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

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.

Liaison psychiatry before and after the COVID-19 pandemic

“…The standards of prescription improved after the intervention of the LPTs. The added difficulty of changes in specific treatments for COVID and its interactions with psychotropic drugs should be noted ( Plasencia-García et al, 2021 ). The challenge of implementing new treatment and follow-up programs, for example, for healthcare personnel, should also be considered.…”

Pain Management and COVID-19: A Latin American Perspective

“…Lithium is contraindicated for concurrent use with hydroxychloroquine, chloroquine, and azithromycin. Anticonvulsants and benzodiazepines present little or no risk for adverse interaction with COVID-19 treatments [54].…”

Joint European policy on the COVID-19 risks for people with mental disorders: An umbrella review and evidence- and consensus-based recommendations for mental and public health

“…cardiovascular and metabolic disorders, coagulopathies, immunological disorders, etc. ), and possible drug interactions that can result in either reduced drug tolerance, efficacy or safety [43,44,75], caution should be paid when prescribing specific classes of drugs in psychiatric patients. Studies on drug safety and effectiveness in people with pre-existent mental disorders and using psychopharmacological treatments are required.…”