Skip to main content

Advertisement

SpringerLink
Log in

The toxicology and comorbidities of fatal cases involving quetiapine

  • Original Article
  • Published:
Forensic Science, Medicine, and Pathology Aims and scope Submit manuscript

Abstract

The use of quetiapine in Australia has increased rapidly in recent years. Anecdotal and post-marketing surveillance reports indicate an increase in quetiapine misuse in prisons as well as an increase in its availability on the black-market. This study examined a cohort of quetiapine-associated deaths occurring in Victoria, Australia, between 2001 and 2009, to determine the prevalence of deaths associated with this drug and to determine whether misuse represents a legitimate concern. Case details were extracted from the National Coronial Information System. There were 224 cases with an average age of 43 years of age (range 15–87 years). The cause of death was mostly drug toxicity (n = 114, 51 %), followed by natural disease (n = 60, 27 %), external injury (n = 31, 14 %) and unascertained causes (n = 19, 8 %). Depression and/or anxiety were common, observed in over a third of the cohort (80 cases, 36 %). About 20 % of cases did not mention a psychiatric diagnosis at all which raises the question of whether quetiapine had been prescribed correctly in these cases. Cardiovascular disease was the most commonly reported illness after mental disease. Quetiapine ranged in concentration from the limit of reporting (0.01 mg/L) to 110 mg/L. The median concentration of quetiapine was much lower in the natural disease deaths (0.25 mg/L) compared with drug caused deaths (0.7 mg/L). The most commonly co-administered drug was diazepam in 81 (36 %) cases. There were a small number of cases where quetiapine contributed to a death where it had not apparently been prescribed, including the death of a 15 year old boy and one of a 34 year old female. Overall, misuse of quetiapine did not appear to be a significant issue in this cohort; use of the drug only occasionally led to fatalities when used in excess or concomitantly with interacting drugs. However, considering that it is a recent social concern, it is possible that analysis of cases post 2009 would reveal more cases of quetiapine abuse. Close monitoring of quetiapine is therefore advised to prevent adverse outcomes, particularly in vulnerable populations such as substance abusers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ray WA, Meredith S, Thapa PB, Meador KG, Hall K, Murray KT. Antipsychotics and the risk of sudden cardiac death. Arch Gen Psychiatry. 2001;58(12):1161–7.

    Article  PubMed  CAS  Google Scholar 

  2. Department of Health and Ageing (DHA). Pharmaceutical benefits scheme expenditure and prescriptions twelve months to 30 june 2011. Canberra; 2011.

  3. Heilbronn CE, Lloyd B, McElwee P, Eade A, Lubman DI. Quetiapine-related harms are on the rise. Aust N Z J Psychiatry. 2012;46(3):279–80.

    Article  PubMed  Google Scholar 

  4. Bogart GTO, Ott CA. Abuse of second generation antipsychotics: what prescribers need to know. Curr Psychiatry. 2011;10(5):77–9.

    Google Scholar 

  5. Hanley MJ, Kenna GA. Quetiapine: treatment for substance abuse and drug of abuse. Am J Health Syst Pharm. 2008;65(7):611–8.

    Article  PubMed  CAS  Google Scholar 

  6. Hussain MZ, Waheed W, Hussain S. Intravenous quetiapine abuse. Am J Psychiatry. 2005;162(9):1755–6.

    Article  PubMed  CAS  Google Scholar 

  7. Morin AK. Possible intranasal quetiapine misuse. Am J Health Syst Pharm. 2007;64(7):723–5.

    Article  PubMed  CAS  Google Scholar 

  8. Murphy D, Bailey K, Stone M, Wirshing WC. Addictive potential of quetiapine. Am J Psychiatry. 2008;165(7):918.

    Article  PubMed  Google Scholar 

  9. Paparrigopoulos T, Karaiskos D, Liappas J. Quetiapine: another drug with potential for misuse? A case report. J Clin Psychiatry. 2008;69(1):162–3.

    Article  PubMed  Google Scholar 

  10. Sansone RA, Sansone LA. Is seroquel developing an illicit reputation for misuse/abuse? Psychiatry (Edgmont). 2010;7(1):13–6.

    Google Scholar 

  11. Tcheremissine OV. Is quetiapine a drug of abuse? Reexamining the issue of addiction. Expert Opin Drug Saf. 2008;7(6):739–48.

    Article  PubMed  CAS  Google Scholar 

  12. Keltner NL, Vance DE. Biological perspectives incarcerated care and quetiapine abuse. Perspect Psychiatr Care. 2008;44(3):202–6.

    Article  PubMed  Google Scholar 

  13. Micromedex® healthcare series [database on the internet] 1974–2010. http://www.thomsonhc.com.ezproxy.lib.monash.edu.au. Accessed 16 Jul 2010.

  14. Caroff SN, Mann SC. Neuroleptic malignant syndrome. Med Clin N Am. 1993;77(1):185–202.

    PubMed  CAS  Google Scholar 

  15. Carbone JR. The neuroleptic malignant and serotonin syndromes. Emerg Med Clin N Am. 2000;18(2):317–25.

    Article  CAS  Google Scholar 

  16. Keck PE Jr, Caroff SN, McElroy SL. Neuroleptic malignant syndrome and malignant hyperthermia: end of a controversy? J Neuropsychiatry Clin Neurosci. 1995;7(2):135–44.

    PubMed  Google Scholar 

  17. Stafford JB, Burns L. Australian drug trends 2011: findings from the illicit drug reporting system (idrs). Sydney: University of New South Wales; 2012.

    Google Scholar 

  18. McLarnon ME, Fulton HG, Macisaac C, Barrett SP. Characteristics of quetiapine misuse among clients of a community-based methadone maintenance program. J Clin Psychopharmacol. 2012;32(5):721–3.

    Article  PubMed  Google Scholar 

  19. Alvarez PA, Pahissa J. Qt alterations in psychopharmacology: proven candidates and suspects. Curr Drug Saf. 2010;5(1):97–104.

    Article  PubMed  CAS  Google Scholar 

  20. Brauer R, Douglas I, Smeeth L. The association between antipsychotic agents and the risk of myocardial infarction: a systematic review. Br J Clin Pharmacol. 2011;72(6):871–8.

    Article  PubMed  Google Scholar 

  21. Degner D, Bleich S, Grohmann R, Bandelow B, Ruther E. Myocarditis associated with clozapine treatment. Aust N Z J Psychiatry. 2000;34(5):880.

    Article  PubMed  CAS  Google Scholar 

  22. Glassman AH, Bigger JT Jr. Antipsychotic drugs: prolonged QTc interval, torsade de pointes, and sudden death. Am J Psychiatry. 2001;158(11):1774–82.

    Article  PubMed  CAS  Google Scholar 

  23. Muench J, Hamer AM. Adverse effects of antipsychotic medications. Am Fam Physician. 2010;81(5):617–22.

    PubMed  Google Scholar 

  24. Freedman R. Schizophrenia. N Engl J Med. 2003;349(18):1738–49.

    Article  PubMed  CAS  Google Scholar 

  25. Cardno AG, Gottesman II. Twin studies of schizophrenia: from bow-and-arrow concordances to star wars mx and functional genomics. Am J Med Genet. 2000;97(1):12–7.

    Article  PubMed  CAS  Google Scholar 

  26. McGuffin P, Farmer AE, Gottesman II, Murray RM, Reveley AM. Twin concordance for operationally defined schizophrenia. Confirmation of familiality and heritability. Arch Gen Psychiatry. 1984;41(6):541–5.

    Article  PubMed  CAS  Google Scholar 

  27. Sullivan PF, Kendler KS, Neale MC. Schizophrenia as a complex trait: evidence from a meta-analysis of twin studies. Arch Gen Psychiatry. 2003;60(12):1187–92.

    Article  PubMed  Google Scholar 

  28. Brown S. Excess mortality of schizophrenia. A meta-analysis. Br J Psychiatry. 1997;171:502–8.

    Article  PubMed  CAS  Google Scholar 

  29. Rosh A, Sampson BA, Hirsch CS. Schizophrenia as a cause of death. J Forensic Sci. 2003;48(1):164–7.

    PubMed  Google Scholar 

  30. Koponen H, Alaraisanen A, Saari K, Pelkonen O, Huikuri H, Raatikainen MJ, et al. Schizophrenia and sudden cardiac death: a review. Nord J Psychiatry. 2008;62(5):342–5.

    Article  PubMed  Google Scholar 

  31. Baselt RC. Disposition of toxic drugs and chemicals in man. 9th ed. Seal Beach: Biomedical; 2011.

    Google Scholar 

Download references

Acknowledgments

The authors thank the National Coronial Information System and the State Coroner’s Office for their help in obtaining mortality data. We also acknowledge the assistance of pathologists, forensic technicians and toxicologists, at the Victorian Institute of Forensic Medicine.

Author information

Authors and Affiliations

  1. Department of Forensic Medicine, Monash University, 57-83 Kavanagh Street, Southbank, VIC, 3006, Australia

    Jennifer L. Pilgrim & Olaf H. Drummer

  2. Victorian Institute of Forensic Medicine, 57-83 Kavanagh Street, Southbank, VIC, 3006, Australia

    Olaf H. Drummer

Authors
  1. Jennifer L. Pilgrim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Olaf H. Drummer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer L. Pilgrim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pilgrim, J.L., Drummer, O.H. The toxicology and comorbidities of fatal cases involving quetiapine. Forensic Sci Med Pathol 9, 170–176 (2013). https://doi.org/10.1007/s12024-012-9404-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12024-012-9404-4

Keywords

Search

Navigation