quetiapine-fumarate and Emergencies

Agitation can present as an emergency in the course of numerous psychiatric conditions including intoxication, schizophrenia, bipolar disorder, and delirium. This article reviews relevant literature regarding the definition, etiology, measurement, and management of episodic agitation and pays particular attention to intramuscular treatments. The impact of changes in methodology between the era of first- and second-generation antipsychotics, the implications of those changes for external validity of studies of second-generation studies, and the recent evolution of expert consensus are discussed.

Topics: Antipsychotic Agents; Aripiprazole; Benzodiazepines; Dibenzothiazepines; Emergencies; Humans; Olanzapine; Piperazines; Psychomotor Agitation; Quetiapine Fumarate; Quinolones; Risperidone; Schizophrenia; Thiazoles

Topics: Antidepressive Agents, Tricyclic; Chromatography, High Pressure Liquid; Emergencies; False Negative Reactions; Female; Gas Chromatography-Mass Spectrometry; Glucuronides; Humans; Hydrolysis; Immunoassay; Inactivation, Metabolic; Infant; Lorazepam; Quetiapine Fumarate

Topics: Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Consciousness Disorders; Dibenzothiazepines; Drug Therapy, Combination; Emergencies; Epilepsy, Tonic-Clonic; Female; Humans; Middle Aged; Olanzapine; Quetiapine Fumarate; Receptors, Adrenergic, alpha; Receptors, Histamine

Quetiapine is an atypical antipsychotic agent increasingly used to treat schizophrenia and bipolar disorder in pediatric patients. Few published data exist concerning quetiapine's effects in therapeutic settings or short-term overdose in pediatric and adolescent populations. In this report, we describe a 15-year-old adolescent girl who experienced continued delirium 5 days after an overdose of quetiapine, trazodone, and clonidine. The patient initially presented with sedation and stable vital signs. After 3 days of gradual improvement, she experienced episodes of delirium coinciding with an increase in resting heart rate. On the basis of suspicion for quetiapine-associated antimuscarinic effects, the patient was administered intravenously with physostigmine on the fifth day after ingestion. Treatment resulted in a brief resolution of symptoms. Serum quetiapine levels measured 1 day and 5 days after ingestion were 3400 and 4800 ng/mL, respectively. The use of physostigmine and interpretation of serum levels are discussed further.

Topics: Adolescent; Antipsychotic Agents; Cholinergic Antagonists; Clonidine; Cytochrome P-450 CYP3A; Delirium; Depression; Dibenzothiazepines; Drug Interactions; Emergencies; Female; Heart Block; Humans; Hypotension; Physostigmine; Quetiapine Fumarate; Self-Injurious Behavior; Suicide, Attempted; Tachycardia; Time Factors; Trazodone