Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations
Giovanni Ostuzzi,
Davide Papola,
Chiara Gastaldon,
Georgios Schoretsanitis,
Federico Bertolini,
Francesco Amaddeo,
Alessandro Cuomo,
Robin Emsley,
Andrea Fagiolini,
Giuseppe Imperadore,
Taishiro Kishimoto,
Giulia Michencigh,
Michela Nosé,
Marianna Purgato,
Dursun Serdar,
Brendon Stubbs,
David Taylor,
Graham Thornicroft,
Philip B. Ward,
Christoph Hiemke,
Christoph U. Correll,
Corrado Barbui
Affiliations
Giovanni Ostuzzi
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
Davide Papola
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
Chiara Gastaldon
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
Georgios Schoretsanitis
Department of Psychiatry, The Zucker Hillside Hospital
Federico Bertolini
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
Francesco Amaddeo
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
Alessandro Cuomo
Department of Molecular Medicine, University of Siena
Robin Emsley
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University
Andrea Fagiolini
Department of Molecular Medicine, University of Siena
Giuseppe Imperadore
Azienda ULSS 9 Scaligera
Taishiro Kishimoto
Department of Neuropsychiatry, Keio University School of Medicine
Giulia Michencigh
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
Michela Nosé
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
Marianna Purgato
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
Dursun Serdar
Department of Psychiatry, University of Alberta
Brendon Stubbs
Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London
David Taylor
Pharmacy Department, Maudsley Hospital
Graham Thornicroft
Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
Philip B. Ward
School of Psychiatry, UNSW Sydney and Schizophrenia Research Unit, Ingham Institute of Applied Medical Research
Christoph Hiemke
Department of Psychiatry and Psychotherapy, University Medical Center of Mainz
Christoph U. Correll
Department of Psychiatry, The Zucker Hillside Hospital
Corrado Barbui
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
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.
