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Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake
of Coronavirus Disease-2019: Psychopharmacological Interactions and
Neuropsychiatric Sequelae
#MMPMID32800347
Hamm BS
; Rosenthal LJ
Psychosomatics
2020[Nov]; 61
(6
): 597-606
PMID32800347
show ga
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.
|Antiviral Agents/*adverse effects/therapeutic use
[MESH]
|Anxiety/chemically induced
[MESH]
|Betacoronavirus
[MESH]
|Bipolar Disorder/chemically induced
[MESH]
|COVID-19
[MESH]
|Chloroquine/*adverse effects/therapeutic use
[MESH]
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