Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations
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RESEARCH ARTICLE
Open Access
Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations Giovanni Ostuzzi1* , Davide Papola1, Chiara Gastaldon1, Georgios Schoretsanitis2, Federico Bertolini1, Francesco Amaddeo1, Alessandro Cuomo3, Robin Emsley4, Andrea Fagiolini3, Giuseppe Imperadore5, Taishiro Kishimoto6, Giulia Michencigh1, Michela Nosé1, Marianna Purgato1, Dursun Serdar7, Brendon Stubbs8,9, David Taylor10, Graham Thornicroft11, Philip B. Ward12, Christoph Hiemke13, Christoph U. Correll2,14,15 and Corrado Barbui1
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. Keywords: Novel coronavirus, COVID-19, Psychopharmacology, Psychiatric comorbidity, Drug–drug interactions
* Correspondence: [email protected] 1 WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy Full list of author information is available at the end of the article
© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, a
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