Drug Interactions Between COVID-19 and Psychiatric Medications: A Mini Review

Abstract

Coronavirus disease 2019 (COVID-19) has become a pandemic with 8,708,000 confirmed cases and 461,715 death in the world until June 21, 2020. The Severe Acute Respiratory Syndrome Coronavirus 2 virus, which is an enveloped and single-stranded RNA virus belonging to Coronaviridea family, causes multiple organ systems diseases such as respiratory, gastrointestinal, hepatic, and neurological tracts in humans and animals. With the rapid and global spread of COVID-19, the scientific authorities have developed treatment algorithms for COVID-19. Besides the supportive care, chloroquine, hydroxychloroquine, lopinavir/ritonavir, favipiravir, tocilizumab, azithromycin, Vitamin C, and convalescent plasma therapy are frequently used off-label to treat COVID-19. For severe COVID-19 cases, the US Food and Drug Administration has issued an Emergency Use Authorization Remdesivir, which is the first drug to earn the title. COVID-19 treatment may cause many side effects and drug interactions. Psychiatric diseases are also chronic diseases, and psychiatric drugs may have severe interactions with COVID-19 medications. Drug interactions with psychiatric medication and neuropsychiatric side effects should be considered within the action mechanism of COVID-19 treatments. Thus, in this review, we aimed to elucidate the interactions of COVID-19 medications with the antidepressants, antipsychotics, and the other psychotropic drugs that have been frequently used in psychiatric diseases. Chloroquine, hydroxychloroquine, azithromycin, ribavirin, and lopinavir/ritonavir have interactions with psychiatric medications such as antidepressants, antipsychotics, anticonvulsants, and anxiolytics in terms of QTc interval prolongation, hepatotoxicity, myelosuppression, increased or decreased concentration of medications. Remdesivir has lower interactions with most of the psychiatric drugs except St John's Wort and some anticonvulsants. However, favipiravir is considered as the COVID-19 medication, which has lower interaction and side effects in combination with psychiatric medication. The use of tocilizumab is also safe with most of the psychiatric drugs and has a positive effect on depressive symptoms, although there is a risk of hepatotoxicity.