Pharmacopsychiatry
DOI: 10.1055/a-1492-3293
Review

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

1  Department of Psychiatry, University Hospital Virgen del Rocio Spain
,
María Isabel Rico-Rangel
1  Department of Psychiatry, University Hospital Virgen del Rocio Spain
,
Gonzalo Rodríguez-Menéndez
1  Department of Psychiatry, University Hospital Virgen del Rocio Spain
,
Ana Rubio-García
1  Department of Psychiatry, University Hospital Virgen del Rocio Spain
,
Jaime Torelló-Iserte
2  Department of Clinical Pharmacology, University Hospital Virgen del Rocio Spain
,
Benedicto Crespo-Facorro
1  Department of Psychiatry, University Hospital Virgen del Rocio Spain
3  Biomedical Research Centre in Mental Health Network (CIBERSAM) Spain
4  University of Sevilla Spain
› Author Affiliations
Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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.

Supplementary Material



Publication History

Received: 03 November 2020

Accepted: 21 April 2021

Publication Date:
25 June 2021 (online)

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