Psychopharmacology of COVID-19.
Identifieur interne : 001655 ( Main/Corpus ); précédent : 001654; suivant : 001656Psychopharmacology of COVID-19.
Auteurs : Melanie Bilbul ; Patricia Paparone ; Anna M. Kim ; Shruti Mutalik ; Carrie L. ErnstSource :
- Psychosomatics [ 1545-7206 ]
English descriptors
- KwdEn :
- Adenosine Monophosphate (adverse effects), Adenosine Monophosphate (analogs & derivatives), Adenosine Monophosphate (therapeutic use), Adrenal Cortex Hormones (adverse effects), Adrenal Cortex Hormones (therapeutic use), Alanine (adverse effects), Alanine (analogs & derivatives), Alanine (therapeutic use), Amides (adverse effects), Amides (therapeutic use), Anti-Inflammatory Agents (adverse effects), Anti-Inflammatory Agents (therapeutic use), Antibodies, Monoclonal, Humanized (adverse effects), Antibodies, Monoclonal, Humanized (therapeutic use), Antiviral Agents (adverse effects), Antiviral Agents (therapeutic use), Ascorbic Acid (adverse effects), Ascorbic Acid (therapeutic use), Azithromycin (adverse effects), Azithromycin (therapeutic use), Betacoronavirus (MeSH), COVID-19 (MeSH), Chloroquine (adverse effects), Chloroquine (therapeutic use), Colchicine (adverse effects), Colchicine (therapeutic use), Coronavirus Infections (complications), Coronavirus Infections (drug therapy), Coronavirus Infections (metabolism), Coronavirus Infections (therapy), Drug Combinations (MeSH), Drug Interactions (MeSH), Humans (MeSH), Hydroxychloroquine (adverse effects), Hydroxychloroquine (therapeutic use), Immunization, Passive (MeSH), Interferons (adverse effects), Interferons (therapeutic use), Lopinavir (adverse effects), Lopinavir (therapeutic use), Mental Disorders (chemically induced), Mental Disorders (complications), Mental Disorders (drug therapy), Pandemics (MeSH), Pneumonia, Viral (complications), Pneumonia, Viral (drug therapy), Pneumonia, Viral (metabolism), Psychotropic Drugs (adverse effects), Psychotropic Drugs (metabolism), Psychotropic Drugs (therapeutic use), Pyrazines (adverse effects), Pyrazines (therapeutic use), Ritonavir (adverse effects), Ritonavir (therapeutic use), SARS-CoV-2 (MeSH), Vitamins (adverse effects), Vitamins (therapeutic use).
- MESH :
- chemical , adverse effects : Adenosine Monophosphate, Adrenal Cortex Hormones, Alanine, Amides, Anti-Inflammatory Agents, Antibodies, Monoclonal, Humanized, Antiviral Agents, Ascorbic Acid, Azithromycin, Chloroquine, Colchicine, Hydroxychloroquine, Interferons, Lopinavir, Psychotropic Drugs, Pyrazines, Ritonavir, Vitamins.
- chemical , analogs & derivatives : Adenosine Monophosphate, Alanine.
- chemical , metabolism : Psychotropic Drugs.
- chemical , therapeutic use : Adenosine Monophosphate, Adrenal Cortex Hormones, Alanine, Amides, Anti-Inflammatory Agents, Antibodies, Monoclonal, Humanized, Antiviral Agents, Ascorbic Acid, Azithromycin, Chloroquine, Colchicine, Hydroxychloroquine, Interferons, Lopinavir, Psychotropic Drugs, Pyrazines, Ritonavir, Vitamins.
- chemically induced : Mental Disorders.
- complications : Coronavirus Infections, Mental Disorders, Pneumonia, Viral.
- drug therapy : Coronavirus Infections, Mental Disorders, Pneumonia, Viral.
- metabolism : Coronavirus Infections, Pneumonia, Viral.
- therapy : Coronavirus Infections.
- Betacoronavirus, COVID-19, Drug Combinations, Drug Interactions, Humans, Immunization, Passive, Pandemics, SARS-CoV-2.
Abstract
Background
With the rapid, global spread of severe acute respiratory syndrome coronavirus 2, hospitals have become inundated with patients suffering from coronavirus disease 2019. Consultation-liaison psychiatrists are actively involved in managing these patients and should familiarize themselves with how the virus and its proposed treatments can affect psychotropic management. The only Food and Drug Administration-approved drug to treat COVID-19 is remdesivir, and other off-label medications used include chloroquine and hydroxychloroquine, tocilizumab, lopinavir/ritonavir, favipiravir, convalescent plasma therapy, azithromycin, vitamin C, corticosteroids, interferon, and colchicine.
Objective
To provide an overview of the major safety considerations relevant to clinicians who prescribe psychotropics to patients with COVID-19, both related to the illness and its proposed treatments.
Methods
In this targeted review, we performed structured literature searches in PubMed to identify articles describing the impacts of COVID-19 on different organ systems, the neuropsychiatric adverse effects of treatments, and any potential drug interactions with psychotropics. The articles most relevant to this one were included.
Results
COVID-19 impacts multiple organ systems, including gastrointestinal, renal, cardiovascular, pulmonary, immunological, and hematological systems. This may lead to pharmacokinetic changes that impact psychotropic medications and increase sensitivity to psychotropic-related adverse effects. In addition, several proposed treatments for COVID-19 have neuropsychiatric effects and potential interactions with commonly used psychotropics.
Conclusions
Clinicians should be aware of the need to adjust existing psychotropics or avoid using certain medications in some patients with COVID-19. They should also be familiar with neuropsychiatric effects of medications being used to treat this disease. Further research is needed to identify strategies to manage psychiatric issues in this population.
DOI: 10.1016/j.psym.2020.05.006
PubMed: 32425246
PubMed Central: PMC7232075
Links to Exploration step
pubmed:32425246Le document en format XML
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Kim</name><affiliation><nlm:affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Mutalik, Shruti" sort="Mutalik, Shruti" uniqKey="Mutalik S" first="Shruti" last="Mutalik">Shruti Mutalik</name><affiliation><nlm:affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Ernst, Carrie L" sort="Ernst, Carrie L" uniqKey="Ernst C" first="Carrie L" last="Ernst">Carrie L. Ernst</name><affiliation><nlm:affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. 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Kim</name><affiliation><nlm:affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Mutalik, Shruti" sort="Mutalik, Shruti" uniqKey="Mutalik S" first="Shruti" last="Mutalik">Shruti Mutalik</name><affiliation><nlm:affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</nlm:affiliation></affiliation></author><author><name sortKey="Ernst, Carrie L" sort="Ernst, Carrie L" uniqKey="Ernst C" first="Carrie L" last="Ernst">Carrie L. Ernst</name><affiliation><nlm:affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. 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use)</term><term>Antiviral Agents (adverse effects)</term><term>Antiviral Agents (therapeutic use)</term><term>Ascorbic Acid (adverse effects)</term><term>Ascorbic Acid (therapeutic use)</term><term>Azithromycin (adverse effects)</term><term>Azithromycin (therapeutic use)</term><term>Betacoronavirus (MeSH)</term><term>COVID-19 (MeSH)</term><term>Chloroquine (adverse effects)</term><term>Chloroquine (therapeutic use)</term><term>Colchicine (adverse effects)</term><term>Colchicine (therapeutic use)</term><term>Coronavirus Infections (complications)</term><term>Coronavirus Infections (drug therapy)</term><term>Coronavirus Infections (metabolism)</term><term>Coronavirus Infections (therapy)</term><term>Drug Combinations (MeSH)</term><term>Drug Interactions (MeSH)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (adverse effects)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Immunization, Passive (MeSH)</term><term>Interferons (adverse effects)</term><term>Interferons (therapeutic use)</term><term>Lopinavir (adverse effects)</term><term>Lopinavir (therapeutic use)</term><term>Mental Disorders (chemically induced)</term><term>Mental Disorders (complications)</term><term>Mental Disorders (drug therapy)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Pneumonia, Viral (drug therapy)</term><term>Pneumonia, Viral (metabolism)</term><term>Psychotropic Drugs (adverse effects)</term><term>Psychotropic Drugs (metabolism)</term><term>Psychotropic Drugs (therapeutic use)</term><term>Pyrazines (adverse effects)</term><term>Pyrazines (therapeutic use)</term><term>Ritonavir (adverse effects)</term><term>Ritonavir (therapeutic use)</term><term>SARS-CoV-2 (MeSH)</term><term>Vitamins (adverse effects)</term><term>Vitamins (therapeutic use)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="adverse effects" xml:lang="en"><term>Adenosine Monophosphate</term><term>Adrenal Cortex Hormones</term><term>Alanine</term><term>Amides</term><term>Anti-Inflammatory Agents</term><term>Antibodies, Monoclonal, Humanized</term><term>Antiviral Agents</term><term>Ascorbic Acid</term><term>Azithromycin</term><term>Chloroquine</term><term>Colchicine</term><term>Hydroxychloroquine</term><term>Interferons</term><term>Lopinavir</term><term>Psychotropic Drugs</term><term>Pyrazines</term><term>Ritonavir</term><term>Vitamins</term></keywords><keywords scheme="MESH" type="chemical" qualifier="analogs & derivatives" xml:lang="en"><term>Adenosine Monophosphate</term><term>Alanine</term></keywords><keywords scheme="MESH" type="chemical" qualifier="metabolism" xml:lang="en"><term>Psychotropic Drugs</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Adenosine Monophosphate</term><term>Adrenal Cortex Hormones</term><term>Alanine</term><term>Amides</term><term>Anti-Inflammatory Agents</term><term>Antibodies, Monoclonal, Humanized</term><term>Antiviral Agents</term><term>Ascorbic Acid</term><term>Azithromycin</term><term>Chloroquine</term><term>Colchicine</term><term>Hydroxychloroquine</term><term>Interferons</term><term>Lopinavir</term><term>Psychotropic Drugs</term><term>Pyrazines</term><term>Ritonavir</term><term>Vitamins</term></keywords><keywords scheme="MESH" qualifier="chemically induced" xml:lang="en"><term>Mental Disorders</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Mental Disorders</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Coronavirus Infections</term><term>Mental Disorders</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="metabolism" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Betacoronavirus</term><term>COVID-19</term><term>Drug Combinations</term><term>Drug Interactions</term><term>Humans</term><term>Immunization, Passive</term><term>Pandemics</term><term>SARS-CoV-2</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Background</b></p><p>With the rapid, global spread of severe acute respiratory syndrome coronavirus 2, hospitals have become inundated with patients suffering from coronavirus disease 2019. Consultation-liaison psychiatrists are actively involved in managing these patients and should familiarize themselves with how the virus and its proposed treatments can affect psychotropic management. The only Food and Drug Administration-approved drug to treat COVID-19 is remdesivir, and other off-label medications used include chloroquine and hydroxychloroquine, tocilizumab, lopinavir/ritonavir, favipiravir, convalescent plasma therapy, azithromycin, vitamin C, corticosteroids, interferon, and colchicine.</p></div><div type="abstract" xml:lang="en"><p><b>Objective</b></p><p>To provide an overview of the major safety considerations relevant to clinicians who prescribe psychotropics to patients with COVID-19, both related to the illness and its proposed treatments.</p></div><div type="abstract" xml:lang="en"><p><b>Methods</b></p><p>In this targeted review, we performed structured literature searches in PubMed to identify articles describing the impacts of COVID-19 on different organ systems, the neuropsychiatric adverse effects of treatments, and any potential drug interactions with psychotropics. The articles most relevant to this one were included.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>COVID-19 impacts multiple organ systems, including gastrointestinal, renal, cardiovascular, pulmonary, immunological, and hematological systems. This may lead to pharmacokinetic changes that impact psychotropic medications and increase sensitivity to psychotropic-related adverse effects. In addition, several proposed treatments for COVID-19 have neuropsychiatric effects and potential interactions with commonly used psychotropics.</p></div><div type="abstract" xml:lang="en"><p><b>Conclusions</b></p><p>Clinicians should be aware of the need to adjust existing psychotropics or avoid using certain medications in some patients with COVID-19. They should also be familiar with neuropsychiatric effects of medications being used to treat this disease. Further research is needed to identify strategies to manage psychiatric issues in this population.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32425246</PMID><DateCompleted><Year>2020</Year><Month>10</Month><Day>05</Day></DateCompleted><DateRevised><Year>2021</Year><Month>01</Month><Day>10</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1545-7206</ISSN><JournalIssue CitedMedium="Internet"><Volume>61</Volume><Issue>5</Issue><PubDate><MedlineDate>2020 Sep-Oct</MedlineDate></PubDate></JournalIssue><Title>Psychosomatics</Title><ISOAbbreviation>Psychosomatics</ISOAbbreviation></Journal><ArticleTitle>Psychopharmacology of COVID-19.</ArticleTitle><Pagination><MedlinePgn>411-427</MedlinePgn></Pagination><ELocationID EIdType="pii" ValidYN="Y">S0033-3182(20)30144-4</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.1016/j.psym.2020.05.006</ELocationID><Abstract><AbstractText Label="Background">With the rapid, global spread of severe acute respiratory syndrome coronavirus 2, hospitals have become inundated with patients suffering from coronavirus disease 2019. Consultation-liaison psychiatrists are actively involved in managing these patients and should familiarize themselves with how the virus and its proposed treatments can affect psychotropic management. The only Food and Drug Administration-approved drug to treat COVID-19 is remdesivir, and other off-label medications used include chloroquine and hydroxychloroquine, tocilizumab, lopinavir/ritonavir, favipiravir, convalescent plasma therapy, azithromycin, vitamin C, corticosteroids, interferon, and colchicine.</AbstractText><AbstractText Label="Objective">To provide an overview of the major safety considerations relevant to clinicians who prescribe psychotropics to patients with COVID-19, both related to the illness and its proposed treatments.</AbstractText><AbstractText Label="Methods">In this targeted review, we performed structured literature searches in PubMed to identify articles describing the impacts of COVID-19 on different organ systems, the neuropsychiatric adverse effects of treatments, and any potential drug interactions with psychotropics. The articles most relevant to this one were included.</AbstractText><AbstractText Label="Results">COVID-19 impacts multiple organ systems, including gastrointestinal, renal, cardiovascular, pulmonary, immunological, and hematological systems. This may lead to pharmacokinetic changes that impact psychotropic medications and increase sensitivity to psychotropic-related adverse effects. In addition, several proposed treatments for COVID-19 have neuropsychiatric effects and potential interactions with commonly used psychotropics.</AbstractText><AbstractText Label="Conclusions">Clinicians should be aware of the need to adjust existing psychotropics or avoid using certain medications in some patients with COVID-19. They should also be familiar with neuropsychiatric effects of medications being used to treat this disease. Further research is needed to identify strategies to manage psychiatric issues in this population.</AbstractText><CopyrightInformation>© 2020 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Bilbul</LastName><ForeName>Melanie</ForeName><Initials>M</Initials><AffiliationInfo><Affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Paparone</LastName><ForeName>Patricia</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Kim</LastName><ForeName>Anna M</ForeName><Initials>AM</Initials><AffiliationInfo><Affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Mutalik</LastName><ForeName>Shruti</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ernst</LastName><ForeName>Carrie L</ForeName><Initials>CL</Initials><AffiliationInfo><Affiliation>Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medical Education, Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: carrie.ernst@mssm.edu.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D016454">Review</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>05</Month><Day>18</Day></ArticleDate></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>Psychosomatics</MedlineTA><NlmUniqueID>0376506</NlmUniqueID><ISSNLinking>0033-3182</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000305">Adrenal Cortex Hormones</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000577">Amides</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000893">Anti-Inflammatory Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D061067">Antibodies, Monoclonal, Humanized</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000998">Antiviral Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D004338">Drug Combinations</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D011619">Psychotropic Drugs</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D011719">Pyrazines</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D014815">Vitamins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="C558899">lopinavir-ritonavir drug combination</NameOfSubstance></Chemical><Chemical><RegistryNumber>2494G1JF75</RegistryNumber><NameOfSubstance UI="D061466">Lopinavir</NameOfSubstance></Chemical><Chemical><RegistryNumber>3QKI37EEHE</RegistryNumber><NameOfSubstance UI="C000606551">remdesivir</NameOfSubstance></Chemical><Chemical><RegistryNumber>415SHH325A</RegistryNumber><NameOfSubstance UI="D000249">Adenosine Monophosphate</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>83905-01-5</RegistryNumber><NameOfSubstance UI="D017963">Azithromycin</NameOfSubstance></Chemical><Chemical><RegistryNumber>886U3H6UFF</RegistryNumber><NameOfSubstance UI="D002738">Chloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>9008-11-1</RegistryNumber><NameOfSubstance UI="D007372">Interferons</NameOfSubstance></Chemical><Chemical><RegistryNumber>EW5GL2X7E0</RegistryNumber><NameOfSubstance UI="C462182">favipiravir</NameOfSubstance></Chemical><Chemical><RegistryNumber>I031V2H011</RegistryNumber><NameOfSubstance UI="C502936">tocilizumab</NameOfSubstance></Chemical><Chemical><RegistryNumber>O3J8G9O825</RegistryNumber><NameOfSubstance UI="D019438">Ritonavir</NameOfSubstance></Chemical><Chemical><RegistryNumber>OF5P57N2ZX</RegistryNumber><NameOfSubstance UI="D000409">Alanine</NameOfSubstance></Chemical><Chemical><RegistryNumber>PQ6CK8PD0R</RegistryNumber><NameOfSubstance UI="D001205">Ascorbic Acid</NameOfSubstance></Chemical><Chemical><RegistryNumber>SML2Y3J35T</RegistryNumber><NameOfSubstance UI="D003078">Colchicine</NameOfSubstance></Chemical></ChemicalList><SupplMeshList><SupplMeshName Type="Protocol" UI="C000705127">COVID-19 drug treatment</SupplMeshName><SupplMeshName Type="Protocol" UI="C000705128">COVID-19 serotherapy</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000249" MajorTopicYN="N">Adenosine Monophosphate</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000031" MajorTopicYN="N">analogs & derivatives</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000305" MajorTopicYN="N">Adrenal Cortex Hormones</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000409" MajorTopicYN="N">Alanine</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000031" MajorTopicYN="N">analogs & derivatives</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000577" MajorTopicYN="N">Amides</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000893" MajorTopicYN="N">Anti-Inflammatory Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D061067" MajorTopicYN="N">Antibodies, Monoclonal, Humanized</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000998" MajorTopicYN="N">Antiviral Agents</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse effects</QualifierName><QualifierName UI="Q000627" MajorTopicYN="Y">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001205" MajorTopicYN="N">Ascorbic Acid</DescriptorName><QualifierName UI="Q000009" MajorTopicYN="N">adverse 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