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

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.

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

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