A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome

Clozapine is the only medication approved for treatment-resistant schizophrenia. Clozapine toxicity associated with COVID-19 infection could be amplified by concomitant nirmatrelvir/ritonavir. Knowledge gaps among clinicians and patients led to patient safety concerns and the implementation of a qua...

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Main Authors: Monica Fahmy, PharmD, Youssef Bessada, PharmD, Cassandra Ramsey, APRN, Jennifer R. Zigun, MD
Format: Article
Language:English
Published: American Association of Psychiatric Pharmacists 2025-04-01
Series:Mental Health Clinician
Subjects:
Online Access:https://theijpt.org/doi/pdf/10.9740/mhc.2025.04.062
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author Monica Fahmy, PharmD
Youssef Bessada, PharmD
Cassandra Ramsey, APRN
Jennifer R. Zigun, MD
author_facet Monica Fahmy, PharmD
Youssef Bessada, PharmD
Cassandra Ramsey, APRN
Jennifer R. Zigun, MD
author_sort Monica Fahmy, PharmD
collection DOAJ
description Clozapine is the only medication approved for treatment-resistant schizophrenia. Clozapine toxicity associated with COVID-19 infection could be amplified by concomitant nirmatrelvir/ritonavir. Knowledge gaps among clinicians and patients led to patient safety concerns and the implementation of a quality improvement (QI) project focused on rapid education dissemination. This QI project focused on clinicians, patients, and caregivers. Steps included clinician education at system, regional, and national levels and patient/caregiver education at system and regional levels. Optimization of electronic health record (EHR) tools facilitated efficient clinical workflows, targeted patient education to facilitate shared decision making, and promoted best practices. Education concerning risk for COVID-19, clozapine toxicity, and nirmatrelvir/ritonavir drug interactions was distributed to more than 1400 clinicians via e-mail and conference presentations. Enduring continuing education materials had more than 1200 views. Verbal or written education was rapidly delivered to 231 patients/caregivers and documented via autotext, an EHR tool. Following presentation of this QI project at a schizophrenia conference, more than 95% of attendees, including health care clinicians and patients/caregivers, rated their understanding of COVID-19, clozapine toxicity, and the interaction with nirmatrelvir/ritonavir as “very high” or “high.” Separately, web-hosted continuing education platforms indicated that more than 75% of clinicians rated their understanding of these 2 issues as “very high” or “high” upon module completion. By educating patients/caregivers and clinicians about COVID-19 infection and nirmatrelvir-/ritonavir-associated toxicity risks, this project helped ensure safe prescription of clozapine during the COVID-19 pandemic. This project could serve as a rapid risk mitigation dissemination model of patient safety education.
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spelling doaj-art-7523addd8964475b8a091ec7a7363db22025-08-20T02:15:47ZengAmerican Association of Psychiatric PharmacistsMental Health Clinician2168-97092025-04-01152626810.9740/mhc.2025.04.062i2168-9709-15-2-62A case report on the safety and efficacy of aripiprazole for depression in Brugada syndromeMonica Fahmy, PharmD0https://orcid.org/0000-0002-5723-5607Youssef Bessada, PharmD1https://orcid.org/0000-0001-5999-9099Cassandra Ramsey, APRN2https://orcid.org/0009-0001-1229-0194Jennifer R. Zigun, MD3https://orcid.org/0009-0005-8780-79781 Clinical Pharmacy Specialist, Yale New Haven Hospital, New Haven, Connecticut2 Assistant Clinical Professor, University of Connecticut School of Pharmacy, Storrs, Connecticut3 Psychiatric Mental Health Nurse Practitioner, Yale New Haven Hospital, New Haven, Connecticut4 Attending Psychiatrist, Adult Ambulatory Services, Yale New Haven Health, Hamden, Connecticut; Assistant Clinical Professor, Department of Psychiatry, Yale School of Medicine, New Haven, ConnecticutClozapine is the only medication approved for treatment-resistant schizophrenia. Clozapine toxicity associated with COVID-19 infection could be amplified by concomitant nirmatrelvir/ritonavir. Knowledge gaps among clinicians and patients led to patient safety concerns and the implementation of a quality improvement (QI) project focused on rapid education dissemination. This QI project focused on clinicians, patients, and caregivers. Steps included clinician education at system, regional, and national levels and patient/caregiver education at system and regional levels. Optimization of electronic health record (EHR) tools facilitated efficient clinical workflows, targeted patient education to facilitate shared decision making, and promoted best practices. Education concerning risk for COVID-19, clozapine toxicity, and nirmatrelvir/ritonavir drug interactions was distributed to more than 1400 clinicians via e-mail and conference presentations. Enduring continuing education materials had more than 1200 views. Verbal or written education was rapidly delivered to 231 patients/caregivers and documented via autotext, an EHR tool. Following presentation of this QI project at a schizophrenia conference, more than 95% of attendees, including health care clinicians and patients/caregivers, rated their understanding of COVID-19, clozapine toxicity, and the interaction with nirmatrelvir/ritonavir as “very high” or “high.” Separately, web-hosted continuing education platforms indicated that more than 75% of clinicians rated their understanding of these 2 issues as “very high” or “high” upon module completion. By educating patients/caregivers and clinicians about COVID-19 infection and nirmatrelvir-/ritonavir-associated toxicity risks, this project helped ensure safe prescription of clozapine during the COVID-19 pandemic. This project could serve as a rapid risk mitigation dissemination model of patient safety education.https://theijpt.org/doi/pdf/10.9740/mhc.2025.04.062brugada syndromeantipsychoticsdepressiondrug-disease interactionsaripiprazole
spellingShingle Monica Fahmy, PharmD
Youssef Bessada, PharmD
Cassandra Ramsey, APRN
Jennifer R. Zigun, MD
A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome
Mental Health Clinician
brugada syndrome
antipsychotics
depression
drug-disease interactions
aripiprazole
title A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome
title_full A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome
title_fullStr A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome
title_full_unstemmed A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome
title_short A case report on the safety and efficacy of aripiprazole for depression in Brugada syndrome
title_sort case report on the safety and efficacy of aripiprazole for depression in brugada syndrome
topic brugada syndrome
antipsychotics
depression
drug-disease interactions
aripiprazole
url https://theijpt.org/doi/pdf/10.9740/mhc.2025.04.062
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