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Major Neurologic Adverse Drug Reactions, Potential Drug–Drug Interactions and Pharmacokinetic Aspects of Drugs Used in COVID-19 Patients with Stroke: A Narrative Review

Authors Ghasemiyeh P, Borhani-Haghighi A, Karimzadeh I, Mohammadi-Samani S, Vazin A, Safari A, Qureshi AI

Received 22 April 2020

Accepted for publication 10 June 2020

Published 30 June 2020 Volume 2020:16 Pages 595—605

DOI https://doi.org/10.2147/TCRM.S259152

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Garry Walsh


Parisa Ghasemiyeh,1,2 Afshin Borhani-Haghighi,3 Iman Karimzadeh,1 Soliman Mohammadi-Samani,2,4 Afsaneh Vazin,1 Anahid Safari,5 Adnan I Qureshi6

1Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 2Pharmaceutical Sciences Research Center, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 3Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 4Department of Pharmaceutics, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 5Stem Cells Technology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 6Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO, USA

Correspondence: Afshin Borhani-Haghighi
Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
+98-713-6281572
Email neuro.ab@gmail.com

Abstract: Stroke has been considered as one of the underlying diseases that increases the probability of severe infection and mortality. Meanwhile, there are ongoing reports of stroke subsequent to COVID-19 infection. In this narrative paper, we reviewed major neurologic adverse drug reactions (ADRs) and pharmacokinetics of drugs which are routinely used for COVID-19 infection and their potential drug–drug interactions (PDDIs) with common drugs used for the treatment of stroke. It is highly recommended to monitor patients on chloroquine (CQ), hydroxychloroquine (HCQ), antiviral drugs, and/or corticosteroids about initiation or progression of cardiac arrhythmias, delirium, seizure, myopathy, and/or neuropathy. In addition, PDDIs of anti-COVID-19 drugs with tissue plasminogen activator (tPA), anticoagulants, antiaggregants, statins, antihypertensive agents, and iodine-contrast agents should be considered. The most dangerous PDDIs were interaction of lopinavir/ritonavir or atazanavir with clopidogrel, prasugrel, and new oral anticoagulants (NOACs).

Keywords: SARS-CoV-2, COVID-19, stroke, potential drug–drug interactions, adverse drug reactions, pharmacokinetics

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