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Review
. 2021 Apr;35(4):345-384.
doi: 10.1007/s40263-021-00811-2. Epub 2021 Apr 18.

Clinically Significant Drug Interactions Between Psychotropic Agents and Repurposed COVID-19 Therapies

Milo Gatti  1   2 , Fabrizio De Ponti  1 , Federico Pea  3   4
Affiliations
Review

Clinically Significant Drug Interactions Between Psychotropic Agents and Repurposed COVID-19 Therapies

Milo Gatti et al. CNS Drugs. 2021 Apr.

Abstract

As many patients with underlying psychiatric disorders may be infected with COVID-19, and COVID-19-affected subjects may frequently experience a new onset of psychiatric manifestations, concomitant use of psychotropic medications and COVID-19 therapies is expected to be highly likely and raises concerns of clinically relevant drug interactions. In this setting, four major mechanisms responsible for drug interactions involving psychotropic agents and COVID-19 therapies may be identified: (1) pharmacokinetic drug-drug interactions mainly acting on cytochrome P450; (2) pharmacodynamic drug-drug interactions resulting in additive or synergistic toxicity; (3) drug-disease interactions according to stage and severity of the disease; and (4) pharmacogenetic issues associated with polymorphisms of cytochrome P450 isoenzymes. In this review, we summarise the available literature on relevant drug interactions between psychotropic agents and COVID-19 therapies, providing practical clinical recommendations and potential management strategies according to severity of illness and clinical scenario.

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Conflict of interest statement

Federico Pea participated in the speaker bureau for Angelini, Basilea Pharmaceutica Gilead, Hikma, Merck Sharp and Dohme, Nordic Pharma, Pfizer and Sanofi Aventis, and in an advisory board for Angelini, Basilea Pharmaceutica, Correvio, Gilead, Merck Sharp and Dohme, Nordic Pharma, Novartis, Pfizer and Thermo–Fisher. Milo Gatti and Fabrizio De Ponti have no conflicts of interest that are directly relevant to the content of this article.

Figures

Fig. 1
Fig. 1
Relationship between severity of COVID-19 disease, clinical scenarios, and use of specific psychotropic and COVID-19 therapies. ICU intensive care unit
Fig. 2
Fig. 2
Proposed algorithm for the management of potential clinically relevant interactions between psychotropic medications and repurposed COVID-19 agents according to disease severity/stage of the infection. BZD benzodiazepine, DDIs drug–drug interactions, ICU intensive care unit, IL interleukin, TDM therapeutic drug monitoring
See this image and copyright information in PMC

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