Table 1.
Summary of drug-drug interaction between psychotropics and pharmacological treatments used for COVID-19
| Psychotropic Medication | Lopinavir/Ritonavir | Chloroquine/hydroxychloroquine | Implication | ||
|---|---|---|---|---|---|
| Antidepressants | SSRIs | ↑risk for serotonin syndrome and hypoglycemia | Caution in patients with diabetes | ||
| Fluoxetine | ↑Ritonavir via CYP2D6 and CYP3A4 | Risk of hypoglycemia | |||
| Sertraline | ↑Sertraline via CYP3A4 | Risk of hypoglycemia | |||
| Citalopram | ↑QTc | Cardiac monitoring especially in high-risk patients | |||
| Escitalopram | ↑QTc | Cardiac monitoring especially in high-risk patients | |||
| Paroxetine | ↓Paroxetine via CYP2D6 and protein binding displacement | Risk of hypoglycemia | |||
| Fluvoxamine | ↑Ritonavir via CYP3A4 | Risk of hypoglycemia | |||
| SNRIs | ↑QTc | Cardiac monitoring especially in high-risk patients dose reduction | |||
| TCAs | ↑TCAs via CYP2D6 | ↑QTc | is not necessary, monitor TCA side effects | ||
| MAOIs | Risk of hypoglycemia | Caution in patients with diabetes | |||
| Bupropion | ↓Bupropion via CYP2B6 | Monitor clinical effectiveness of bupropion | |||
| Trazodone | ↑Trazodone via CYP3A4 | ↑QTc | Cardiac monitoring especially in high-risk patients Sedation may also occur | ||
| Mirtazapine | ↑Mirtazapine via CYP3A4 | Use the lowest efficient dose | |||
| Vortioxetine | ↑Vortioxetine via CYP2D6 | Not clinically significant | |||
| Vilazodone | ↑Vilazodone via CYP3A4 | Dose reduction by 50% or using and alternative is suggested | |||
| Mood stabilizers | Valproic acid | ↓Valproate | Monitor for lopinavir toxicity and virologic response | ||
| ↑Lopinavir | |||||
| Lamotrigine | ↓Lam via UGTs | A dose increase is recommended | |||
| Carbamazepine | ↓Lopinavir | ↑Chloroquine | |||
| Lithium | |||||
| Antipsychotics | Second-generation antipsychotics | Risperidone | ↑Risperidone via CYP3A4 and 2D6 | ||
| Aripiprazole | ↑Aripiprazole via CYP3A4 and 2D6 | Dose reduction | |||
| Olanzapine | ↓Olanzapine via CYP1A2 | ↑QTc | |||
| Quetiapine | ↑Quetiapine via CYP3A4 | ↑QTc | Cardiac monitoring | ||
| First-generation antipsychotics | Ziprasidone | ↑Que via CYP3A4 | |||
| Clozapine | Additive metabolic toxicities | ↑QTc | Consider alternative agents | ||
| Chlorpromazine | ↑QTc | ||||
| Pimozide | ↑Pimozide via CYP3A4 | ↑QTc | Contraindicated | ||
| Anxiolytics | Benzodiazepines | Midazolam | ↑Midazolam via CYP3A4 | Contraindicated | |
| Diazepam | ↑Diazepam via 3A4 | Dose reduction | |||
| Alprazolam | ↑Alprazolam via 3A4 | Monitor sedation and dose reduction | |||
| Triazolam | ↓Triazolam via 3A4 | ||||
| Zolpidem | ↑Zolpidem via 3A4 | Not clinically significant | |||
| Buspirone | ↑Buspirone via 3A4 | Dose adjustment is not usually necessary | |||
SSRIs: Selective Serotonin Reuptake Inhibitors; SNRIs: Serotonin-Norepinephrine Reuptake Inhibitors; TCAs: Tricyclic Antidepressants; MAOIs: Monoamine Oxidase Inhibitors