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. 2022 Jan;55(1):40-47.
doi: 10.1055/a-1492-3293. Epub 2021 Jun 25.

Drug-drug Interactions between COVID-19 Treatments and Antidepressants, Mood Stabilizers/Anticonvulsants, and Benzodiazepines: Integrated Evidence from 3 Databases

Beatriz Oda Plasencia-García  1 , María Isabel Rico-Rangel  1 , Gonzalo Rodríguez-Menéndez  1 , Ana Rubio-García  1 , Jaime Torelló-Iserte  2 , Benedicto Crespo-Facorro  1   3   4
Affiliations

Drug-drug Interactions between COVID-19 Treatments and Antidepressants, Mood Stabilizers/Anticonvulsants, and Benzodiazepines: Integrated Evidence from 3 Databases

Beatriz Oda Plasencia-García et al. Pharmacopsychiatry. 2022 Jan.

Abstract

Introduction: The SARS-CoV-2 pandemic with psychiatric comorbidities leads to a scenario in which the use of psychotropic drugs may be required. This requires the support of evidence-based medicine to take into account possible interactions between antidepressants, mood stabilizers, benzodiazepines, and coronavirus infection treatments.

Methods: Three databases were consulted: (a) Lexicomp Drug Interactions, (b) Micromedex Solutions Drugs Interactions, (c)Liverpool Drug Interaction Group for COVID-19 therapies. The CredibleMeds QTDrugs List was also queried. Hydroxychloroquine, chloroquine, azithromycin, lopinavir-ritonavir, remdesivir, favipiravir, tocilizumab, baricitinib, anakinra, and dexamethasone - drugs used for SARS-CoV-2 - were analyzed, and consensus recommendations are made.

Results: The potential interactions of agomelatine, desvenlafaxine, duloxetine, milnacipran, and vortioxetine with COVID-19 treatments shall be considered less risky. Antidepressant interactions with hydroxychloroquine, chloroquine, and azithromycin enhance the risk of QT prolongation, and ECG monitoring is advised for most antidepressants. Antidepressants with lopinavir/ritonavir involve multiple CYP enzyme interactions (except with milnacipran). Gabapentin, oxcarbazepine, pregabalin, topiramate, and zonisamide are safe treatment options that have no significant interactions with COVID-19 treatments. Lithium is contraindicated with hydroxychloroquine, chloroquine, and azithromycin. Precaution should be taken in using valproic acid with lopinavir-ritonavir. The use of benzodiazepines does not present a risk of drug interaction with COVID-19 treatments, except lopinavir/ritonavir.

Conclusions: Clinicians prescribing antidepressants, mood stabilizers/anticonvulsants, and benzodiazepines, should be aware of the probable risk of drug-drug interaction with COVID-19 medications and may benefit from heeding these recommendations for use to ensure patient safety.

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Conflict of interest statement

BO Plasencia-García received consulting/advisory board fees from Otsuka Pharmaceuticals, Lundbeck, and Janssen Johnson & Johnson, and lecture fees from Otsuka Pharmaceuticals, Lundbeck, Janssen Johnson & Johnson, Angelini, and Pfizer. B Crespo-Facorro received consulting/advisory board fees from Otsuka Pharmaceuticals, Takeda, and Angelini as well as lecture fees from Janssen Johnson & Johnson, Lundbeck, Roche, and Otsuka Pharmaceutical. The other authors declare that they have no known conflicts of interest. No pharmaceutical industry or institutional sponsors participated in the study design, data collection, analysis, and interpretation of the result.

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