Clinical and analytical features of severe suicidal quetiapine overdoses - A retrospective cohort study

Clinical Toxicology

Volumn 49, Issue 9, 2011, Pages 846-853

  Eyer, Florian ^a   Pfab, Rudolf ^a   Felgenhauer, Norbert ^a   Strubel, Tim ^a   Saugel, Bernd ^a   Zilker, Thomas ^a  

^a TECHNICAL UNIVERSITY OF MUNICH   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

ACTIVATED CARBON; ALCOHOL; ANTIBIOTIC AGENT; CITALOPRAM; LORAZEPAM; MIRTAZAPINE; NORTRIPTYLINE; PHYSOSTIGMINE; QUETIAPINE; RISPERIDONE; TRICYCLIC ANTIDEPRESSANT AGENT; ZOPICLONE;

ADULT; ANTIBIOTIC THERAPY; ANTICHOLINERGIC DELIRIUM; ARTICLE; ARTIFICIAL VENTILATION; CLINICAL ARTICLE; COHORT ANALYSIS; COMA; DELIRIUM; DISEASE SEVERITY; DROWSINESS; DRUG CONCENTRATION; DRUG HALF LIFE; DRUG INTOXICATION; DRUG OVERDOSE; ELECTROCARDIOGRAM; ENDOTRACHEAL INTUBATION; FEMALE; HEART ARRHYTHMIA; HEART RIGHT BUNDLE BRANCH BLOCK; HUMAN; HYPERGLYCEMIA; HYPOKALEMIA; HYPOTENSION; MALE; PNEUMONIA; POISON SEVERITY SCORE; QRS COMPLEX; QT INTERVAL; QT PROLONGATION; RESPIRATION DEPRESSION; RETROSPECTIVE STUDY; SCORING SYSTEM; SEIZURE; SINGLE DRUG DOSE; SUICIDE ATTEMPT; TACHYCARDIA; TREATMENT RESPONSE; VENTILATOR ASSOCIATED PNEUMONIA;

ADULT; ANTIPSYCHOTIC AGENTS; ARRHYTHMIAS, CARDIAC; COHORT STUDIES; COMA; DIBENZOTHIAZEPINES; FEMALE; HALF-LIFE; HUMANS; HYPOTENSION; INTENSIVE CARE UNITS; MALE; MIDDLE AGED; OVERDOSE; PNEUMONIA; RETROSPECTIVE STUDIES; TACHYCARDIA;

EID: 81255173325     PISSN: 15563650     EISSN: 15569519     Source Type: Journal    
DOI: 10.3109/15563650.2011.624100     Document Type: Article

References (41)

1. DeVane CL, Nemeroff CB. Clinical pharmacokinetics of quetiap ine: An atypical antipsychotic. Clin Pharmacokinet 2001; 40(7):509-522.
2. Ngo A, Ciranni M, Olson KR. Acute quetiapine overdose in adults: A 5-year retrospective case series. Ann Emerg Med 2008; 52(5): 541-547.
3. Riedel M, Muller N, Strassnig M, Spellmann I, Engel RR, Musil R, et al. Quetiapine has equivalent effi cacy and superior tolerability to risperidone in the treatment of schizophrenia with predominantly negative symptoms. Eur Arch Psychiatry Clin Neurosci 2005; 255(6):432-437.
4. Tan HH, Hoppe J, Heard K. A systematic review of cardiovascular effects after atypical antipsychotic medication overdose. Am. J. Emerg Med 2009; 27(5):607-616.
5. Fernandes PP, Marcil WA. Death associated with quetiapine overdose. Am. J. Psychiatry 2002; 159(12):2114.
6. Langman LJ, Kaliciak HA, Carlyle S. Fatal overdoses associated with quetiapine. J Anal Toxicol 2004; 28(6):520-525.
7. Griffi ths C, Flanagan RJ. Fatal poisoning with antipsychotic drugs, England and Wales 1993 - 2002. J Psychopharmacol 2005; 19(6): 667-674.
8. Hunfeld NG, Westerman EM, Boswijk DJ, de Haas JA, van Putten MJ, Touw DJ. Quetiapine in overdosage: A clinical and pharmacokinetic analysis of 14 cases. Ther Drug Monit 2006; 28(2):185-189.
9. Kramer I, Rauber-Luthy C, Kupferschmidt H. Acute Intoxication with Quetiapine: A cohort study. Clin. Toxicol.Phila) 2008; 46(7):643.
10. Strachan PM, Benoff BA. Mental status change, myoclonus, electrocardiographic changes, and acute respiratory distress syndrome induced by quetiapine overdose. Pharmacotherapy 2006; 26(4): 578-582.
11. Balit CR, Isbister GK, Hackett LP, Whyte IM. Quetiapine poisoning: A case series. Ann Emerg Med 2003; 42(6):751-758.
12. Harmon TJ, Benitez JG, Krenzelok EP, Cortes-Belen E. Loss of onsciousness from acute quetiapine overdosage. J Toxicol Clin. Toxicol. 1998; 36(6):599-602.
13. Mowry J, Sanftleben J, Smith J. Eighteen month retrospective evaluation of Seroquel exposures [abstract]. J Toxicol Clin. Toxicol. 1999; 37:631.
14. Pollak PT, Zbuk K. Quetiapine fumarate overdose: Clinical and harmacokinetic lessons from extreme conditions. Clin Pharmacol Ther 2000; 68(1):92-97.
15. Isbister GK, Duffull SB. Quetiapine overdose: Predicting intubation, duration of ventilation, cardiac monitoring and the effect of activated charcoal. Int Clin Psychopharmacol 2009; 24(4):174-180.
16. Isbister GK, Friberg LE, Hackett LP, Duffull SB. Pharmacokinetics of quetiapine in overdose and the effect of activated charcoal. Clin Pharmacol Ther 2007; 81(6):821-827.
17. Lund C, Shafi ei M, Molden E, Jacobsen D. Toxicokinetics of Quetiapine and its active metabolite N-desalkylquetiapine during acute poisoning. Clin. Toxicol.Phila) 2011; 49(3):267.
18. Bazett H. An analysis of the time relations of electrocardiograms. Heart 1920; 7:353-370.
19. Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is "normal". J Cardiovasc Electrophysiol 2006; 17(3):333-336.
20. Josphson ME. Clinical Cardiac Electrophysiology: Techniques and Interpretations. 3rd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002.
21. Chan A, Isbister GK, Kirkpatrick CM, Dufful SB. Drug-induced QT prolongation and torsades de pointes: evaluation of a QT nomogram. Qjm 2007; 100(10):609-615.
22. Persson HE, Sjoberg GK, Haines JA, Pronczuk de Garbino J. Poisoning severity score. Grading of acute poisoning. J Toxicol Clin. Toxicol. 1998; 36(3):205-213.
23. Hasselstrom J, Linnet K. Quetiapine serum concentrations in psychiatric patients: The infl uence of comedication. Ther Drug Monit 2004; 26(5):486-491.
24. Waring WS, Graham A, Gray J, Wilson AD, Howell C, Bateman DN. Evaluation of a QT nomogram for risk assessment after antidepressant overdose. Br J Clin Pharmacol 2010; 70(6):881-885.
25. Gajwani P, Pozuelo L, Tesar GE. QT interval prolongation associated with quetiapine (Seroquel) overdose. Psychosomatics 2000; 41(1):63-65.
26. Mattoo SK, Shah R, Rajagopal R, Biswas PS, Singh SM. Quetiapine: Relatively safe in overdose? Indian J Psychiatry 2009; 51(2): 139-140.
27. Ciranni MA, Kearney TE, Olson KR. Comparing acute toxicity of fi rst- and second-generation antipsychotic drugs: A 10-year, retrospective cohort study. J Clin Psychiatry 2009; 70(1):122-129.
28. Druid H, Holmgren P. A compilation of fatal and control concentrations of drugs in postmortem femoral blood. J Forensic Sci 1997; 42(1):79-87.
29. Luchini D, Morabito G, Centini F. Case report of a fatal intoxication by citalopram. Am. J. Forensic Med Pathol 2005; 26(4):352-354.
30. Waring WS, Gray JA, Graham A. Predictive factors for generalized seizures after deliberate citalopram overdose. Br J Clin Pharmacol 2008; 66(6):861-865.
31. Burns MJ. The pharmacology and toxicology of atypical antipsychotic agents. J Toxicol Clin. Toxicol. 2001; 39(1):1-14.
32. Dev V, Raniwalla J. Quetiapine: A review of its safety in the management of schizophrenia. Drug Saf 2000; 23(4):295-307.
33. Bodmer M, Burkard T, Kummer O, Beyrau R, Krahenbuhl S, Haschke M. Pharmacokinetics and pharmacodynamics of quetiapine in a patient with a massive overdose. Ther Drug Monit 2008; 30(4):553-556.
34. Muller C, Reuter H, Dohmen C. Intoxication after extreme oral overdose of quetiapine to attempt suicide: Pharmacological concerns of side effects. Case Report Med 2009; 2009:371698.
35. Nonogaki K, Strack AM, Dallman MF, Tecott LH. Leptin-independent hyperphagia and type 2 diabetes in mice with a mutated serotonin 5-HT2C receptor gene. Nat Med 1998; 4(10):1152-1156.
36. Al-Khatib SM, LaPointe NM, Kramer JM, Califf RM. What clinicians should know about the QT interval. Jama 2003; 289(16):2120-2127.
37. Isbister GK, Balit CR. Bupropion overdose: QTc prolongation and its clinical signifi cance. Ann Pharmacother 2003; 37(7 - 8):999-1002.
38. Isbister GK, Friberg LE, Stokes B, Buckley NA, Lee C, Gunja N, et al. Activated charcoal decreases the risk of QT prolongation after citalopram overdose. Ann Emerg Med 2007; 50(5):593-600, 600 e591-546.
39. Alexander J. Delirium as a symptom of quetiapine poisoning. Aust N Z J Psychiatry 2009; 43(8):781.
40. Geddes J, Freemantle N, Harrison P, Bebbington P. Atypical antipsychotics in the treatment of schizophrenia: systematic overview and meta-regression analysis. Bmj 2000; 321(7273):1371-1376.
41. Burns MJ, Linden CH, Graudins A, Brown RM, Fletcher KE. A comparison of physostigmine and benzodiazepines for the treatment of anticholinergic poisoning. Ann Emerg Med 2000; 35(4):374-381.