Quetiapine

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Summary sheet: Quetiapine
Quetiapine
Quetiapine.svg
Chemical Nomenclature
Common names Quetiapine, Seroquel
Substitutive name Xeroquel, Ketipinor
Systematic name 2-(2-(4-dibenzo[b,f] [1,4]thiazepine- 11-yl- 1-piperazinyl)ethoxy) ethanol
Class Membership
Psychoactive class Antipsychotic
Chemical class Dibenzothiazepine
Routes of Administration

WARNING: Always start with lower doses due to differences between individual body weight, tolerance, metabolism, and personal sensitivity. See responsible use section.



⇣ Oral
Dosage
Bioavailability 100% - 100%
Threshold 10 mg
Light 25 - 50 mg
Common 50 - 150 mg
Strong 150 - 300 mg
Heavy 300 mg +
Duration
Total 4 - 8 hours
Onset 20 - 40 minutes
Peak 1.5 - 6 hours
Offset 6 - 7 hours
After effects 24 - 48 hours









DISCLAIMER: PW's dosage information is gathered from users and resources for educational purposes only. It is not a recommendation and should be verified with other sources for accuracy.

Interactions
Stimulants
Dissociatives
Depressants

Quetiapine (branded as Seroquel, Xeroquel, and Ketipinor) is a short-acting atypical 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]

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.[1] 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.[1] 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.[2] The U.S. patent,[3] which was set to expire in 2011, received a pediatric exclusivity extension which pushed its expiration to March 26, 2012.[3][4] The patent has already expired in Canada.

There are now several name brand versions of quetiapine, such as Quepin, Seroquel and Ketipinor.[5]

Chemistry

Quetiapine is an atypical antipsychotic drug and dibenzothiazepine derivative. Quetiapine contains a thiazepine ring, a seven-membered ring containing one sulfur and one nitrogen group, located at R1 and R4 respectively. This ring is fused to two benzene rings, thus forming a dibenzothiazepine moiety. Dibenzothiazepine is connected at R11 to the nitrogen group of a piperidine ring at R4.

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 R2 of an ethane chain through an oxygen bridge to an ethanol group. This forms the structure of quetiapine.

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 dopaminergic, serotonergic, and adrenergic antagonist, as well as a potent antihistamine with clinically negligible anticholinergic properties.[6][7][8][9] Quetiapine binds strongly to serotonin receptors; the drug acts as partial agonist at 5-HT1A receptors.[10] 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

Disclaimer: The effects listed below cite the Subjective Effect Index (SEI), an open research literature based on anecdotal user reports and the personal analyses of PsychonautWiki contributors. As a result, they should be viewed with a healthy degree of skepticism.

It is also worth noting that these effects will not necessarily occur in a predictable or reliable manner, although higher doses are more liable to induce the full spectrum of effects. Likewise, adverse effects become increasingly likely with higher doses and may include addiction, severe injury, or death ☠.

Physical effects
Child.svg

Cognitive effects
User.svg

After effects
Aftereffects (3).svg


Combination effects

  • Cannabis: Cannabis' effects synergise with quetiapine's effects thus increasing the physical effects of the "high" while decreasing the cognitive effects. [11]
  • Psychedelics: Due to it being a 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. [12]

Experience reports

Anecdotal reports which describe the effects of this compound within our experience index include:

Additional experience reports can be found here:

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.[13]
  • Bipolar disorder: In those with bipolar disorder, quetiapine is used to treat depressive episodes and acute manic episodes associated with bipolar I disorder.[14][15]
  • Major depressive disorder: Quetiapine is effective when used by itself and when used along with other medications in major depressive disorder (MDD).[16][17] However, sedation is often an undesirable side effect.[16]
  • 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.[18][19]
  • 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.[20][21] It is sometimes used off-label, often as an augmentation agent, to treat conditions such as Tourette syndrome,[22] musical hallucinations[23] and anxiety disorders.[24] It is particularly useful as a tool for forced sedation during bad trips or prolonged unwanted stimulation.

Toxicity and harm potential

Quetiapine likely has a 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[25] lawsuits[26][27][28] 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.[29] According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.[29] Although quetiapine and clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.[30]

Weight gain can be a problem for some, with quetiapine causing more weight gain than other more commonly used antipsychotics.[31]

It is strongly recommended that one use harm reduction practices when using this drug.

Lethal dosage

Compared to other antipsychotics, quetiapine has been reported to be relatively safer in overdose.[32] 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.[33]

Tolerance and addiction potential

Quitiapine is moderately physically and psychologically addictive.

Tolerance will develop to the antipsychotic effects and within a week of continuous use. The tolerance to the amount of sedation will be the most noticeable. After cessation, the tolerance returns to baseline in 7 - 14 days. Withdrawal symptoms or rebound symptoms may occur after ceasing usage abruptly following a few weeks or longer of steady dosing, and may necessitate a gradual dose reduction.

The addictive qualities of quetiapine have not been formally studied and are largely known through anecdotal sources. For example, a letter to the editor that appeared in the January 2007 American Journal of Psychiatry has proposed a “need for additional studies to explore the addiction-potential of quetiapine”. The letter reports that its authors are physicians who work in the Ohio correctional system. They report that “prisoners have threatened legal action and even suicide when presented with discontinuation of quetiapine” and that they have “not seen similar drug-seeking behavior with other second-generation antipsychotics of comparable efficacy”.

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.[34][35] 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.[36][37]

Dangerous interactions

Warning: Many psychoactive substances that are reasonably safe to use on their own can suddenly become dangerous and even life-threatening when combined with certain other substances. The following list provides some known dangerous interactions (although it is not guaranteed to include all of them).

Always conduct independent research (e.g. Google, DuckDuckGo, PubMed) to ensure that a combination of two or more substances is safe to consume. Some of the listed interactions have been sourced from TripSit.

  • Stimulants - It can be dangerous to combine depressants with stimulants due to the risk of accidental excessive intoxication. Stimulants mask the 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 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.

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.[38]
  • 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

External links

References

  1. ↑ 1.0 1.1 Pierre, J. M., Shnayder, I., Wirshing, D. A., Wirshing, W. C. (September 2004). "Intranasal Quetiapine Abuse". American Journal of Psychiatry. 161 (9): 1718–1718. doi:10.1176/appi.ajp.161.9.1718. ISSN 0002-953X. 
  2. ↑ SEROQUEL Loss of Exclusivity (LOE). When will the SEROQUEL patents expire, and when will generic SEROQUEL be available? 
  3. ↑ 3.0 3.1 Warawa, E. J., Migler, B. M., United States Patent: 4879288 - Novel dibenzothiazepine antipsychotic 
  4. ↑ 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
  5. ↑ Quepin Tablets (Specifar), Drug Reference Encyclopedia 
  6. ↑ http://www1.astrazeneca-us.com/pi/Seroquel.pdf
  7. ↑ Richelson, E., Souder, T. (24 November 2000). "Binding of antipsychotic drugs to human brain receptors: Focus on newer generation compounds". Life Sciences. 68 (1): 29–39. doi:10.1016/S0024-3205(00)00911-5. ISSN 0024-3205. 
  8. ↑ Davis, K. L., Neuropsychopharmacology, A. C. of (2002). Neuropsychopharmacology: The Fifth Generation of Progress : an Official Publication of the American College of Neuropsychopharmacology. Lippincott Williams & Wilkins. ISBN 9780781728379. 
  9. ↑ http://www.drugs.com/pro/seroquel.html
  10. ↑ Mechanism of Action of Quetiapine, Psychopharmacology Institute 
  11. ↑ https://www.drugs.com/interactions-check.php?drug_list=1979-0,2758-0
  12. ↑ 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
  13. ↑ Srisurapanont, M., Maneeton, B., Maneeton, N., Lankappa, S., Gandhi, R. (19 April 2004). Cochrane Schizophrenia Group, ed. "Quetiapine for schizophrenia". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD000967.pub2. ISSN 1465-1858. 
  14. ↑ Thase, M. E., Macfadden, W., Weisler, R. H., Chang, W., Paulsson, B., Khan, A., Calabrese, J. R. (December 2006). "Efficacy of Quetiapine Monotherapy in Bipolar I and II Depression: A Double-blind, Placebo-controlled Study (The BOLDER II Study)". Journal of Clinical Psychopharmacology. 26 (6): 600–609. doi:10.1097/01.jcp.0000248603.76231.b7. ISSN 0271-0749. 
  15. ↑ British national formulary, no 65 (March - September 2013). BMJ/Pharmaceutical Press. 2013. ISBN 9780857110848. 
  16. ↑ 16.0 16.1 Komossa, K., Depping, A. M., Gaudchau, A., Kissling, W., Leucht, S. (8 December 2010). Cochrane Common Mental Disorders Group, ed. "Second-generation antipsychotics for major depressive disorder and dysthymia". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD008121.pub2. ISSN 1465-1858. 
  17. ↑ Spielmans, G. I., Berman, M. I., Linardatos, E., Rosenlicht, N. Z., Perry, A., Tsai, A. C. (12 March 2013). "Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes". PLOS Medicine. 10 (3): e1001403. doi:10.1371/journal.pmed.1001403. ISSN 1549-1676. 
  18. ↑ Shotbolt, P., Samuel, M., David, A. (November 2010). "Quetiapine in the treatment of psychosis in Parkinson's disease". Therapeutic Advances in Neurological Disorders. 3 (6): 339–350. doi:10.1177/1756285610389656. ISSN 1756-2864. 
  19. ↑ Taylor, D., Paton, C., Kapur, S., Taylor, D., South London and Maudsley NHS Trust, Oxleas NHS Foundation Trust (2012). The Maudsley prescribing guidelines in psychiatry. ISBN 9780470979693. 
  20. ↑ Coe, H. V., Hong, I. S. (May 2012). "Safety of Low Doses of Quetiapine When Used for Insomnia". Annals of Pharmacotherapy. 46 (5): 718–722. doi:10.1345/aph.1Q697. ISSN 1060-0280. 
  21. ↑ 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. (2011). Off-Label Use of Atypical Antipsychotics: An Update. AHRQ Comparative Effectiveness Reviews. Agency for Healthcare Research and Quality (US). 
  22. ↑ Mukaddes, N. M., Abali, O. (September 2003). "Quetiapine Treatment of Children and Adolescents with Tourette's Disorder". Journal of Child and Adolescent Psychopharmacology. 13 (3): 295–299. doi:10.1089/104454603322572624. ISSN 1044-5463. 
  23. ↑ Sacks, O. (2008). Musicophilia: tales of music and the brain. Vintage Books. ISBN 9781400033539. 
  24. ↑ Becker, P. M. (1 October 2006). "Treatment of sleep dysfunction and psychiatric disorders". Current Treatment Options in Neurology. 8 (5): 367–375. doi:10.1007/s11940-006-0026-6. ISSN 1534-3138. 
  25. ↑ Questions loom over drug for sleepless vets | http://www.marinecorpstimes.com/article/20100830/NEWS/8300315/Questions-loom-over-drug-for-sleepless-vets
  26. ↑ Wilson, D. (2011), Heart Warning Added to Label on Popular Antipsychotic Drug 
  27. ↑ Seroquel linked to Deadly Side Effects | http://www.defendingtheconsumer.com/drug-injury-lawyer/seroquel-linked-to-deadly-side-effects/
  28. ↑ Seroquel | http://www.resource4thepeople.com/defectivedrugs/seroquel.html
  29. ↑ 29.0 29.1 Correll, C. U., Schenk, E. M. (March 2008). "Tardive dyskinesia and new antipsychotics:". Current Opinion in Psychiatry. 21 (2): 151–156. doi:10.1097/YCO.0b013e3282f53132. ISSN 0951-7367. 
  30. ↑ Aia, P. G., Revuelta, G. J., Cloud, L. J., Factor, S. A. (1 June 2011). "Tardive Dyskinesia". Current Treatment Options in Neurology. 13 (3): 231–241. doi:10.1007/s11940-011-0117-x. ISSN 1534-3138. 
  31. ↑ Allison, D. B., Mentore, J. L., Heo, M., Chandler, L. P., Cappelleri, J. C., Infante, M. C., Weiden, P. J. (1 November 1999). "Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis". American Journal of Psychiatry. 156 (11): 1686–1696. doi:10.1176/ajp.156.11.1686. ISSN 0002-953X. 
  32. ↑ Mattoo, S. K., Shah, R., Rajagopal, R., Biswas, P. S., Singh, S. M. (2009). "Quetiapine: Relatively safe in overdose?". Indian Journal of Psychiatry. 51 (2): 139–140. doi:10.4103/0019-5545.49456. ISSN 0019-5545. 
  33. ↑ Fitzgerald, R. L. (1 December 2009). "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". Clinical Chemistry. 55 (12): 2232–2232. doi:10.1373/clinchem.2009.133827. ISSN 0009-9147. 
  34. ↑ Kim, D. R., Staab, J. P. (May 2005). "Quetiapine Discontinuation Syndrome". American Journal of Psychiatry. 162 (5): 1020–1020. doi:10.1176/appi.ajp.162.5.1020. ISSN 0002-953X. 
  35. ↑ Reversible withdrawal dyskinesia associated with quetiapine | http://onlinelibrary.wiley.com/Michaelides, C., Thakore-James, M., Durso, R. (June 2005). "Reversible withdrawal dyskinesia associated with quetiapine". Movement Disorders. 20 (6): 769–770. doi:10.1002/mds.20427. ISSN 0885-3185. 
  36. ↑ Seroquel, Seroquel XR (quetiapine) dosing, indications, interactions, adverse effects, and more 
  37. ↑ http://www.medicines.org.uk/emc/medicine/26575/SPC/Quetiapine+25+mg+film-coated+tablets/
  38. ↑ Anlage 1 AMVV - Einzelnorm 
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