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

Giovanni Ostuzzi; D. Papola; C. Gastaldon; Georgios Schoretsanitis; F. Bertolini; F Amaddeo; A Cuomo; R. Emsley; A Fagiolini; G Imperadore; T Kishimoto; G Michencigh; M Nose; Marianna Purgato; D Serdar; Brendon Stubbs; David Taylor; Graham Thornicroft; PB Ward; C Hiemke; Christoph  U.   Correll; C Barbui

doi:10.1186/s12916-020-01685-9

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

Giovanni Ostuzzi, D. Papola, C. Gastaldon, Georgios Schoretsanitis, F. Bertolini, F Amaddeo, A Cuomo, R. Emsley, A Fagiolini, G Imperadore, T Kishimoto, G Michencigh, M Nose, Marianna Purgato, D Serdar, Brendon Stubbs, David Taylor, Graham Thornicroft, PB Ward, C HiemkeChristoph U. Correll, C Barbui

Research output: Contribution to journal › Review article › peer-review

115 Citations (Scopus)

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.

Original language	English
Article number	215
Journal	BMC Medicine
Volume	18
Issue number	1
DOIs	https://doi.org/10.1186/s12916-020-01685-9
Publication status	Published - 15 Jul 2020

Keywords

COVID-19
Drug-drug interactions
Novel coronavirus
Psychiatric comorbidity
Psychopharmacology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

Ostuzzi, G., Papola, D., Gastaldon, C., Schoretsanitis, G., Bertolini, F., Amaddeo, F., Cuomo, A., Emsley, R., Fagiolini, A., Imperadore, G., Kishimoto, T., Michencigh, G., Nose, M., Purgato, M., Serdar, D., Stubbs, B., Taylor, D., Thornicroft, G., Ward, PB., ... Barbui, C. (2020). Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations. BMC Medicine, 18(1), Article 215. https://doi.org/10.1186/s12916-020-01685-9

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title = "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.",

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author = "Giovanni Ostuzzi and D. Papola and C. Gastaldon and Georgios Schoretsanitis and F. Bertolini and F Amaddeo and A Cuomo and R. Emsley and A Fagiolini and G Imperadore and T Kishimoto and G Michencigh and M Nose and Marianna Purgato and D Serdar and Brendon Stubbs and David Taylor and Graham Thornicroft and PB Ward and C Hiemke and Correll, {Christoph U.} and C Barbui",

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Ostuzzi, G, Papola, D, Gastaldon, C, Schoretsanitis, G, Bertolini, F, Amaddeo, F, Cuomo, A, Emsley, R, Fagiolini, A, Imperadore, G, Kishimoto, T, Michencigh, G, Nose, M, Purgato, M, Serdar, D, Stubbs, B , Taylor, D , Thornicroft, G, Ward, PB, Hiemke, C, Correll, CU & Barbui, C 2020, 'Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations', BMC Medicine, vol. 18, no. 1, 215. https://doi.org/10.1186/s12916-020-01685-9

TY - JOUR

T1 - Safety of psychotropic medications in people with COVID-19: evidence review and practical recommendations

AU - Ostuzzi, Giovanni

AU - Papola, D.

AU - Gastaldon, C.

AU - Schoretsanitis, Georgios

AU - Bertolini, F.

AU - Amaddeo, F

AU - Cuomo, A

AU - Emsley, R.

AU - Fagiolini, A

AU - Imperadore, G

AU - Kishimoto, T

AU - Michencigh, G

AU - Nose, M

AU - Purgato, Marianna

AU - Serdar, D

AU - Stubbs, Brendon

AU - Taylor, David

AU - Thornicroft, Graham

AU - Ward, PB

AU - Hiemke, C

AU - Correll, Christoph U.

AU - Barbui, C

PY - 2020/7/15

Y1 - 2020/7/15

N2 - 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.

AB - 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.

KW - COVID-19

KW - Drug-drug interactions

KW - Novel coronavirus

KW - Psychiatric comorbidity

KW - Psychopharmacology

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U2 - 10.1186/s12916-020-01685-9

DO - 10.1186/s12916-020-01685-9

M3 - Review article

SN - 1741-7015

VL - 18

JO - BMC Medicine

JF - BMC Medicine

IS - 1

M1 - 215

ER -

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

Abstract

Keywords

UN SDGs

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