The Effect of Multiple Doses of Cimetidine on the Steady-State Pharmacokinetics of Quetiapine in Men With Selected Psychotic Disorders

Strakowski, Stephen M.; Keck, Paul E.; Wong, Y.W. James; Thyrum, Per T.; Yeh, Chiao

doi:10.1097/00004714-200204000-00015

Cited by 18 publications

(8 citation statements)

References 8 publications

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“…Since quetiapine is extensively metabolised by the CYP450-3A4 isoenzyme, the manic symptoms related to quetiapine treatment in those patients could be explained by the fact that these patients may have poor metaboliser phenotypes for CYP450-3A4. Accordingly, when they receive the antipsychotic drug having mood stabilizing properties, they won't benefit from its effect unless higher doses than usual were attained [13].…”

Section: Discussionmentioning

confidence: 99%

Quetiapine Induced Hypomania: A Case Report and a Review of the Literature

Khalil¹,

Baddoura²

2012

CDS

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Objectives: The 5-HT2 antagonistic action of quetiapine may disinhibit the dopaminergic system enhancing dopaminergic activity in the forebrain and influencing the mood state. Our objective is to investigate the possible induction of manic symptoms by quetiapine through a case report and a review of the literature. Method:We report the case of a 54 year old woman suffering from bipolar depression who developed hypomania seven weeks after the initiation of 300 mg/d of quetiapine. A literature review concerning the induction of hypomania or mania by quetiapine have retrieved the presence of seven similar case reports or series.Results: Available literature points toward an early induction of hypomania or mania with low dosage of quetiapine treatment (between 100 and 400 mg/day never exceeding 600 mg/day). Hypomania or mania are possible short term complications that can be present few days to few weeks of treatment initiation. The discontinuation of the drug or the increase of its dose seems to reverse the hypomanic or manic symptoms. Patients described in the literature suffer mostly from schizophrenia. Conclusion:The atypical antipsychotic drug quetiapine, which have antidepressant properties at low doses via its indirect dopamine enhancing activity due its serotoninergic antagonism, appears to be involved in the induction of rare hypomanic or manic state in patients suffering from bipolar disorders and to have mood stabilizing properties at higher doses when its dopamine antagonist activity becomes more prominent. Its manic/hypomanic induction properties should not prevent its administration to patients suffering from bipolar disorder.

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Section: Discussionmentioning

confidence: 99%

Quetiapine Induced Hypomania: A Case Report and a Review of the Literature

Khalil¹,

Baddoura²

2012

CDS

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“…Consitent with this, in a recent investigation in healthy volunteers, imipramine, a CYP2D6 substrate, had no significant effect on the pharmacokinetics of quetiapine, while fluoxetine, a potent CYP2D6 inhibitor and a moderate CYP3A4 inhibitor, caused a minimal, not statistically significant increase in the AUC (by 12%) and C max (by 26%) of the antipsychotic [216]. In a pharmacokinetic study involving 13 psychotic patients, concomitant administration of cimetidine, a potent nonspecific inhibitor of the CYP system, produced minimimal, not statistically significant changes in the pharmacokinetics of quetiapine [217].…”

Section: Quetiapinementioning

confidence: 99%

Metabolic drug interactions with new psychotropic agents

Spina

Scordo

D'Arrigo

2003

Fundamemntal Clinical Pharma

118

104

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New psychotropic drugs introduced in clinical practice in recent years include new antidepressants, such as selective serotonin reuptake inhibitors (SSRI) and 'third generation' antidepressants, and atypical antipsychotics, i.e. clozapine, risperidone, olanzapine, quetiapine, ziprasidone and amisulpride. These agents are extensively metabolized in the liver by cytochrome P450 (CYP) enzymes and are therefore susceptible to metabolically based drug interactions with other psychotropic medications or with compounds used for the treatment of concomitant somatic illnesses. New antidepressants differ in their potential for metabolic drug interactions. Fluoxetine and paroxetine are potent inhibitors of CYP2D6, fluvoxamine markedly inhibits CYP1A2 and CYP2C19, while nefazodone is a potent inhibitor of CYP3A4. These antidepressants may be involved in clinically significant interactions when coadministered with substrates of these isoforms, especially those with a narrow therapeutic index. Other new antidepressants including sertraline, citalopram, venlafaxine, mirtazapine and reboxetine are weak in vitro inhibitors of the different CYP isoforms and appear to have less propensity for important metabolic interactions. The new atypical antipsychotics do not affect significantly the activity of CYP isoenzymes and are not expected to impair the elimination of other medications. Conversely, coadministration of inhibitors or inducers of the CYP isoenzymes involved in metabolism of the various antipsychotic compounds may alter their plasma concentrations, possibly leading to clinically significant effects. The potential for metabolically based drug interactions of any new psychotropic agent may be anticipated on the basis of knowledge about the CYP enzymes responsible for its metabolism and about its effect on the activity of these enzymes. This information is essential for rational prescribing and may guide selection of an appropriate compound which is less likely to interact with already taken medication(s).

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“…Poor metabolisers of CYP450 have slight/no activity in any sub-group of this enzyme. 13 Since quetiapine is extensively metabolised by the CYP450-3A4 isoenzyme, 14 the manic symptoms related to quetiapine treatment in this report can be explained by the fact that these patients may have poor metaboliser phenotypes for CYP450-3A4. It may also be possible to say that they may concurrently have poor metaboliser phenotypes of other CYP450 isoenzymes (i.e.…”

Section: Discussionmentioning

confidence: 79%

Manic symptoms probably associated with short-term low-dose quetiapine use

Erberk-Özen

2008

Adv Therapy

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Nowadays, there is a widespread use of atypical (second-generation) antipsychotics as an adjunct pharmacotherapy in psychiatry clinics, especially at lower doses in several diagnoses. Here, 2 cases are reported where patients with diagnosed schizophrenia displayed manic symptoms on quetiapine 100 mg/d. The cases presented here had no history of mood disorders. It is discussed that the mania/hypomania may be associated with quetiapine treatment and defined as an adverse effect. Manic symptoms may be a 'probable adverse effect' according to the Naranjo adverse drug reactions probability scale, with a score of 6 points in both our cases. Several studies have suggested that quetiapine-induced mania/hypomania may be associated with frontal dopamine release via serotonin 5HT2A receptor blockade. Hence, clinicians should monitor the mood alterations of patients carefully during the atypical antipsychotic treatment. This is also the conclusion of our study as the patients may be slow metabolisers of CYP450-3A4, as suggested by their previous side effects on different antipsychotics.

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The Effect of Multiple Doses of Cimetidine on the Steady-State Pharmacokinetics of Quetiapine in Men With Selected Psychotic Disorders

Cited by 18 publications

References 8 publications

Quetiapine Induced Hypomania: A Case Report and a Review of the Literature

Quetiapine Induced Hypomania: A Case Report and a Review of the Literature

Metabolic drug interactions with new psychotropic agents

Manic symptoms probably associated with short-term low-dose quetiapine use

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