Journal Article

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

Purgato, Marianna, Barbui, Corrado, Ostuzzi, Giovanni, Hiemke, Christoph, Cuomo, Alessandro, Gastaldon, Chiara, Stubbs, Brendon, Kishimoto, Taishiro, Dursun, Serdar, Nosé, Michela, Correll, Christoph U., Amaddeo, Francesco, Taylor, David, Bertolini, Federico, Michencigh, Giulia, Papola, Davide, Schoretsanitis, Georgios, Thornicroft, Graham, Fagiolini, Andrea, Ward, Philip B., Imperadore, Giuseppe, Emsley, Robin

2020

Overview

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.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Antidepressants / Betacoronavirus / Biomedicine / Cardiovascular diseases / Care and treatment / Comorbidity / Coronaviridae / Coronavirus Infections - complications / Coronaviruses / COVID-19 / Disease susceptibility / Drug Interactions / Drugs / Drug–drug interactions / Epidemics / Evidence-Based Medicine / Health risks / Humans / Medical practice / Medical treatment / Medicine / Medicine & Public Health / Mental Disorders - drug therapy / Mental Disorders - epidemiology / Mortality / Novel coronavirus / Pandemics / Pneumonia, Viral - complications / Production methods / Psychiatric comorbidity / Psychopharmacology / Psychotropic drugs / Psychotropic Drugs - adverse effects / Psychotropic Drugs - therapeutic use / Public Health / Randomized Controlled Trials as Topic / Research Article / Risk / Risk management / Safety / Safety and security measures / SARS-CoV-2 / Systematic Reviews as Topic / Therapeutics / Viral diseases