quetiapine-fumarate and Bezoars

Radiopaque densities can be observed on imaging after the ingestion of either foreign bodies or some medications. Our case report discusses an 11-year-old boy with autism spectrum disorder and attention deficient disorder who presented to the emergency department because of concerns for constipation and dehydration. Incidentally, an abdominal x-ray showed numerous radiopaque densities throughout his intestines in addition to his constipation. He was admitted, and his home regimen was reviewed to attempt to identify a potential source for these radiopaque densities. This case presented an interesting teaching opportunity in the identification of the radiopaque densities and review of pharmacokinetics.

Topics: Abdomen; Abdominal Pain; Antidepressive Agents; Attention Deficit Disorder with Hyperactivity; Autism Spectrum Disorder; Bezoars; Child; Constipation; Diagnosis, Differential; Foreign Bodies; Humans; Lisdexamfetamine Dimesylate; Male; Quetiapine Fumarate; Radiography, Abdominal; Tomography, X-Ray Computed

Although extended-release (XR) formulations are recognized to bear some risk of pharmacobezoar formation in overdose, there are no previously documented reports of this phenomenon with quetiapine. We describe nine cases of pharmacobezoar formation in acute quetiapine XR overdose.. Observational case series of all patients who underwent gastroscopy after quetiapine XR overdose, which were reported by physicians to the Swiss Toxicological Information Centre between January 2010 and December 2012, with detailed analysis of cases with documented pharmacobezoar.. Gastric pharmacobezoars were detected in 9 out of 19 gastroscopic evaluations performed during the study period. All these patients ingested a large dose of quetiapine XR (10-61 tablets; 6-24.4 g quetiapine). All patients but one also coingested at least one other substance, and in three cases another XR drug formulation. Gastroscopic pharmacobezoar removal was achieved without complications in all patients, but was difficult due to the particular "gelatinous-sticky-pasty" consistency of the concretion. The subsequent clinical course was favorable.. The possibility of pharmacobezoar formation following a large quetiapine XR overdose should be considered, as this may influence acute patient management. Complete endoscopic pharmacobezoar removal may be a promising approach in selected cases, but further studies are needed to define its role.

Topics: Adult; Antipsychotic Agents; Bezoars; Chemistry, Pharmaceutical; Delayed-Action Preparations; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Overdose; Female; Humans; Male; Middle Aged; Quetiapine Fumarate; Stomach; Tablets; Young Adult

Topics: Antidepressive Agents, Second-Generation; Antipsychotic Agents; Bezoars; Cyclohexanols; Delayed-Action Preparations; Dibenzothiazepines; Humans; Intestines; Prescription Drug Misuse; Quetiapine Fumarate; Time Factors; Venlafaxine Hydrochloride