Review

. 2020 Jul 15;18(1):215.

doi: 10.1186/s12916-020-01685-9.

Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

Giovanni Ostuzzi¹, Davide Papola², Chiara Gastaldon², Georgios Schoretsanitis³, Federico Bertolini², Francesco Amaddeo², Alessandro Cuomo⁴, Robin Emsley⁵, Andrea Fagiolini⁴, Giuseppe Imperadore⁶, Taishiro Kishimoto⁷, Giulia Michencigh², Michela Nosé², Marianna Purgato², Serdar Dursun⁸, Brendon Stubbs^{9

10}, David Taylor¹¹, Graham Thornicroft¹², Philip B Ward¹³, Christoph Hiemke¹⁴, Christoph U Correll^{3

15

16}, Corrado Barbui²

Affiliations

¹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. giovanni.ostuzzi@univr.it.
² WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
³ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
⁴ Department of Molecular Medicine, University of Siena, Siena, Italy.
⁵ Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, 8000, South Africa.
⁶ Azienda ULSS 9 Scaligera, Verona, Italy.
⁷ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
⁸ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
⁹ Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
¹⁰ Physiotherapy Department, South London and Maudsley National Health Services Foundation Trust, London, UK.
¹¹ Pharmacy Department, Maudsley Hospital, London, UK.
¹² Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹³ School of Psychiatry, UNSW Sydney and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
¹⁴ Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany.
¹⁵ Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁶ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.

PMID: 32664944
PMCID: PMC7360478
DOI: 10.1186/s12916-020-01685-9

Review

Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

Giovanni Ostuzzi et al. BMC Med. 2020.

. 2020 Jul 15;18(1):215.

doi: 10.1186/s12916-020-01685-9.

Authors

Affiliations

¹ WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy. giovanni.ostuzzi@univr.it.
² WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy.
³ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
⁴ Department of Molecular Medicine, University of Siena, Siena, Italy.
⁵ Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Campus, Cape Town, 8000, South Africa.
⁶ Azienda ULSS 9 Scaligera, Verona, Italy.
⁷ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
⁸ Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada.
⁹ Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.
¹⁰ Physiotherapy Department, South London and Maudsley National Health Services Foundation Trust, London, UK.
¹¹ Pharmacy Department, Maudsley Hospital, London, UK.
¹² Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
¹³ School of Psychiatry, UNSW Sydney and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia.
¹⁴ Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany.
¹⁵ Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
¹⁶ Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany.

PMID: 32664944
PMCID: PMC7360478
DOI: 10.1186/s12916-020-01685-9

Erratum in

Correction to: Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations.
Ostuzzi G, Papola D, Gastaldon C, Schoretsanitis G, Bertolini F, Amaddeo F, Cuomo A, Emsley R, Fagiolini A, Imperadore G, Kishimoto T, Michencigh G, Nosé M, Purgato M, Dursun S, Stubbs B, Taylor D, Thornicroft G, Ward PB, Hiemke C, Correll CU, Barbui C. Ostuzzi G, et al. BMC Med. 2020 Sep 12;18(1):291. doi: 10.1186/s12916-020-01757-w. BMC Med. 2020. PMID: 32919477 Free PMC article.

Abstract

Background: The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments.

Methods: In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug-drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group.

Results: All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication.

Conclusions: The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.

Keywords: COVID-19; Drug–drug interactions; Novel coronavirus; Psychiatric comorbidity; Psychopharmacology.

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Conflict of interest statement

Alessandro Cuomo has been a consultant and/or a speaker for Angelini, Lundbeck, and Otsuka. Christoph U. Correll has been a consultant and/or advisor to or has received honoraria from Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, Gerson Lehrman Group, IntraCellular Therapies, Janssen/J&J, LB Pharma, Lundbeck, MedAvante-ProPhase, Medscape, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He has provided expert testimony for Janssen and Otsuka. He served on a Data Safety Monitoring Board for Lundbeck, Rovi, Supernus, and Teva. He received grant support from the Berlin Institute of health (BIH), Janssen, the National Institute of Mental Health (NIMH), Patient Centered Outcomes Research Institute (PCORI), Takeda, and the Thrasher Foundation. He received royalties from UpToDate and is also a stock option holder of LB Pharma. Dr. Robin Emsley has participated in speakers/advisory boards and received honoraria from Janssen, Lundbeck, Servier, and Otsuka and has received research funding from Janssen and Lundbeck. Andrea Fagiolini has been a consultant and/or a speaker and/or has received research grants from Allergan, Angelini, Apsen, Boheringer, Ingelheim, Daiichi, Sankyo, Brasil Farmacêutica, Doc Generici, FB-Health, Italfarmaco, Janssen, Lundbeck, Mylan, Otsuka, Pfizer, Recordati, Sanofi, Aventis, Sunovion, and Vifor. Giuseppe Imperadore has been a consultant and/or a speaker for Lundbeck, Otsuka, Janseen, Pfizer, AstraZeneca, and Eli Lilly. Taishiro Kishimoto has received consultant fees from Dainippon Sumitomo, Novartis, and Otsuka and speaker’s honoraria from Dainippon Sumitomo, Janssen, Novartis, Otsuka, and Pfizer. He has received grant support from Otsuka, Dainippon-Sumitomo, and MICIN. Brendon Stubbs is supported by a Clinical Lectureship (ICA-CL-2017-03-001) jointly funded by Health Education England (HEE) and the National Institute for Health Research (NIHR). Brendon Stubbs is part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust. Brendon Stubbs is also supported by the Maudsley Charity, King’s College London, and the NIHR South London Collaboration for Leadership in Applied Health Research and Care (CLAHRC) funding. David Taylor has received research funding and consulting payments from Sunovion, Lundbeck, Janssen, and Recordati. Graham Thornicroft is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration South London at King’s College London NHS Foundation Trust and by the NIHR Asset Global Health Unit award. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. GT also receives support from the National Institute of Mental Health of the National Institutes of Health under award number R01MH100470 (Cobalt study). GT is supported by the UK Medical Research Council in relation to the Emilia (MR/S001255/1) and Indigo Partnership (MR/R023697/1) awards. Christoph Hiemke has received speaker’s or consultancy fees from the following pharmaceutical companies: Janssen and Servier. He declares no conflict of interest related to this article. All the other authors have no conflict of interest to declare.

References

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Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

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Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

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Erratum in

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Conflict of interest statement

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