BehaveNet^® Clinical Capsule™:

drug: quetiapine

• Clinical class: atypical antipsychotic
• Chemical class: dibenzothiazepine
• Action: antagonist of serotonin 5HT_1A and 5HT₂; dopamine D₁ and D₂; histamine H₁; andrenergic alpha₁ and alpha₂
• Active metabolite: N-desalkyl quetiapine (norquetiapine)
• CSA schedule: none
• DEA number: none
• FDA Medwatch Consumer Advisory (name confusion: Seroquel^® & Serzone^®)
• MEDLINEplus^® Drug Information

U.S. Preparations:

• Seroquel^® (AstraZeneca Pharmaceuticals) FDA approved for:
  9.26.97 treatment of manifestations of psychotic disorders
  3.27.2001 schizophrenia
  1.12.2004 short term treatment of acute manic episodes associated with Bipolar I Disorder, as either monotherapy or adjunct therapy to lithium or divalproex
  7.21.2004 short term treatment of acute manic episodes associated with Bipolar I Disorder, as either monotherapy or adjunct therapy to lithium or divalproex up to 12 weeks
  10.20.2006 depressive episodes associated with Bipolar Disorder
  5.13.2008 maintenance treatment of Bipolar I Disorder as adjunct therapy to lithium or divalproex
  US Prescribing Information

• Seroquel XR^® (AstraZeneca Pharmaceuticals) FDA approved for:
  5.17.2007 treatment of schizophrenia
  11.15.2007 maintenance treatment of schizophrenia
  US Prescribing Information

Stephen Stahl's Clinical Pearls* (Consult your physician before making any change in your treatment.)

• Some patients respond to quetiapine who have failed to respond to other atypical antipsychotics.
• Anecdotal reports of usefulness for bipolar and treatment-refractory cases, and for positive symptoms of psychosis in disorders other than schizophrenia
• Early studies support use in adolescents and elderly people, and for hostility/aggression, cognition and affective symptoms in schizophrenia.
• Better than placebo (but not haloperidol) for negative symptoms, although least likely to cause negative symptoms secondary to EPS
• May be the preferred antipsychotic for psychosis in Parkinson's Disease.
• Never say never, but essentially no EPS or prolactin elevation at any dose
• Cataracts caused at high doses in dogs but not monkeys or humans, possibly as a result of species-specific inhibition of cholesterol biosynthesis in the lens of dogs.
• However, in the USA, there is an FDA precaution to monitor for development of cataracts every six months (similar to precaution for carbamazepine and HMGCoA (hydroxymethylglutaryl-ICoA) reductase inhibitors of cholesterol biosynthesis).
• Postmarketing experience to date does not support a causal link between quetiapine and lens opacities.
• Not necessary to have eyes examined until dose has been stabilized and plans made for long-term use.

*Reprinted with permission from: Stahl, Stephen M Psychopharmacology of Antipsychotics Paperback 1999 Martin Dunitz, Ltd You cannot fully appreciate this book until you have seen the extraordinary illustrations of every aspect of this area of psychopharmacology and neurochemistry. Loaded with practical clinical "pearls."

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