Quetiapine Poisoning – Epidemiology, Toxicokinetics and Review of the Literature Volume 5 - Issue 5

Langberg C¹, Hadley CL², Midtrevold M³, Edvardsen HME⁴, Molden E⁵, Shafiei M⁶ and Jacobsen D^1,2,3*

• ¹Institue of Clinical Medicine, University of Oslo, Norway
• ²Department of Acute Medicine at the Oslo University Hospital, Norway
• ³Norwegian Poisons Information Centre, Norway
• ⁴Department of Forensic Sciences at the Oslo University Hospital, Norway
• ⁵Diakonhjemmet Hospital, Oslo, Norway
• ⁶Department of Surgery and Anaesthesiology at Skien Hospital, Telemark, Norway

Received: July 27, 2021   Published: August 4, 2021

*Corresponding author: Jacobsen D, Department of Acute Medicine at the Oslo University Hospital, Norway

DOI: 10.32474/LOJMS.2021.05.000224

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Abstract

Background: With increasing use and availability of Quetiapine (Q) the number of self-poisonings has increased. The toxic effects of Q may be lethal and an increased knowledge of these poisonings may improve the outcome in these patients.

Methods: Two cases of Q poisoning are presented, one with toxicokinetic data of both Q and NQ, as well as a literature review of Q poisoning. Epidemiological data on Q poisoning in Norway and the frequency of these poisonings in the forensic reports are presented in the supplementary material.

Results: The two cases of severe Q poisoning, of whom one was fatal, illustrated the cardiovascular complications and the convulsions also found in the literature review. The toxicokinetic data indicated a biphasic elimination of Q and a persisting high level of the metabolite N-desalkylquetiapine (NQ) even after 80 hours. Q was a toxic agent in 1-2% of the inquiries to the National Poisons Information Center and was detected in 7% of the poisoning fatalities.

Conclusion: As Q poisonings have increased, clinicians need to be aware of the cardiovascular and neurological complications of these poisonings. The toxicokinetic data may indicate delayed gastric emptying in severe poisoning. This may be due to anticholinergic effects, and thus gastric lavage with installation of active charcoal should be considered even later than two hours after ingestion. Patients with suspected severe Q poisoning should be admitted to an ICU as their condition may deteriorate rapidly.

Abstract| Introduction| Materials and Methods| Results| Review of the Literature| Data from the National Poisons Information Center (NPIC) and the Forensic data are given in Supplementary material| Discussion| Conclusions| References|