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Covid-19 Primary Care Resources

Prescribing for high risk patients with insomnia or depression during the pandemic

Advice from an expert pharmacist

This information is sourced from Dr Siobhan Gee, Principal Pharmacist Liaison Psychiatry

Q. I have adult patients who are at high risk for Covid and have been shielding who are struggling with their sleep. Does prescribing short courses of zopiclone or promethazine increase their risk if they become unwell with Covid?  Should I consider providing short courses of melatonin instead?

A. We don’t think that short courses of zopiclone or promethazine will increase risks in patients who contract Covid-19.  Antihistamines  (such as promethazine) can thicken lung secretions, impairing expectoration.  Caution should be used in those with underlying lung disease, although short-term use is unlikely to be a problem.  Melatonin is safe, but is only effective for sleep impairment where the underlying cause is a disruption in the circadian rhythm.  It is licensed for patients over the age of 55 at a dose of 2mg once daily, 1 – 2 hours before bedtime and after food

Q.  Should I change my prescribing practices when initiating antidepressants for patients with moderate or high risk for Covid? I normally start with sertraline or mirtazapine

A.  There is no reason to change prescribing practice of antidepressants during the pandemic.  Sertraline and mirtazapine are, broadly speaking, good first line choices for many people