Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

Abstract

Background The novel coronavirus pandemic calls for a rapid adaptation of conventional medical practices to meet the evolving needs of such vulnerable patients. People with coronavirus disease (COVID-19) may frequently require treatment with psychotropic medications, but are at the same time at higher risk for safety issues because of the complex underlying medical condition and the potential interaction with medical treatments. Methods In order to produce evidence-based practical recommendations on the optimal management of psychotropic medications in people with COVID-19, an international, multi-disciplinary working group was established. The methodology of the WHO Rapid Advice Guidelines in the context of a public health emergency and the principles of the AGREE statement were followed. Available evidence informing on the risk of respiratory, cardiovascular, infective, hemostatic, and consciousness alterations related to the use of psychotropic medications, and drug–drug interactions between psychotropic and medical treatments used in people with COVID-19, was reviewed and discussed by the working group. Results All classes of psychotropic medications showed potentially relevant safety risks for people with COVID-19. A set of practical recommendations was drawn in order to inform frontline clinicians on the assessment of the anticipated risk of psychotropic-related unfavorable events, and the possible actions to take in order to effectively manage this risk, such as when it is appropriate to avoid, withdraw, switch, or adjust the dose of the medication. Conclusions The present evidence-based recommendations will improve the quality of psychiatric care in people with COVID-19, allowing an appropriate management of the medical condition without worsening the psychiatric condition and vice versa.

Mental health in times of COVID: Thoughts after the state of alarm

“…They have had to care for patients who were being administered medicinal products for the infectious disease that carry the risk of inducing neuropsychiatric symptoms, such as azithromycin, hydroxychloroquine or glucocorticoids, which have been positively linked with psychotic symptoms and mood disorders (depression/mania). 6 The safety of psychopharmacological treatment has been an important aspect to monitor, given the potential interactions that exist between drugs metabolised by CYP3A4 (e.g. hydroxychloroquine), i.e.…”

“…antipsychotics or antidepressants). 6 Adapting hospitals to the care of COVID-19 patients has had consequences on the mental health of patients. Rates of anxiety have increased with restrictions on family visits and uncertainty about the prognosis of the disease.…”

Salud mental en tiempos de la COVID: reflexiones tras el estado de alarma

“…Además del componente de estrés asociado a este aislamiento o el temor de padecer una enfermedad infecciosa grave, el manejo psicofarmacológico del paciente COVID con síntomas psicopatológicos ha supuesto un reto para los psiquiatras de interconsulta. Estos han tenido que atender a pacientes que estaban recibiendo tratamientos para la enfermedad infecciosa con posibilidad de inducir síntomas neuropsiquiátricos, como serían la azitromicina, la hidroxicloroquina o los glucocorticoides, que se han asociado a síntomas psicóticos y síntomas afectivos (depresión/manía) 6 . La seguridad del tratamiento psicofarmacológico ha resultado un aspecto importante para monitorizar, dadas las interacciones potenciales que existen entre fármacos metabolizados por el CYP3A4 (p.ej., hidroxicloroquina), el riesgo de prolongación del QT al combinar fármacos utilizados para la COVID-19 (p.ej., azitromicina, hidroxicloroquina) con psicofármacos que pueden alargar el QT (p.ej., antipsicóticos o antidepresivos) 6 .…”

“…Se han incrementado las tasas de ansiedad con las restricciones en las visitas de familiares y la incertidumbre por el pronóstico de la enfermedad. Además, han aparecido en algunos pacientes síntomas afectivos y psicóticos relacionados con los tratamientos farmacológicos de la infección 6 que han determinado un manejo más complejo de estos pacientes.…”

Correction to: Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

“…The original version of this article [ 1 ] unfortunately included an error to an author’s name. Author Serdar Dursun was erroneously presented as Dursun Serdar.…”