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editorial
. 2020 May 4:1–4. doi: 10.1192/bjp.2020.92

Table 1.

Preferred psychotropic drugs during experimental COVID-19 therapies

Drug class Caution for QT and/or PR interval prolongationa Caution for drug–drug interactionsb Preferred drugsc
Antidepressants (Es)citalopram
Mirtazapine
Tricyclic antidepressantsd
Venlafaxine		 St John's wort Agomelatine
Bupropion
Duloxetine
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline
Antipsychotic drugs All, except for: aripiprazole, brexpiprazole, cariprazine, lurasidone Pimozide
Quetiapine		 Amisulpridee
Aripiprazole
Brexpiprazole
Cariprazine
Lurasidone
Olanzapinee
Benzodiazepines None All (especially midazolam), except for: lorazepam, lormetazepam, oxazepam, temazepamf Lorazepamf
Lormetazepamf
Oxazepamf
Temazepamf
Mood stabilisers Lithium Carbamazepine Lamotrigine
Lithiume
Valproate
a.

Relevant when lopinavir/ritonavir or (hydroxyl)chloroquine are used to treat COVID-19.

b.

Especially relevant when atazanavir or lopinavir/ritonavir are used to treat COVID-19, because CYP3A4 inhibition causes higher blood levels of psychotropic drugs. St John's wort and carbamazepine may reduce blood levels of several drugs used to treat COVID-19.

c.

Therapeutic drug monitoring may be helpful when considering dose modifications.

d.

For example amitriptyline, clomipramine, imipramine, nortriptyline.

e.

Based on efficacy, with careful monitoring of electrocardiogram if applicable.4

f.

For sedatives/anxiolytics/hypnotics, the benzodiazepines with no active metabolites that only undergo glucuronidation (lorazepam, lormetazepam, oxazepam, and temazepam) are generally preferred.