SARS-CoV-2 vaccination and plasma levels of psychotropic agents: a prospective cohort study

Expert Opinion on Drug Metabolism & Toxicology, vol. 21, pp. 1213–1218

Abstract

BACKGROUND: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infections induce immunological and inflammatory reactions that may have an impact on cytochrome P450 activity, altering the metabolism of psychotropic drugs. In a cohort study, we prospectively investigated whether SARS-CoV-2 vaccination affects plasma levels of psychotropic agents in association with inflammatory parameter changes. METHODS: We analyzed data from a cohort of 13 psychiatric inpatients receiving psychotropic treatment who underwent two inoculations of a SARS-CoV-2 mRNA vaccination. Plasma levels of psychotropic drugs and inflammatory markers were measured before and after vaccination. RESULTS: In clozapine-treated patients, plasma levels remained by mean almost constant after both inoculations, although changes were larger in patients without vs. with co-medication with fluvoxamine (p < 0.001 at all timepoints except for timepoint T2; p = 0.9), with minor changes in interleukin 6 (IL-6) and C-reactive protein (CRP). For aripiprazole, quetiapine, olanzapine, lithium, sertraline, escitalopram, duloxetine, and paroxetine, no distinct plasma level patterns at post-vaccination emerged. CONCLUSION: SARS-CoV-2 vaccination was not associated with essential alterations of psychotropic drug levels. Observed CRP increases did not reach concentrations that may be associated with elevated drug levels. Nevertheless, monitoring of CRP and drug levels is recommended to capture post-vaccine plasma level changes, particularly in patients receiving clozapine.

Authors 6

1. Nazar Kuzo

   University of Zurich

   Affiliation as printed

   University of Zurich

   Department of Psychiatry

2. Giancarlo Giupponi
   Affiliation as printed

   Bolzano Health District

   Department of Psychiatry

3. Agnese Raponi Aachen Psychotherapy and Psychosomatics

   RWTH Aachen University

   Affiliation as printed

   Bolzano Health District

   Alexianer Centre for Mental Health aachen/Gangelt

   Psychotherapy and Psychosomatics, RWTH Aachen University, and jara - Translational Brain Medicine

4. Michael Paulzen Aachen Psychotherapy and Psychosomatics

   RWTH Aachen University · Jülich Aachen Research Alliance · University Medical Center of the Johannes Gutenberg University Mainz

   Affiliation as printed

   Alexianer Centre for Mental Health Aachen/Gangelt

   Psychotherapy and Psychosomatics, RWTH Aachen University, and JARA - Translational Brain Medicine

   University Medical Center of Mainz

5. Andreas Conca

   University of Zurich · Northwell Health · Hofstra University

   Affiliation as printed

   Bolzano Health District

   Northwell Health

   The Hofstra Northwell School of Medicine

   University of Zurich

6. Georgios Schoretsanitis

   University of Zurich · Northwell Health · Hofstra University

   Affiliation as printed

   Northwell Health

   The Hofstra Northwell School of Medicine

   University of Zurich