{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:43:41Z","timestamp":1787316221674,"version":"build-2736575974"},"reference-count":58,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T00:00:00Z","timestamp":1741651200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy Timi\u0219oara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Remdesivir (RDV) and nirmatrelvir\/ritonavir (NMVr) are among the most widely used antivirals in the treatment of COVID-19, aiming to reduce disease severity and progression. Adverse neuropsychiatric effects, such as anxiety, sleep disturbances, and movement disorders, have emerged as significant concerns associated with these treatments. To better understand the safety profiles of RDV and NMVr, this study performs a pharmacovigilance analysis of individual case safety reports (ICSRs) from the EudraVigilance (EV) database. Objectives: This study evaluates the risk of neuropsychiatric adverse events associated with RDV and NMVr. Comparisons with other antiviral drugs, including darunavir, sofosbuvir, ribavirin, tenofovir, ritonavir, and sotrovimab, are also performed to develop a comprehensive understanding of the safety profiles. Methods: A retrospective analysis of ICSRs submitted to EV until 7 July 2024, with data extraction on 12 July 2024, was conducted. Demographic characteristics (age, sex, geographic region, and reporter type) and case severity were included in the descriptive analysis. Disproportionality analysis using reporting odds ratio (ROR) and 95% confidence intervals (CI) was performed to compare adverse drug reaction (ADRs) frequencies across 27 system organ classes (SOCs), with emphasis on \u201cNervous system disorders\u201d and \u201cPsychiatric disorders. Results: The total number of ICSRs was significantly higher for NMVr (n = 8078) compared to RDV (n = 3934). Nervous system disorders accounted for 3.07% of the total RDV reports and for 17.31% of NMVr reports, while psychiatric disorders represented 0.92% of the total ADRs reported for RDV (n = 60) and 3.61% for NMVr (n = 672). On the other hand, RDV showed a significantly lower frequency of reporting headache compared to NMVr (ROR: 0.1057; 95% CI: 0.0676\u20130.1653). Conclusions: NMVr presents a higher risk of neuropsychiatric ADRs than RDV, underscoring the need for enhanced monitoring, particularly in patients with preexisting central nervous system (CNS) conditions. These findings contribute to optimizing antiviral safety and informing clinical decision making.<\/jats:p>","DOI":"10.3390\/jcm14061886","type":"journal-article","created":{"date-parts":[[2025,3,11]],"date-time":"2025-03-11T08:59:52Z","timestamp":1741683592000},"page":"1886","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Analysis of Neuropsychiatric Adverse Reactions Associated with Remdesivir and Nirmatrelvir\/Ritonavir in COVID-19 Treatment: Insights from EudraVigilance Data"],"prefix":"10.3390","volume":"14","author":[{"given":"Aliteia-Maria","family":"Pacnejer","sequence":"first","affiliation":[{"name":"Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timi\u0219oara, Romania"},{"name":"Preclinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3002-7656","authenticated-orcid":false,"given":"Mihaela Cristina","family":"Negru","sequence":"additional","affiliation":[{"name":"Department of ENT, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9801-0060","authenticated-orcid":false,"given":"Anca Maria","family":"Arseniu","sequence":"additional","affiliation":[{"name":"Preclinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Trandafirescu","sequence":"additional","affiliation":[{"name":"Discipline of Pharmaceutical Chemistry, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristian","family":"Oancea","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Center for Research and Innovation in Personalized Medicine of Respiratory Diseases, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3167-9864","authenticated-orcid":false,"given":"Felicia Gabriela","family":"Gligor","sequence":"additional","affiliation":[{"name":"Preclinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2730-8729","authenticated-orcid":false,"given":"Claudiu","family":"Morgovan","sequence":"additional","affiliation":[{"name":"Preclinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1540-641X","authenticated-orcid":false,"given":"Anca","family":"Butuca","sequence":"additional","affiliation":[{"name":"Preclinical Department, Faculty of Medicine, \u201cLucian Blaga\u201d University of Sibiu, 550169 Sibiu, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina Adriana","family":"Dehelean","sequence":"additional","affiliation":[{"name":"Department of Toxicology, Drug Industry, Management and Legislation, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, 2nd Eftimie Murgu Square, 300041 Timi\u0219oara, Romania"},{"name":"Research Center for Pharmaco-Toxicological Evaluations, Faculty of Pharmacy, \u201cVictor Babe\u0219\u201d University of Medicine and Pharmacy, Eftimie Murgu Square No. 2, 300041 Timi\u0219oara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1016\/S0140-6736(20)30183-5","article-title":"Clinical Features of Patients Infected with 2019 Novel Coronavirus in Wuhan, China","volume":"395","author":"Huang","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1016\/S0140-6736(20)30566-3","article-title":"Clinical Course and Risk Factors for Mortality of Adult Inpatients with COVID-19 in Wuhan, China: A Retrospective Cohort Study","volume":"395","author":"Zhou","year":"2020","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Rochette, L., and Ghibu, S. (2021). Mechanics Insights of Alpha-Lipoic Acid against Cardiovascular Diseases during COVID-19 Infection. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22157979"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Punekar, M., Kshirsagar, M., Tellapragada, C., and Patil, K. (2022). Repurposing of Antiviral Drugs for COVID-19 and Impact of Repurposed Drugs on the Nervous System. Microb. Pathog., 168.","DOI":"10.1016\/j.micpath.2022.105608"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pacnejer, A.-M., Butuca, A., Dobrea, C.M., Arseniu, A.M., Frum, A., Gligor, F.G., Arseniu, R., Vonica, R.C., Vonica-Tincu, A.L., and Oancea, C. (2024). Neuropsychiatric Burden of SARS-CoV-2: A Review of Its Physiopathology, Underlying Mechanisms, and Management Strategies. Viruses, 16.","DOI":"10.3390\/v16121811"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1056\/NEJMoa2015301","article-title":"Remdesivir for 5 or 10 Days in Patients with Severe COVID-19","volume":"383","author":"Goldman","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1056\/NEJMoa2007764","article-title":"Remdesivir for the Treatment of COVID-19\u2014Final Report","volume":"383","author":"Beigel","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2327","DOI":"10.1056\/NEJMoa2007016","article-title":"Compassionate Use of Remdesivir for Patients with Severe COVID-19","volume":"382","author":"Grein","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1056\/NEJMoa2116846","article-title":"Early Remdesivir to Prevent Progression to Severe COVID-19 in Outpatients","volume":"386","author":"Gottlieb","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2128","DOI":"10.1111\/bph.15452","article-title":"Therapeutic Strategies to Fight COVID-19: Which Is the Status Artis?","volume":"179","author":"Scavone","year":"2022","journal-title":"Br. J. Pharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1056\/NEJMoa2118542","article-title":"Oral Nirmatrelvir for High-Risk, Nonhospitalized Adults with COVID-19","volume":"386","author":"Hammond","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1016\/S0140-6736(20)31022-9","article-title":"Remdesivir in Adults with Severe COVID-19: A Randomised, Double-Blind, Placebo-Controlled, Multicentre Trial","volume":"395","author":"Wang","year":"2020","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1186\/s13063-020-04352-9","article-title":"Evaluation of the Efficacy and Safety of Intravenous Remdesivir in Adult Patients with Severe COVID-19: Study Protocol for a Phase 3 Randomized, Double-Blind, Placebo-Controlled, Multicentre Trial","volume":"21","author":"Wang","year":"2020","journal-title":"Trials"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1001\/jama.2020.16349","article-title":"Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients with Moderate COVID-19","volume":"324","author":"Spinner","year":"2020","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1002\/phar.2464","article-title":"Acetylcysteine for the Treatment of Suspected Remdesivir-Associated Acute Liver Failure in COVID-19: A Case Series","volume":"40","author":"Carothers","year":"2020","journal-title":"Pharmacother. J. Hum. Pharmacol. Drug Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/s00213-020-05716-4","article-title":"Drug-Drug Interactions between COVID-19 Treatments and Antipsychotics Drugs: Integrated Evidence from 4 Databases and a Systematic Review","volume":"238","year":"2021","journal-title":"Psychopharmacology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1310\/hct1103-163","article-title":"Neuropsychiatric Adverse Events with Ritonavir-Boosted Darunavir Monotherapy in HIV-Infected Individuals: A Randomised Prospective Study","volume":"11","author":"Winston","year":"2010","journal-title":"HIV Clin. Trials"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Marinho, M., Novais, C., Marques, J., and Bragan\u00e7a, M. (2017). Efavirenz and Neuropsychiatric Effects\u2013When the Treatment Complicates Matter Further. Eur. Psychiatry, 41.","DOI":"10.26226\/morressier.5885d719d462b8028d892917"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.therap.2022.10.066","article-title":"Safety Profile of the Lopinavir\/Ritonavir Combination before and during the SARS-CoV-2 Pandemic","volume":"78","author":"Lory","year":"2023","journal-title":"Therapies"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1016\/j.genhosppsych.2020.06.001","article-title":"Covid-19 Treatment-Induced Neuropsychiatric Adverse Effects","volume":"67","author":"Huerta","year":"2020","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.psym.2020.05.006","article-title":"Psychopharmacology of COVID-19","volume":"61","author":"Bilbul","year":"2020","journal-title":"Psychosomatics"},{"key":"ref_22","unstructured":"International Council for Harmonisation of Technical (2021). Requirements for Pharmaceuticals for Human Use. Introductory Guide for Standardised MedDRA Queries (SMQs) Version 24.1, International Council for Harmonisation of Technical."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Morgovan, C., Dobrea, C.M., Chis, A.A., Juncan, A.M., Arseniu, A.M., Rus, L.L., Gligor, F.G., Ardelean, S.A., Stoicescu, L., and Ghibu, S. (2023). A Descriptive Analysis of Direct Oral Anticoagulant Drugs Dosing Errors Based on Spontaneous Reports from the EudraVigilance Database. Pharmaceuticals, 16.","DOI":"10.3390\/ph16030455"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Vintila, B.I., Arseniu, A.M., Morgovan, C., Butuca, A., Sava, M., B\u00eerlu\u021biu, V., Rus, L.L., Ghibu, S., Bereanu, A.S., and Roxana Codru, I. (2023). A Pharmacovigilance Study Regarding the Risk of Antibiotic-Associated Clostridioides Difficile Infection Based on Reports from the EudraVigilance Database: Analysis of Some of the Most Used Antibiotics in Intensive Care Units. Pharmaceuticals, 16.","DOI":"10.3390\/ph16111585"},{"key":"ref_25","unstructured":"MedCalc Software Ltd. (2025, January 18). Odds Ratio Calculator. Version 23.1.3. Available online: https:\/\/www.medcalc.org\/calc\/odds_ratio.php."},{"key":"ref_26","unstructured":"European Medicines Agency (2025, January 18). Screening for Adverse Reactions in EudraVigilance. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/other\/screening-adverse-reactions-eudravigilance_en.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2598","DOI":"10.1056\/NEJMp2032369","article-title":"FDA Approval of Remdesivir\u2014A Step in the Right Direction","volume":"383","author":"Rubin","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Ohl, M.E., Miller, D.R., Lund, B.C., Kobayashi, T., Richardson Miell, K., Beck, B.F., Alexander, B., Crothers, K., and Vaughan Sarrazin, M.S. (2021). Association of Remdesivir Treatment with Survival and Length of Hospital Stay Among US Veterans Hospitalized with COVID-19. JAMA Netw. Open, 4.","DOI":"10.1001\/jamanetworkopen.2021.14741"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lin, D.-Y., Abi Fadel, F., Huang, S., Milinovich, A.T., Sacha, G.L., Bartley, P., Duggal, A., and Wang, X. (2023). Nirmatrelvir or Molnupiravir Use and Severe Outcomes from Omicron Infections. JAMA Netw. Open, 6.","DOI":"10.1001\/jamanetworkopen.2023.35077"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Aggarwal, N.R., Beaty, L.E., Bennett, T.D., Fish, L.E., Jacobs, J.R., Mayer, D.A., Molina, K.C., Peers, J.L., Richardson, D.B., and Russell, S. (2024). Real-World Use of Nirmatrelvir-Ritonavir in COVID-19 Outpatients during BQ.1, BQ.1.1., and XBB.1.5 Predominant Omicron Variants in Three U.S. Health Systems: A Retrospective Cohort Study. Lancet Reg. Health Am., 31.","DOI":"10.1016\/j.lana.2024.100693"},{"key":"ref_31","first-page":"1","article-title":"Neuropsychiatric Effects of Tenofovir in Comparison with Other Antiretroviral Drugs","volume":"5","author":"Ferrer","year":"2013","journal-title":"Neurobehav. HIV Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1177\/135965350601100214","article-title":"Neuropsychiatric Adverse Events after Switching from an Antiretroviral Regimen Containing Efavirenz without Tenofovir to an Efavirenz Regimen Containing Tenofovir: A Report of Nine Cases","volume":"11","author":"Allavena","year":"2006","journal-title":"Antivir. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.4254\/wjh.v8.i31.1318","article-title":"Safe and Effective Sofosbuvir-Based Therapy in Patients with Mental Health Disease on Hepatitis C Virus Treatment","volume":"8","author":"Tang","year":"2016","journal-title":"World J. Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.cld.2017.03.008","article-title":"Neurologic Manifestations of Hepatitis C Virus Infection","volume":"21","author":"Iriana","year":"2017","journal-title":"Clin. Liver Dis."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Zareifopoulos, N., Lagadinou, M., Karela, A., Kyriakopoulou, O., and Velissaris, D. (2020). Neuropsychiatric Effects of Antiviral Drugs. Cureus, 12.","DOI":"10.7759\/cureus.9536"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/135965350801300101","article-title":"Darunavir: Pharmacokinetics and Drug Interactions","volume":"13","author":"Back","year":"2008","journal-title":"Antivir. Ther."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/S0213-005X(08)76553-4","article-title":"Interacciones Medicamentosas de Darunavir","volume":"26","author":"Valle","year":"2008","journal-title":"Enferm. Infecc. Microbiol. Clin."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Marin, R.-C., Behl, T., Negrut, N., and Bungau, S. (2021). Management of Antiretroviral Therapy with Boosted Protease Inhibitors\u2014Darunavir\/Ritonavir or Darunavir\/Cobicistat. Biomedicines, 9.","DOI":"10.3390\/biomedicines9030313"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Li, M., Zhang, Q.-S., Liu, X.-L., Wang, H.-L., and Liu, W. (2022). Adverse Events Associated with Nirmatrelvir\/Ritonavir: A Pharmacovigilance Analysis Based on FAERS. Pharmaceuticals, 15.","DOI":"10.3390\/ph15121455"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1038\/s41401-020-00537-9","article-title":"Pharmacokinetics and Tissue Distribution of Remdesivir and Its Metabolites Nucleotide Monophosphate, Nucleotide Triphosphate, and Nucleoside in Mice","volume":"42","author":"Hu","year":"2021","journal-title":"Acta Pharmacol. Sin."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1111\/apt.16894","article-title":"Remdesivir Use and Risks of Acute Kidney Injury and Acute Liver Injury among Patients Hospitalised with COVID-19: A Self-Controlled Case Series Study","volume":"56","author":"Wong","year":"2022","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"4450","DOI":"10.1111\/bcp.14831","article-title":"LUMC-Covid-19 research group Liver and Kidney Function in Patients with Covid-19 Treated with Remdesivir","volume":"87","author":"Guchelaar","year":"2021","journal-title":"Br. J. Clin. Pharmacol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1384","DOI":"10.1681\/ASN.2020050589","article-title":"Remdesivir in Patients with Acute or Chronic Kidney Disease and COVID-19","volume":"31","author":"Adamsick","year":"2020","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12985-023-01973-9","article-title":"An Overview on the Treatments and Prevention against COVID-19","volume":"20","author":"Panahi","year":"2023","journal-title":"Virol. J."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Sakamaki, A., Kamimura, K., Fukui, N., Watanabe, H., Sakai, N., Tominaga, K., Mizuno, K., Takamura, M., Kawai, H., and Sugai, T. (2019). A Case Report of Psychiatric Symptoms Following Direct-Acting Antiviral and Ribavirin Combination Therapy for Chronic Hepatitis C in a Patient with Innate Anxiety. BMC Gastroenterol., 19.","DOI":"10.1186\/s12876-019-1013-1"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Focosi, D., Casadevall, A., Franchini, M., and Maggi, F. (2024). Sotrovimab: A Review of Its Efficacy against SARS-CoV-2 Variants. Viruses, 16.","DOI":"10.3390\/v16020217"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1236","DOI":"10.1001\/jama.2022.2832","article-title":"Effect of Sotrovimab on Hospitalization or Death Among High-Risk Patients with Mild to Moderate COVID-19","volume":"327","author":"Gupta","year":"2022","journal-title":"JAMA"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1038\/s43856-024-00720-7","article-title":"Uptake and Safety of Sotrovimab for Prevention of Severe COVID-19 in a Cohort and Self-Controlled Case Series Study","volume":"5","author":"Patone","year":"2025","journal-title":"Commun. Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Amani, B., and Amani, B. (2022). Efficacy and Safety of Sotrovimab in Patients with COVID-19: A Rapid Review and Meta-analysis. Rev. Med. Virol., 32.","DOI":"10.1002\/rmv.2402"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"810","DOI":"10.3949\/ccjm.83a.15129","article-title":"Serotonin Syndrome: Preventing, Recognizing, and Treating It","volume":"83","author":"Wang","year":"2016","journal-title":"Cleve Clin. J. Med."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Majerov\u00e1, T., and Konvalinka, J. (2022). Viral Proteases as Therapeutic Targets. Mol. Asp. Med., 88.","DOI":"10.1016\/j.mam.2022.101159"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Matt, S.M., and Gaskill, P.J. (2019). Dopaminergic Impact of CART and Anti-Depressants on HIV Neuropathogenesis in Older Adults. Brain Res., 1723.","DOI":"10.1016\/j.brainres.2019.146398"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Watson, S., Caster, O., Rochon, P.A., and den Ruijter, H. (2019). Reported Adverse Drug Reactions in Women and Men: Aggregated Evidence from Globally Collected Individual Case Reports during Half a Century. EClinicalMedicine, 17.","DOI":"10.1016\/j.eclinm.2019.10.001"},{"key":"ref_54","first-page":"7390","article-title":"Neuropsychological Adverse Drug Reactions of Remdesivir: Analysis Using VigiBase, the WHO Global Database of Individual Case Safety Reports","volume":"25","author":"Lee","year":"2021","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Strohbehn, I.A., Ouyang, T., Lee, M.D., Zhao, S., Harden, D., Mejia, S.M., Cao, A., Bhattacharyya, R.P., and Sise, M.E. (2024). The Effect of Nirmatrelvir-Ritonavir on Short- and Long-Term Adverse Outcomes from COVID-19 Among Patients with Kidney Disease: A Propensity Score\u2013Matched Study. Open Forum Infect. Dis., 12.","DOI":"10.1093\/ofid\/ofae756"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Sun, J., Deng, X., Huang, J., He, G., and Huang, S. (2024). Data Mining of Adverse Drug Event Signals with Nirmatrelvir\/Ritonavir from FAERS. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0316573"},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Gon\u00e7alves de Andrade, E., \u0160imon\u010di\u010dov\u00e1, E., Carrier, M., Vecchiarelli, H.A., Robert, M.-\u00c8., and Tremblay, M.-\u00c8. (2021). Microglia Fighting for Neurological and Mental Health: On the Central Nervous System Frontline of COVID-19 Pandemic. Front. Cell. Neurosci., 15.","DOI":"10.3389\/fncel.2021.647378"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Brown, R.L., Benjamin, L., Lunn, M.P., Bharucha, T., Zandi, M.S., Hoskote, C., McNamara, P., and Manji, H. (2023). Pathophysiology, Diagnosis, and Management of Neuroinflammation in COVID-19. 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