Management of COVID-19 in patients with seizures: Mechanisms of action of potential COVID-19 drug treatments and consideration for potential drug-drug interactions with anti-seizure medications

• Published in: Epilepsy research 2021-08, Vol.174, p.106675-106675, Article 106675
• Main Authors: Jain, Shreshta, Potschka, Heidrun, Chandra, P. Prarthana, Tripathi, Manjari, Vohora, Divya
• Format: Article
• Language: English
• Subjects: Adenosine Monophosphate - adverse effects; Adenosine Monophosphate - analogs & derivatives; Alanine - adverse effects; Alanine - analogs & derivatives; Amides - adverse effects; Anti-Inflammatory Agents - adverse effects; Antibodies, Monoclonal, Humanized - adverse effects; Anticonvulsants - adverse effects; Antiviral Agents - adverse effects; Antiviral drugs; Chloroquine - adverse effects; COVID-19 - complications; COVID-19 candidate drugs; COVID-19 Drug Treatment; Cytochrome P-450 CYP3A Inducers - adverse effects; Dexamethasone - adverse effects; Drug Combinations; Drug Interactions; Drug-drug interactions; Enzyme Inhibitors - adverse effects; Epilepsy - complications; Epilepsy - drug therapy; Glucocorticoids - adverse effects; Humans; Hydroxychloroquine - adverse effects; Immunomodulatory or anti-inflammatory drugs; Interleukin 1 Receptor Antagonist Protein - adverse effects; Ivermectin - adverse effects; Lopinavir; NSAIDs; Pyrazines - adverse effects; Ritonavir; SARS-CoV-2; Seizures
• ISSN: 0920-1211; 1872-6844; 1872-6844
• DOI: 10.1016/j.eplepsyres.2021.106675

•Persons with epilepsy are not necessarily vulnerable to get infected by SARS-CoV-2.•Management of PWE and COVID-19 needs to consider potential drug-drug interactions.•Remdesivir and tocilizumab exhibit clinically irrelevant interactions with ASMs.•NSAIDs can be cautiously co-administered with ASDs in patients with COVID-19. In regard to the global pandemic of COVID-19, it seems that persons with epilepsy (PWE) are not more vulnerable to get infected by SARS-CoV-2, nor are they more susceptible to a critical course of the disease. However, management of acute seizures in patients with COVID-19 as well as management of PWE and COVID-19 needs to consider potential drug-drug interactions between antiseizure drugs and candidate drugs currently assessed as therapeutic options for COVID-19. Repurposing of several licensed and investigational drugs is discussed for therapeutic management of COVID-19. While for none of these approaches, efficacy and tolerability has been confirmed yet in sufficiently powered and controlled clinical studies, testing is ongoing with multiple clinical trials worldwide. Here, we have summarized the possible mechanisms of action of drugs currently considered as potential therapeutic options for COVID-19 management along with possible and confirmed drug-drug interactions that should be considered for a combination of antiseizure drugs and COVID-19 candidate drugs. Our review suggests that potential drug-drug interactions should be taken into account with drugs such as chloroquine/hydroxychloroquine and lopinavir/ritonavir while remdesivir and tocilizumab may be less prone to clinically relevant interactions with ASMs.