1. COVID-19 impact on different Organs and potential interaction with psychotropics 2. COVID-19 Drugs Psychiatric side effects & Potential interaction with psychotropics 3. Psychotropic drug interactions with COVID-19 disease & treatment according to drug class

1. Psychotropic Drug
Interactions with COVID-19
“Disease and Treatment”
Prof. Sawsan Aboul-Fotouh
Department of Pharmacology, Faculty of Medicine, Ain Shams University
COVID-19

2. No. of people affected by COVID-19 worldwide is >113 M & rapidly ↑ (WHO, Feb. 2021)
COVID-19

3. COVID-19
Although the key symptoms are cough, fever, and
breathlessness, COVID-19 patients might experience,
Anxiety, Delirium, and Agitation in 20-70% (NICE, NHS 2020)
as well as symptoms of depression and insomnia…
Psychosomatics 2020, Psychopharmacology (2021) 238:329–340
▪ Coadministration of COVID-19 drugs and Psychotropics →
Potential drug interactions.
▪ COVID-19 impacts multiple organs → Pharmacokinetic
and Pharmacodynamic interaction with psychotropics.

4. 1. COVID-19 impact on different Organs and
potential interaction with psychotropics
2. COVID-19 Drugs Psychiatric side effects &
Potential interaction with psychotropics
3. Psychotropic drug interactions with COVID-
19 disease & treatment according to drug class
Objectives

5. 1. COVID-19 impact on Multiple Organs
Nature Medicine , (2020)
Cough
↓breath
Pneumonia
ARD
Pulmonary

6. COVID-19 impacts multiple Organs
& DIC
D-dimer
COVID-19 → Myocardial injury
Recommendation

7. COVID-19 impacts multiple Organs
Recommendation

8. COVID-19 impacts multiple organs
Typical AP
Clozapine
Recommendation

9. I- Remdesivir: (Antiviral)
the only FDA approved (2020) for COVID-19.
II- Other drugs “off –label”:
➢ Azithromycin
➢ Vitamin C
➢ Corticosteroids, Colchicine.
➢ Hydroxychloroquin
e, chloroquine.
➢ Lopinavir/ritonavir (Kaletra).
➢ Favipiravir.
➢ Interferon.
➢ Tocilizumab.
2. COVID-19 drugs

10. COVID-19 Drugs Psychiatric side effects & Potential interaction

11. QTc >450 ms in Male
QTc >470 ms in Female
↑QT→↑Risk of Fatal VA “torsades de pointes”
Drugs
(400 - 440 ms)

12. COVID-19 Drugs Psychiatric side effects & Potential interaction
TCAs, Bupropion
Typical AP, Clozapine
CYP3A4
Antimalarial

13. COVID-19 Drugs Psychiatric side effects & Potential interaction
Nefazodone
CYP3A4
Anti-gout

14. COVID-19 Drugs Psychiatric side effects & Potential interaction

15. COVID-19 Drugs Psychiatric side effects & Potential interaction
(Kaletra)
CYP3A4
Inhibitor ----

16. COVID-19 Drugs Psychiatric side effects & Potential interaction

17. COVID-19
3. Psychotropics Interaction
with COVID-19
“Disease and Treatment”
According to Drug Class

18. Academy of Consultation-Liaison Psychiatry, Psychosomatics. Bilbul et al, 2020
Psychotropics interaction with COVID-19
ANC = Absolute Neutrophil Count
A Infection →↑ Clozapine Toxicity
Clozapine →↑ Pneumonia
COVID-19 →↓ Lymphocytes
Clozapine →↓ Neutrophils
Clozapine → ↑ Seizure
COVID-19 →↑ Seizure

19. Academy of Consultation-Liaison Psychiatry, Psychosomatics. Bilbul et al, 2020
Psychotropics interaction with COVID-19
ANC = Absolute Neutrophil Count
Phenothiazines (chlorpromazine, Fluphenazine)
→ Aplastic A. (Rarely)
Typical AP, Clozapine
→ ↑ Seizure
Typical AP, Ziprasidone,
Quetiapine→ ↑ QT
Chlorpromazine

20. Academy of Consultation-Liaison Psychiatry, Psychosomatics. Bilbul et al, 2020
Psychotropics interaction with COVID-19
Antiepileptics
Leukopenia Liver injury
Liver injury
Thrombocytopenia
Pregabalin, Vigabatrin,
Topiramate, Levetiracetam
CrCl (ml/min)

21. Psychotropics interaction with COVID-19
& in Cr. CL <30 ml/min.
SSRIs & SNRIs block 5HT uptake by
platelets → ↓ P. Aggregation →↑Bleeding
COVID-19 drugs→ ↑ QT
& Mirtazapine

22. Psychotropics interaction with COVID-19
COVID-19, Chloroquine → ↑ Seizure
Bupropion→ ↑ Seizure
COVID-19→ Delirium
BZD→ ↑ Delirium
BZD→ ↓Respiration
CYP3A4
LOT
Also, LOT preferred in Liver & Renal Dysfunction

23. Psychotropics interaction with COVID-19
Therapeutic Level = 0.6-1.2 mEq/L
A Toxicity Start > 1.5 mEq/L
Li Toxicity Risk Factors:
Infection, Fever, Dehydration, AKI,
-ve Na balance (diarrhea, vomiting), Drugs ….

24. We have also asked for permission to start a clinical trial ???!!!

25. Lithium Antiviral Action
“esp. HSV”
- Compete e Mg …
- ATP/ADP imbalance
- Regulate B/T cells
- ↓ COX2, IL-1b, TNFα and - ↑ IL-2 & 10
= ↓ NOD-Receptor &inflammasome
= Membrane Depolarization Sci. Pharm. 2021, 89, 11 ?? !!
Sci. Pharm. 2021, 89, 11