Drug-drug interactions between COVID-19 therapeutics and psychotropic medications

ABSTRACT

Introduction

The coronavirus (COVID-19) pandemic has led to as well as exacerbated mental health disorders, leading to increased use of psychotropic medications. Co-administration of COVID-19 and psychotropic medications may result in drug-drug interactions (DDIs), that may compromise both the safety and efficacy of both medications.

Areas covered

This review provides an update of the current evidence on DDIs between COVID-19 and psychotropic medications. The interactions are categorized into pharmacokinetic, pharmacodynamic, and other relevant types. A thorough literature search was conducted using electronic databases to identify relevant studies, and extract data to highlight potential DDIs, clinical implications, and management strategies.

Expert opinion

Understanding and managing potential DDIs between COVID-19 and psychotropic medications is paramount to ensuring safe and effective treatment of patients with COVID-19 and mental illness. Awareness of the diverse spectrum of DDIs, vigilant monitoring, and judicious dose modifications, while choosing pharmacotherapeutic options with low risk of interaction whenever possible, are necessary. Ongoing and future investigations should continue to review the dynamic landscape of COVID-19 therapeutic modalities and their interactions with psychotropic medications.

KEYWORDS:

• COVID-19
• SARS-CoV-2
• drug interaction
• mental health
• psychotropic medication interactions
• pharmacokinetic
• pharmacodynamic

Article highlights

• The COVID-19 pandemic has led to increased use of antiviral and immunomodulatory medications, as well as an increased prevalence of mental health disorders requiring psychotropic medications.

• Drug-drug interactions (DDIs) between COVID-19 and psychotropic medications may affect treatment safety and efficacy, necessitating a deeper understanding of these interactions.

• This narrative review categorizes interactions into pharmacokinetic, pharmacodynamic, serotonin syndrome, QT interval prolongation, and other relevant types and provides a detailed overview of their clinical implications and management strategies. Individual COVID-19 drugs and their degree of interaction are also covered.

• Healthcare providers need to closely monitor patients, adjust doses when necessary, and consider alternative medications to minimize adverse effects and optimize patient care. Ongoing research is critical to keep pace with the evolving landscape of COVID-19 treatments and their potential interactions with psychotropic medications to ensure up-to-date guidance for clinicians in managing patients with mental health disorders during the pandemic.

Acknowledgments

We would like to thank all the researchers and health care providers who have worked tirelessly in the ongoing fight against the COVID-19 pandemic, especially in the early stages of the pandemic when research and clinical care against an unknown disease were particularly difficult, but even today when research and clinical practice are sometimes challenged by unreasonable beliefs reminiscent of the times when anger was directed at those who hypothesized that the Earth was a sphere and not the center of the universe. The dedication of researchers and clinicians to understanding and addressing this public health crisis, despite many difficulties, has been and continues to be invaluable.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.