Aug 29

PMID 32855778

Citations 16

Authors

Niayesh Mohebbi

Ali Talebi

Marjan Moghadamnia

Zahra Nazari Taloki

Alia Shakiba

Affiliations

Soon will be listed here.

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.

Citing Articles

Drug-Drug Interactions Between COVID-19 Treatments and Psychotropic Medications: An Updated Study.

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Drug-Drug Interactions among Patients Hospitalized with COVID-19 in Greece.

Spanakis M, Ioannou P, Tzalis S, Papakosta V, Patelarou E, Tzanakis N J Clin Med. 2022; 11(23).

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Joint European policy on the COVID-19 risks for people with mental disorders: An umbrella review and evidence- and consensus-based recommendations for mental and public health.

Vai B, Mazza M, Marisa C, Beezhold J, Karkkainen H, Saunders J Eur Psychiatry. 2022; 65(1):e47.

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Zaman N, Parvaiz N, Farid R, Navid A, Abbas G, Azam S PLoS One. 2022; 17(6):e0268454.

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Pattnaik J, Das S, Sarkar H, Mahasuar R, Ravan J Indian J Psychol Med. 2022; 43(6):542-545.

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References

Jin X, Potter B, Luong T, Nelson J, Vuong C, Potter C . Pre-clinical evaluation of CYP 2D6 dependent drug-drug interactions between primaquine and SSRI/SNRI antidepressants. Malar J. 2016; 15(1):280. PMC: 4869338. DOI: 10.1186/s12936-016-1329-z. View

Kuhn R . The treatment of depressive states with G 22355 (imipramine hydrochloride). Am J Psychiatry. 1958; 115(5):459-64. DOI: 10.1176/ajp.115.5.459. View

Derijks H, Meyboom R, Heerdink E, De Koning F, Janknegt R, Lindquist M . The association between antidepressant use and disturbances in glucose homeostasis: evidence from spontaneous reports. Eur J Clin Pharmacol. 2008; 64(5):531-8. PMC: 2668653. DOI: 10.1007/s00228-007-0441-y. View

Mandrioli R, Mercolini L, Raggi M . Metabolism of benzodiazepine and non-benzodiazepine anxiolytic-hypnotic drugs: an analytical point of view. Curr Drug Metab. 2010; 11(9):815-29. DOI: 10.2174/138920010794328887. View

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

Spina E, Pisani F, De Leon J . Clinically significant pharmacokinetic drug interactions of antiepileptic drugs with new antidepressants and new antipsychotics. Pharmacol Res. 2016; 106:72-86. DOI: 10.1016/j.phrs.2016.02.014. View

Lim M, Min S, Eron J, Bertz R, Robinson M, Gaedigk A . Coadministration of lopinavir/ritonavir and phenytoin results in two-way drug interaction through cytochrome P-450 induction. J Acquir Immune Defic Syndr. 2004; 36(5):1034-40. DOI: 10.1097/00126334-200408150-00006. View

Knox T, Oleson L, von Moltke L, Kaufman R, Wanke C, Greenblatt D . Ritonavir greatly impairs CYP3A activity in HIV infection with chronic viral hepatitis. J Acquir Immune Defic Syndr. 2009; 49(4):358-68. DOI: 10.1097/qai.0b013e31818c7efe. View

Kronbach T, Mathys D, Umeno M, Gonzalez F, Meyer U . Oxidation of midazolam and triazolam by human liver cytochrome P450IIIA4. Mol Pharmacol. 1989; 36(1):89-96. View

10.

Phillips R, Looareesuwan S, White N, Chanthavanich P, Karbwang J, Supanaranond W . Hypoglycaemia and antimalarial drugs: quinidine and release of insulin. Br Med J (Clin Res Ed). 1986; 292(6531):1319-21. PMC: 1340320. DOI: 10.1136/bmj.292.6531.1319. View

11.

Greenblatt D, von Moltke L, Daily J, Harmatz J, Shader R . Extensive impairment of triazolam and alprazolam clearance by short-term low-dose ritonavir: the clinical dilemma of concurrent inhibition and induction. J Clin Psychopharmacol. 1999; 19(4):293-6. DOI: 10.1097/00004714-199908000-00001. View

12.

Kharasch E, Mitchell D, Coles R, Blanco R . Rapid clinical induction of hepatic cytochrome P4502B6 activity by ritonavir. Antimicrob Agents Chemother. 2008; 52(5):1663-9. PMC: 2346649. DOI: 10.1128/AAC.01600-07. View

13.

Halaby M, Kastein B, Yang D . Chloroquine stimulates glucose uptake and glycogen synthase in muscle cells through activation of Akt. Biochem Biophys Res Commun. 2013; 435(4):708-13. DOI: 10.1016/j.bbrc.2013.05.047. View

14.

Tuite A, Bogoch I, Sherbo R, Watts A, Fisman D, Khan K . Estimation of Coronavirus Disease 2019 (COVID-19) Burden and Potential for International Dissemination of Infection From Iran. Ann Intern Med. 2020; 172(10):699-701. PMC: 7081176. DOI: 10.7326/M20-0696. View

15.

Kakuda T, Scholler-Gyure M, Hoetelmans R . Pharmacokinetic interactions between etravirine and non-antiretroviral drugs. Clin Pharmacokinet. 2010; 50(1):25-39. DOI: 10.2165/11534740-000000000-00000. View

16.

DeVane C, Gill H . Clinical pharmacokinetics of fluvoxamine: applications to dosage regimen design. J Clin Psychiatry. 1997; 58 Suppl 5:7-14. View

17.

Jacobs B, Colbers A, Velthoven-Graafland K, Schouwenberg B, Burger D . Effect of fosamprenavir/ritonavir on the pharmacokinetics of single-dose olanzapine in healthy volunteers. Int J Antimicrob Agents. 2014; 44(2):173-7. DOI: 10.1016/j.ijantimicag.2014.03.014. View

18.

Greenblatt D, von Moltke L, Harmatz J, Fogelman S, Chen G, Graf J . Short-term exposure to low-dose ritonavir impairs clearance and enhances adverse effects of trazodone. J Clin Pharmacol. 2003; 43(4):414-22. DOI: 10.1177/0091270003251864. View

19.

Hendset M, Hermann M, Lunde H, Refsum H, Molden E . Impact of the CYP2D6 genotype on steady-state serum concentrations of aripiprazole and dehydroaripiprazole. Eur J Clin Pharmacol. 2007; 63(12):1147-51. DOI: 10.1007/s00228-007-0373-6. View

20.

Ducharme J, Farinotti R . Clinical pharmacokinetics and metabolism of chloroquine. Focus on recent advancements. Clin Pharmacokinet. 1996; 31(4):257-74. DOI: 10.2165/00003088-199631040-00003. View