Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake of Coronavirus Disease-2019: Psychopharmacological Interactions and Neuropsychiatric Sequelae

IF 3.4 Q2 Medicine
Brandon S. Hamm M.D., M.S., Lisa J. Rosenthal M.D., F.A.C.L.P., D.F.A.P.A.
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引用次数: 30

Abstract

Background

Chloroquine and hydroxychloroquine are among several experimental treatments being investigated in the urgent response to the coronavirus disease-2019. With increased use of these medications, physicians need to become knowledgeable of these drugs' neuropsychiatric side effects and interactions with psychiatric medications. Objective: Clarify evidence base regarding the psychiatric side effects and psychiatric drug interactions of chloroquine and hydroxychloroquine.

Methods

A literature review was performed in PubMed from 1950 to 2020 regarding psychiatric topics and targeted pharmacological properties of chloroquine and hydroxychloroquine.

Results

First, chloroquine and hydroxychloroquine may mildly inhibit CYP2D6 metabolism of psychiatric medications, and psychiatric medications that interfere with CYP2D6 or CYP3A4 activity could alter chloroquine and hydroxychloroquine levels. Second, they may prolong the QT interval, warranting caution with concomitant prescription of other QT prolonging agents. Finally, neuropsychiatric side effects are very uncommon but possible and include a potentially prolonged phenomenon of “psychosis after chloroquine.” Hydroxychloroquine has less information available about its neuropsychiatric side effects than chloroquine, with psychosis literature limited to several case reports. Weak evidence suggests a possible association of hydroxychloroquine exposure and increased suicidal ideation. It is not clear whether patients with psychiatric illness are more vulnerable to neuropsychiatric sequela of these medications; however, overdose of these medications by suicidal patients has high risk of mortality.

Conclusion

The risk of neuropsychiatric side effects of chloroquine and hydroxychloroquine when used for coronavirus disease-2019 treatment is not known. Best practice may include suicide risk assessment for patients treated with hydroxychloroquine. However, delirium is expected to be a more likely etiology of neuropsychiatric symptoms in critically ill patients treated for coronavirus disease-2019, and adjustment disorder is a much more likely etiology of anxiety and depression symptoms than the side effects of chloroquine or hydroxychloroquine.

冠状病毒病-2019后氯喹和羟氯喹治疗的精神病学方面:精神药理学相互作用和神经精神后遗症
氯喹和羟氯喹是目前正在研究的几种实验性治疗方法之一,用于紧急应对2019年冠状病毒病。随着这些药物使用的增加,医生需要了解这些药物的神经精神副作用以及与精神药物的相互作用。目的:阐明氯喹和羟氯喹的精神副反应及精神药物相互作用的证据基础。方法回顾1950 ~ 2020年PubMed上关于氯喹和羟氯喹的精神病学主题和靶向药理学性质的文献。结果首先,氯喹和羟氯喹可轻度抑制精神药物CYP2D6的代谢,干扰CYP2D6或CYP3A4活性的精神药物可改变氯喹和羟氯喹的水平。其次,它们可能延长QT间期,因此在同时使用其他QT间期延长药物时要谨慎。最后,神经精神方面的副作用是非常罕见的,但也是可能的,包括一种潜在的长期的“氯喹后精神病”现象。羟基氯喹在神经精神方面的副作用比氯喹少,精神病方面的文献仅限于几个病例报告。微弱的证据表明,羟氯喹暴露可能与自杀意念增加有关。目前尚不清楚精神疾病患者是否更容易受到这些药物的神经精神后遗症的影响;然而,自杀患者过量服用这些药物有很高的死亡率。结论氯喹和羟氯喹用于治疗冠状病毒病-2019的神经精神副反应风险尚不清楚。最佳做法可能包括对接受羟氯喹治疗的患者进行自杀风险评估。然而,在2019冠状病毒病治疗的危重患者中,谵妄可能是神经精神症状的一个更可能的病因,而适应障碍是焦虑和抑郁症状的一个更可能的病因,而不是氯喹或羟氯喹的副作用。
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来源期刊
Psychosomatics
Psychosomatics 医学-精神病学
CiteScore
3.20
自引率
0.00%
发文量
0
审稿时长
6-12 weeks
期刊介绍: The mission of Psychosomatics is to be the leading psychiatry journal focused on the care of patients with comorbid medical and psychiatric illnesses. The scope of Psychosomatics includes original research, review articles and clinical reports that address psychiatric aspects of medical illnesses and their management. Areas of particular interest include: the effect of co-morbid psychiatric conditions on the management of medical illness; the psychiatric management of patients with comorbid medical illness; educational content for physicians and others specializing in consultation-liaison (C-L) psychiatry; and, the provision of psychiatric services to medical populations, including integrated care.
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