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

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

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.

Publication types

  • Review

MeSH terms

  • Antiviral Agents / adverse effects
  • Antiviral Agents / pharmacokinetics
  • COVID-19 / genetics
  • COVID-19 / metabolism
  • COVID-19 Drug Treatment*
  • Drug Interactions / physiology
  • Drug Repositioning / trends*
  • Humans
  • Mental Disorders / drug therapy
  • Mental Disorders / genetics
  • Mental Disorders / metabolism*
  • Pharmacogenetics / trends
  • Psychotropic Drugs / adverse effects*
  • Psychotropic Drugs / metabolism*

Substances

  • Antiviral Agents
  • Psychotropic Drugs