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.