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Quetiapine: Difference between revisions
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{{SubstanceBox/Quetiapine}} | {{SubstanceBox/Quetiapine}} | ||
'''Quetiapine''' (branded as '''Seroquel''', '''Xeroquel''', '''Ketipinor''', '''Ketilept''' and '''Derin''') is a short-acting atypical [[psychoactive class::antipsychotic]] approved for the treatment of schizophrenia, bipolar disorder, and along with an antidepressant to treat major depressive disorder. | |||
'''Quetiapine''' (branded as '''Seroquel''', '''Xeroquel''', '''Ketipinor''') is a short-acting atypical [[psychoactive class::antipsychotic]] approved for the treatment of schizophrenia, bipolar disorder, and along with an antidepressant to treat major depressive disorder. | |||
Quetiapine was developed by AstraZeneca from 1992-1996 as an improvement from first-generation antipsychotics. It was first approved by the FDA in 1997.{{citation needed}} | |||
Annual sales are approximately $5.7 billion worldwide, with $2.9 billion in the United States.<ref> | Recreational usage is uncommon, but reports of quetiapine abuse have emerged within the medical literature. This seems to be driven by its [[sedative]] and [[anxiolytic]] effects (to help with sleep or to 'calm down') rather than by its antipsychotic properties.<ref name="Pierre2004">{{cite journal | vauthors=((Pierre, J. M.)), ((Shnayder, I.)), ((Wirshing, D. A.)), ((Wirshing, W. C.)) | journal=American Journal of Psychiatry | title=Intranasal Quetiapine Abuse | volume=161 | issue=9 | pages=1718–1718 | date= September 2004 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.161.9.1718 | issn=0002-953X | doi=10.1176/appi.ajp.161.9.1718}}</ref> In addition to oral administration, the drug is sometimes taken intranasally by insufflating pulverized tablets. Some estimate that up to 30% of inmates who were seen for psychiatric services in the Los Angeles County Jail were faking psychotic symptoms in an attempt to obtain quetiapine.<ref name="Pierre2004" /> It is thought that this drug is more commonly abused in prisons than on the street due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances. | ||
==History and culture== | |||
Quetiapine was developed by AstraZeneca from 1992-1996 as an improvement from first-generation antipsychotics. It was first approved by the FDA in 1997.{{citation needed}} | |||
Annual sales of Seroquel are approximately $5.7 billion worldwide, with $2.9 billion in the United States.<ref>{{Citation | title=SEROQUEL Loss of Exclusivity (LOE). When will the SEROQUEL patents expire, and when will generic SEROQUEL be available? | url=//www.DrugPatentWatch.com/p/tradename/index.php?query=SEROQUEL}}</ref> The U.S. patent,<ref name="WarawaPatent">{{Citation | vauthors=((Warawa, E. J.)), ((Migler, B. M.)) | title=United States Patent: 4879288 - Novel dibenzothiazepine antipsychotic | url=https://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=4,879,288.PN.&OS=PN/4,879,288&RS=PN/4,879,288}}</ref> which was set to expire in 2011, received a pediatric exclusivity extension which pushed its expiration to March 26, 2012.<ref name="WarawaPatent" /><ref>Phillip Moeller (2011) Blockbuster Drugs That Will Go Generic Soon | http://money.usnews.com/money/blogs/the-best-life/2011/04/29/blockbuster-drugs-that-will-go-generic-soon</ref> The patent has already expired in Canada. | |||
There are now several name brand versions of quetiapine, such as Quepin, Seroquel and Ketipinor.<ref>{{Citation | title=Quepin Tablets (Specifar), Drug Reference Encyclopedia | url=https://theodora.com/drugs/quepin_tablets_specifar.html}}</ref> | |||
==Chemistry== | ==Chemistry== | ||
Quetiapine is an atypical antipsychotic drug and [[chemical class::dibenzothiazepine]] derivative. Quetiapine contains a thiazepine ring, a seven | Quetiapine is an atypical antipsychotic drug and [[chemical class::dibenzothiazepine]] derivative. Quetiapine contains a thiazepine ring, a seven-membered ring containing one sulfur and one nitrogen group, located at R<sub>1</sub> and R<sub>4</sub> respectively. This ring is fused to two benzene rings, thus forming a dibenzothiazepine moiety. Dibenzothiazepine is connected at R<sub>11</sub> to the nitrogen group of a [[piperidine]] ring at R<sub>4</sub>. | ||
Piperazine is a six-member unsaturated ring with two nitrogen constituents in the 1,4 positions. This ring is connected at its second nitrogen group to an ethoxyethanol chain. It is connected to R<sub>2</sub> of an ethane chain through an oxygen bridge to an ethanol group. This forms the structure of quetiapine. | Piperazine is a six-member unsaturated ring with two nitrogen constituents in the 1,4 positions. This ring is connected at its second nitrogen group to an ethoxyethanol chain. It is connected to R<sub>2</sub> of an ethane chain through an oxygen bridge to an ethanol group. This forms the structure of quetiapine. | ||
It is commonly synthesized by nucleophilic | It is commonly synthesized by nucleophilic substitution to combine the dibenzothiazepine core with the rest of the structure. Quetiapine is present in its pill form as a fumarate salt. | ||
== | ==Pharmacology== | ||
Quetiapine is a powerful [[dopamine]], [[serotonin]], and [[adrenergic]] [[antagonist]], as well as a potent [[antihistamine]] with clinically negligible [[anticholinergic]] properties.<ref>http://www1.astrazeneca-us.com/pi/Seroquel.pdf</ref><ref>Binding of antipsychotic drugs to human brain receptors: Focus on newer generation compounds | Quetiapine is a powerful [[dopamine|dopaminergic]], [[serotonin|serotonergic]], and [[adrenergic]] [[antagonist]], as well as a potent [[antihistamine]] with clinically negligible [[anticholinergic]] properties.<ref>http://www1.astrazeneca-us.com/pi/Seroquel.pdf</ref><ref>{{cite journal | vauthors=((Richelson, E.)), ((Souder, T.)) | journal=Life Sciences | title=Binding of antipsychotic drugs to human brain receptors: Focus on newer generation compounds | volume=68 | issue=1 | pages=29–39 | date=24 November 2000 | url=https://www.sciencedirect.com/science/article/pii/S0024320500009115 | issn=0024-3205 | doi=10.1016/S0024-3205(00)00911-5}}</ref><ref>{{cite book | vauthors=((Davis, K. L.)), ((Neuropsychopharmacology, A. C. of)) | date= 2002 | title=Neuropsychopharmacology: The Fifth Generation of Progress : an Official Publication of the American College of Neuropsychopharmacology | publisher=Lippincott Williams & Wilkins | isbn=9780781728379}}</ref><ref>http://www.drugs.com/pro/seroquel.html</ref> Quetiapine binds strongly to serotonin receptors; the drug acts as partial [[agonist]] at 5-HT1A receptors.<ref>{{Citation | title=Mechanism of Action of Quetiapine | publisher=Psychopharmacology Institute | url=https://psychopharmacologyinstitute.com/antipsychotics/quetiapine/mechanism-of-action/}}</ref> In terms of its [[antipsychotic]] effects, the precise mechanism of action is unknown, but according to the dopamine theory of schizophrenia, antipsychotic effects might be related to the drug’s ability to reduce dopaminergic neurotransmission within the mesolimbic pathway. | ||
==Subjective effects== | ==Subjective effects== | ||
{{Preamble/SubjectiveEffects}} | {{Preamble/SubjectiveEffects}} | ||
{{effects/base | |||
|{{effects/physical| | |||
*'''[[Effect::Sedation]]''' - In terms of energy level alterations, this drug has the potential to be extremely sedating and often results in an overwhelmingly lethargic state. At higher levels, this causes users to suddenly feel as if they are extremely sleep deprived and have not slept for days, forcing them to sit down and generally feel as if they are constantly on the verge of passing out instead of engaging in physical activities. This sense of sleep deprivation increases proportional to dosage and eventually becomes powerful enough to force a person into complete unconsciousness. | |||
*'''[[Effect:: | *'''[[Effect::Perception of bodily heaviness]]''' | ||
*'''[[Effect::Dizziness]]''' | *'''[[Effect::Dizziness]]''' | ||
*'''[[Effect::Dehydration]]''' | *'''[[Effect::Dehydration]]''' | ||
| Line 47: | Line 39: | ||
*'''[[Effect::Decreased libido]]''' | *'''[[Effect::Decreased libido]]''' | ||
*'''[[Effect::Increased blood pressure]]''' | *'''[[Effect::Increased blood pressure]]''' | ||
*'''[[Effect::Appetite enhancement]]''' | |||
*'''[[Effect::Increased heart rate]]''' | *'''[[Effect::Increased heart rate]]''' | ||
*'''[[Effect::Orgasm suppression]]''' | *'''[[Effect::Orgasm suppression]]''' | ||
*'''[[Effect::Difficulty urinating]]''' | |||
*'''[[Effect::Nausea suppression]]''' | |||
*'''[[Effect::Restless Leg Syndrome]]''' | |||
}} | |||
|{{effects/cognitive| | |||
The general headspace of quetiapine is often described as one of sleepiness, emptiness, apathy, stupor, and catatonia. The specific cognitive effects can be broken down into several components which progressively intensify proportional to dosage. | |||
The most prominent of these cognitive effects generally include: | |||
*'''[[Effect::Thought deceleration]]''' | |||
*'''[[Effect::Analysis suppression]]''' | |||
*'''[[Effect::Emotion suppression]]''' | |||
*'''[[Effect::Creativity suppression]]''' | |||
*'''[[Effect::Language suppression]]''' | |||
*'''[[Effect::Focus suppression]]''' | |||
*'''[[Effect::Anxiety suppression]]''' | |||
*'''[[Effect::Disinhibition]]''' | |||
*'''[[Effect::Motivation suppression]]''' | |||
*'''[[Effect::Amnesia]]''' | |||
*'''[[Effect::Dream potentiation]]''' | |||
*'''[[Effect::Sleepiness]]''' | |||
}} | |||
{{effects/aftereffects| | |||
*'''[[Effect::Sleepiness|Residual sleepiness]]''' - While quetiapine can be used as an effective [[hypnotic|sleep-inducing]] aid, its effects may persist into the morning afterward, which may lead to users feeling "groggy" or "dull" for up to a few hours. | |||
*'''[[Effect::Thought deceleration]]''' | |||
*'''[[Effect::Thought disorganization]]''' | |||
*'''[[Effect::Irritability]]''' - This effect typically occurs the morning after quetiapine has been taken as a [[hypnotic|sleep-inducing]] aid, and only occurs for a few hours upon awakening. | |||
}} | |||
}} | |||
===Combination effects=== | |||
*'''[[Cannabis]]''': Cannabis' effects synergise with quetiapine's effects thus increasing the physical effects of the "high" while decreasing the cognitive effects. <ref>https://www.drugs.com/interactions-check.php?drug_list=1979-0,2758-0</ref> | |||
*'''[[Psychedelics]]''': Due to it being a [[serotonin|serotonergic]] [[antagonist]], quetiapine reduces the effects of psychedelics. | |||
*'''[[Nootropics]]''': Quetiapine decreases the effects of some nootropics, especially the ones digested by the CYP450 3A4 enzyme. <ref>https://www.drugs.com/interactions-check.php?drug_list=1979-0,1647-0&types%5B%5D=major&types%5B%5D=minor&types%5B%5D=moderate&types%5B%5D=food&types%5B%5D=therapeutic_duplication&professional=1</ref> | |||
===Experience reports=== | ===Experience reports=== | ||
Anecdotal reports which describe the effects of this compound within our [[experience index]] include: | |||
* [https://www.erowid.org/experiences/subs/exp_Pharms_Quetiapine.shtml Erowid Experience Vaults: Quetiapine] | {{#ask: [[Category:Quetiapine]][[Category:Experience]]|format=ul|Columns=1}} | ||
Additional experience reports can be found here: | |||
*[https://www.erowid.org/experiences/subs/exp_Pharms_Quetiapine.shtml Erowid Experience Vaults: Quetiapine] | |||
==Medical uses== | ==Medical uses== | ||
*'''Schizophrenia:''' There is tentative evidence of the benefit of quetiapine versus placebo in schizophrenia; however, definitive conclusions are not possible due to the high rate of attrition in trials (greater than 50%) and the lack of data on economic outcomes, social functioning, or quality of life.<ref>Quetiapine for schizophrenia | | |||
*'''Bipolar disorder:''' In those with bipolar disorder, quetiapine is used to treat depressive episodes and acute manic episodes associated with bipolar I disorder.<ref>Efficacy of Quetiapine Monotherapy in Bipolar I and II Depression: A Double-blind, Placebo-controlled Study (The BOLDER II Study) | | *'''Schizophrenia:''' There is tentative evidence of the benefit of quetiapine versus placebo in schizophrenia; however, definitive conclusions are not possible due to the high rate of attrition in trials (greater than 50%) and the lack of data on economic outcomes, social functioning, or quality of life.<ref>{{cite journal | vauthors=((Srisurapanont, M.)), ((Maneeton, B.)), ((Maneeton, N.)), ((Lankappa, S.)), ((Gandhi, R.)) | veditors=((Cochrane Schizophrenia Group)) | journal=Cochrane Database of Systematic Reviews | title=Quetiapine for schizophrenia | date=19 April 2004 | url=https://doi.wiley.com/10.1002/14651858.CD000967.pub2 | issn=14651858 | doi=10.1002/14651858.CD000967.pub2}}</ref> | ||
*'''Major depressive disorder:''' Quetiapine is effective when used by itself and when used along with other medications in major depressive disorder (MDD).<ref>Second-generation antipsychotics for major depressive disorder and dysthymia | | *'''Bipolar disorder:''' In those with bipolar disorder, quetiapine is used to treat depressive episodes and acute manic episodes associated with bipolar I disorder.<ref>{{cite journal | vauthors=((Thase, M. E.)), ((Macfadden, W.)), ((Weisler, R. H.)), ((Chang, W.)), ((Paulsson, B.)), ((Khan, A.)), ((Calabrese, J. R.)) | journal=Journal of Clinical Psychopharmacology | title=Efficacy of Quetiapine Monotherapy in Bipolar I and II Depression: A Double-blind, Placebo-controlled Study (The BOLDER II Study) | volume=26 | issue=6 | pages=600–609 | date= December 2006 | url=https://journals.lww.com/00004714-200612000-00009 | issn=0271-0749 | doi=10.1097/01.jcp.0000248603.76231.b7}}</ref><ref>{{cite book | date= 2013 | title=British national formulary, no 65 (March - September 2013). | publisher=BMJ/Pharmaceutical Press | isbn=9780857110848}}</ref> | ||
*'''Parkinsons disease:''' Quetiapine and clozapine are the most widely used medications for the treatment of Parkinson's disease psychosis due to their very low extrapyramidal side effect liability. Owing to the risks associated with clozapine (e.g., agranulocytosis, diabetes mellitus, etc.), clinicians often attempt treatment with quetiapine first, although the evidence to support quetiapine's use for this indication is significantly weaker than that of clozapine.<ref>Quetiapine in the treatment of psychosis in Parkinson’s disease | http:// | *'''Major depressive disorder:''' Quetiapine is effective when used by itself and when used along with other medications in major depressive disorder (MDD).<ref name="Komossa2010">{{cite journal | vauthors=((Komossa, K.)), ((Depping, A. M.)), ((Gaudchau, A.)), ((Kissling, W.)), ((Leucht, S.)) | veditors=((Cochrane Common Mental Disorders Group)) | journal=Cochrane Database of Systematic Reviews | title=Second-generation antipsychotics for major depressive disorder and dysthymia | date=8 December 2010 | url=https://doi.wiley.com/10.1002/14651858.CD008121.pub2 | issn=14651858 | doi=10.1002/14651858.CD008121.pub2}}</ref><ref>{{cite journal | vauthors=((Spielmans, G. I.)), ((Berman, M. I.)), ((Linardatos, E.)), ((Rosenlicht, N. Z.)), ((Perry, A.)), ((Tsai, A. C.)) | journal=PLOS Medicine | title=Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes | volume=10 | issue=3 | pages=e1001403 | date=12 March 2013 | url=https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001403 | issn=1549-1676 | doi=10.1371/journal.pmed.1001403}}</ref> However, sedation is often an undesirable side effect.<ref name="Komossa2010" /> | ||
*'''Other:''' The use of low doses of quetiapine for insomnia, while common, is not recommended; there is little evidence of benefit and concerns regarding adverse effects.<ref>Safety of Low Doses of Quetiapine When Used for Insomnia | http:// | *'''Parkinsons disease:''' Quetiapine and clozapine are the most widely used medications for the treatment of Parkinson's disease psychosis due to their very low extrapyramidal side effect liability. Owing to the risks associated with clozapine (e.g., agranulocytosis, diabetes mellitus, etc.), clinicians often attempt treatment with quetiapine first, although the evidence to support quetiapine's use for this indication is significantly weaker than that of clozapine.<ref>{{cite journal | vauthors=((Shotbolt, P.)), ((Samuel, M.)), ((David, A.)) | journal=Therapeutic Advances in Neurological Disorders | title=Quetiapine in the treatment of psychosis in Parkinson’s disease | volume=3 | issue=6 | pages=339–350 | date= November 2010 | url=http://journals.sagepub.com/doi/10.1177/1756285610389656 | issn=1756-2864 | doi=10.1177/1756285610389656}}</ref><ref>{{cite book | vauthors=((Taylor, D.)), ((Paton, C.)), ((Kapur, S.)), ((Taylor, D.)), ((South London and Maudsley NHS Trust)), ((Oxleas NHS Foundation Trust)) | date= 2012 | title=The Maudsley prescribing guidelines in psychiatry | url=http://public.eblib.com/choice/publicfullrecord.aspx?p=849912 | isbn=9780470979693}}</ref> | ||
*'''Other:''' The use of low doses of quetiapine for insomnia, while common, is not recommended; there is little evidence of benefit and concerns regarding adverse effects.<ref>{{cite journal | vauthors=((Coe, H. V.)), ((Hong, I. S.)) | journal=Annals of Pharmacotherapy | title=Safety of Low Doses of Quetiapine When Used for Insomnia | volume=46 | issue=5 | pages=718–722 | date= May 2012 | url=http://journals.sagepub.com/doi/10.1345/aph.1Q697 | issn=1060-0280 | doi=10.1345/aph.1Q697}}</ref><ref>{{cite book | vauthors=((Maglione, M.)), ((Maher, A. R.)), ((Hu, J.)), ((Wang, Z.)), ((Shanman, R.)), ((Shekelle, P. G.)), ((Roth, B.)), ((Hilton, L.)), ((Suttorp, M. J.)), ((Ewing, B. A.)), ((Motala, A.)), ((Perry, T.)) | date= 2011 | title=Off-Label Use of Atypical Antipsychotics: An Update | publisher=Agency for Healthcare Research and Quality (US) | series=AHRQ Comparative Effectiveness Reviews | url=http://www.ncbi.nlm.nih.gov/books/NBK66081/}}</ref> It is sometimes used off-label, often as an augmentation agent, to treat conditions such as Tourette syndrome,<ref>{{cite journal | vauthors=((Mukaddes, N. M.)), ((Abali, O.)) | journal=Journal of Child and Adolescent Psychopharmacology | title=Quetiapine Treatment of Children and Adolescents with Tourette’s Disorder | volume=13 | issue=3 | pages=295–299 | date= September 2003 | url=https://www.liebertpub.com/doi/abs/10.1089/104454603322572624 | issn=1044-5463 | doi=10.1089/104454603322572624}}</ref> musical hallucinations<ref>{{cite book | vauthors=((Sacks, O.)) | date= 2008 | title=Musicophilia: tales of music and the brain | publisher=Vintage Books | isbn=9781400033539}}</ref> and anxiety disorders.<ref>{{cite journal | vauthors=((Becker, P. M.)) | journal=Current Treatment Options in Neurology | title=Treatment of sleep dysfunction and psychiatric disorders | volume=8 | issue=5 | pages=367–375 | date=1 October 2006 | url=https://doi.org/10.1007/s11940-006-0026-6 | issn=1534-3138 | doi=10.1007/s11940-006-0026-6}}</ref> It is particularly useful as a tool for forced sedation during bad trips or prolonged unwanted stimulation. | |||
==Toxicity and harm potential== | ==Toxicity and harm potential== | ||
Quetiapine likely has a [[Toxicity::low toxicity]] relative to dose. Although simply trying this substance at a low to moderate dosage is considered as quite safe, there is an emerging controversy regarding quetiapine fatalities. Approximately 10,000<ref>Questions loom over drug for sleepless vets | http://www.marinecorpstimes.com/article/20100830/NEWS/8300315/Questions-loom-over-drug-for-sleepless-vets</ref> lawsuits<ref>Heart Warning Added to Label on Popular Antipsychotic Drug | | Quetiapine likely has a [[Toxicity::low toxicity]] relative to dose. Although simply trying this substance at a low to moderate dosage is considered as quite safe, there is an emerging controversy regarding quetiapine fatalities. Approximately 10,000<ref>Questions loom over drug for sleepless vets | http://www.marinecorpstimes.com/article/20100830/NEWS/8300315/Questions-loom-over-drug-for-sleepless-vets</ref> lawsuits<ref>{{Citation | vauthors=((Wilson, D.)) | year=2011 | title=Heart Warning Added to Label on Popular Antipsychotic Drug | url=https://www.nytimes.com/2011/07/19/health/19drug.html}}</ref><ref>Seroquel linked to Deadly Side Effects | http://www.defendingtheconsumer.com/drug-injury-lawyer/seroquel-linked-to-deadly-side-effects/</ref><ref>Seroquel | http://www.resource4thepeople.com/defectivedrugs/seroquel.html</ref> against AstraZeneca for problems ranging from slurred speech and chronic insomnia to death have been filed by individuals from civilian populations. | ||
Both typical and atypical antipsychotics can cause tardive dyskinesia.<ref>Tardive dyskinesia and new antipsychotics | http://journals.lww.com/ | Both typical and atypical antipsychotics can cause tardive dyskinesia.<ref name="Correll2008">{{cite journal | vauthors=((Correll, C. U.)), ((Schenk, E. M.)) | journal=Current Opinion in Psychiatry | title=Tardive dyskinesia and new antipsychotics: | volume=21 | issue=2 | pages=151–156 | date= March 2008 | url=http://journals.lww.com/00001504-200803000-00012 | issn=0951-7367 | doi=10.1097/YCO.0b013e3282f53132}}</ref> According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.<ref name="Correll2008" /> Although quetiapine and clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.<ref>{{cite journal | vauthors=((Aia, P. G.)), ((Revuelta, G. J.)), ((Cloud, L. J.)), ((Factor, S. A.)) | journal=Current Treatment Options in Neurology | title=Tardive Dyskinesia | volume=13 | issue=3 | pages=231–241 | date=1 June 2011 | url=https://doi.org/10.1007/s11940-011-0117-x | issn=1534-3138 | doi=10.1007/s11940-011-0117-x}}</ref> | ||
Weight gain can be a problem for some, with quetiapine causing more weight gain than other more commonly used [[Antipsychotic|antipsychotics]].<ref>Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis | Weight gain can be a problem for some, with quetiapine causing more weight gain than other more commonly used [[Antipsychotic|antipsychotics]].<ref>{{cite journal | vauthors=((Allison, D. B.)), ((Mentore, J. L.)), ((Heo, M.)), ((Chandler, L. P.)), ((Cappelleri, J. C.)), ((Infante, M. C.)), ((Weiden, P. J.)) | journal=American Journal of Psychiatry | title=Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis | volume=156 | issue=11 | pages=1686–1696 | date=1 November 1999 | url=http://ajp.psychiatryonline.org/doi/10.1176/ajp.156.11.1686 | issn=0002-953X | doi=10.1176/ajp.156.11.1686}}</ref> | ||
It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this drug. | It is strongly recommended that one use [[responsible drug use|harm reduction practices]] when using this drug. | ||
===Lethal dosage=== | ===Lethal dosage=== | ||
Compared to other antipsychotics, quetiapine has been reported to be relatively safer in overdose.<ref>Quetiapine: Relatively safe in overdose? | Compared to other antipsychotics, quetiapine has been reported to be relatively safer in overdose.<ref>{{cite journal | vauthors=((Mattoo, S. K.)), ((Shah, R.)), ((Rajagopal, R.)), ((Biswas, P. S.)), ((Singh, S. M.)) | journal=Indian Journal of Psychiatry | title=Quetiapine: Relatively safe in overdose? | volume=51 | issue=2 | pages=139–140 | date= 2009 | url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2755169/ | issn=0019-5545 | doi=10.4103/0019-5545.49456}}</ref> Most instances of acute overdoses result only in sedation, hypotension and tachycardia, but cardiac arrythmia, coma and death have occurred in adults. Quetiapine concentrations within the patients' blood are usually in the 1–10 mg/L range in overdose survivors, while postmortem blood levels of 10–25 mg/L are generally observed in fatal cases.<ref>{{cite journal | vauthors=((Fitzgerald, R. L.)) | journal=Clinical Chemistry | title=Disposition of Toxic Drugs and Chemicals in Man, 8th Edition. Randall C. Baselt. Foster City, CA: Biomedical Publications, 2009, 1720 pp, $247.50. ISBN 978-0- 9626523-7-0 | volume=55 | issue=12 | pages=2232–2232 | date=1 December 2009 | url=https://academic.oup.com/clinchem/article/55/12/2232/5629470 | issn=0009-9147 | doi=10.1373/clinchem.2009.133827}}</ref> | ||
===Tolerance and addiction potential=== | ===Tolerance and addiction potential=== | ||
| Line 79: | Line 115: | ||
====Withdrawal symptoms==== | ====Withdrawal symptoms==== | ||
Withdrawal symptoms reported to occur after discontinuation of quetiapine and other antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostatic hypotension, tachycardia, insomnia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.<ref>Quetiapine Discontinuation Syndrome | | Withdrawal symptoms reported to occur after discontinuation of quetiapine and other antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostatic hypotension, tachycardia, insomnia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.<ref>{{cite journal | vauthors=((Kim, D. R.)), ((Staab, J. P.)) | journal=American Journal of Psychiatry | title=Quetiapine Discontinuation Syndrome | volume=162 | issue=5 | pages=1020–1020 | date= May 2005 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.5.1020 | issn=0002-953X | doi=10.1176/appi.ajp.162.5.1020}}</ref><ref>Reversible withdrawal dyskinesia associated with quetiapine | [http://onlinelibrary.wiley.com/{{cite journal | vauthors=((Michaelides, C.)), ((Thakore-James, M.)), ((Durso, R.)) | journal=Movement Disorders | title=Reversible withdrawal dyskinesia associated with quetiapine | volume=20 | issue=6 | pages=769–770 | date= June 2005 | url=https://onlinelibrary.wiley.com/doi/10.1002/mds.20427 | issn=0885-3185 | doi=10.1002/mds.20427}} http://onlinelibrary.wiley.com/Michaelides,+C.,+Thakore-James,+M.,+Durso,+R.+(June+2005).+%22Reversible+withdrawal+dyskinesia+associated+with+quetiapine%22.+Movement+Disorders.+20+(6):+769–770.+doi:10.1002/mds.20427.+ISSN 0885-3185.]</ref> According to Eli Lilly internal documents, discontinuation of atypical neuroleptics similar to seroquel can also cause psoriasis, gingivitis and other inflammatory conditions, dyspepsia, headache, high blood sugar and other health conditions unrelated to psychiatric condition.<ref>{{Citation | title=Seroquel, Seroquel XR (quetiapine) dosing, indications, interactions, adverse effects, and more | url=https://reference.medscape.com/drug/seroquel-xr-quetiapine-342984#10}}</ref><ref>http://www.medicines.org.uk/emc/medicine/26575/SPC/Quetiapine+25+mg+film-coated+tablets/</ref> | ||
== | ====Dangerous interactions==== | ||
*''' | {{DangerousInteractions/Intro}} | ||
*''' | |||
*''' | *'''[[DangerousInteraction::Depressants]]''' (''[[1,4-Butanediol]], [[2M2B]], [[alcohol]], [[benzodiazepines]], [[barbiturates]], [[GHB]]/[[GBL]], [[methaqualone]], [[opioids]]'') - This combination potentiates the [[muscle relaxation]], [[amnesia]], [[sedation]], and [[respiratory depression]] caused by one another. At higher doses, it can lead to a sudden, unexpected loss of consciousness along with a dangerous amount of depressed respiration. There is also an increased risk of suffocating on one's vomit while unconscious. If [[nausea]] or vomiting occurs before a loss of consciousness, users should attempt to fall asleep in the [[recovery position]] or have a friend move them into it. | ||
*''' | |||
*'''[[UncertainInteraction::Stimulants]]''' - It can be dangerous to combine depressants with [[stimulants]] due to the risk of accidental excessive intoxication. Stimulants mask the [[sedation|sedative]] effect of depressants, which is the main factor most people use to gauge their level of intoxication. Once the stimulant effects wear off, the effects of the depressant will significantly increase, leading to intensified [[disinhibition]], [[motor control loss]], and dangerous [[amnesia|black-out states]]. This combination can also potentially result in severe dehydration if one's fluid intake is not closely monitored. If choosing to combine these substances, one should strictly limit themselves to a pre-set schedule of dosing only a certain amount per hour until a maximum threshold has been reached. | |||
*'''[[UncertainInteraction::Dissociatives]]''' - This combination can unpredictably potentiate the [[amnesia]], [[sedation]], [[motor control loss]] and [[delusions]] that can be caused by each other. It may also result in a sudden loss of consciousness accompanied by a dangerous degree of [[respiratory depression]]. If [[nausea]] or vomiting occurs before consciousness is lost, users should attempt to fall asleep in the [[recovery position]] or have a friend move them into it. | |||
==Legal status== | |||
*'''Austria:''' It is available by prescription only and unscheduled.{{citation needed}} | |||
*'''France:''' It is available by prescription only and unscheduled.{{citation needed}} | |||
*'''Germany:''' Quetiapine is a prescription medicine, according to Anlage 1 AMVV.<ref>{{Citation | title=Anlage 1 AMVV - Einzelnorm | url=https://www.gesetze-im-internet.de/amvv/anlage_1.html}}</ref> | |||
*'''Switzerland:''' Quetiapine is listed as a "Abgabekategorie B" pharmaceutical, which requires a prescription.{{citation needed}} | |||
*'''United Kingdom:''' Available by prescription only - unscheduled, but unpopular.{{citation needed}} | |||
*'''United States:''' Quetiapine (Seroquel) is unscheduled in the United States, but is available by prescription only. This means that sales and distribution are allowed only by those with a license and only to those with a prescription (according to FDA regulations). Possession is not illegal even without a prescription.{{citation needed}} | |||
==See also== | ==See also== | ||
*[[Responsible use]] | *[[Responsible use]] | ||
*[[Depressants]] | *[[Depressants]] | ||
*[[Antipsychotics]] | *[[Antipsychotics]] | ||
==External links== | ==External links== | ||
*[http://en.wikipedia.org/wiki/Quetiapine Quetiapine (Wikipedia)] | *[http://en.wikipedia.org/wiki/Quetiapine Quetiapine (Wikipedia)] | ||
*[https://www.erowid.org/pharms/quetiapine/ Quetiapine (Erowid)] | *[https://www.erowid.org/pharms/quetiapine/ Quetiapine (Erowid Vault)] | ||
*[https://drugs. | *[https://isomerdesign.com/PiHKAL/explore.php?id=8686 Quetiapine (TiHKAL / Isomer Design)] | ||
*[https://go.drugbank.com/drugs/DB01224 Quetiapine (DrugBank)] | |||
*[https://www.drugs.com/quetiapine.html Quetiapine (Drugs.com)] | |||
*[https://drugs-forum.com/wiki/Quetiapine Quetiapine (Drugs-Forum)] | |||
==References== | ==References== | ||
<references/> | <references /> | ||
{{#set:Featured=true}} | {{#set:Featured=true}} | ||
[[Category:Psychoactive substance]] | [[Category:Psychoactive substance]] | ||
[[Category:Piperidine]] | |||
[[Category:Antihistamine]] | |||
[[Category:Depressant]] | |||
[[Category:Antipsychotic]] | [[Category:Antipsychotic]] | ||