The role of antihistaminic effects in the misuse of quetiapine: A case report and review of the literature

Fischer, Bernard A.; Boggs, Douglas L.

doi:10.1016/j.neubiorev.2009.11.003

Cited by 30 publications

(23 citation statements)

References 34 publications

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“…Further, quetiapine has high affinity at 5-HT 2A receptors (Riedel et al, 2007) and ritanserin, a 5-HT 2 -selective antagonist, has been shown to increase cocaine self-administration across a range of cocaine doses (Howell and Byrd, 1995). Finally, it has been suggested that the abuse of quetiapine may be due to its high affinity for the histamine H 1 receptor (Fischer and Boggs, 2010), and there are reports of antihistamine abuse (Halpert et al, 2002;Bailey and Davies, 2008;Thomas et al, 2009) consistent with laboratory findings in humans (Preston et al, 1992;Mumford et al, 1996) and animals (McKearney, 1982;Bergman andSpealman, 1986, 1988;Bergman, 1990;Jun et al, 2004). When tested in combination with cocaine, antihistamines have been shown to enhance the discriminative stimulus effects of cocaine (Campbell et al, 2005), and a combination of diphenhydramine and cocaine in rhesus monkeys had greater reinforcing strength than was predicted based on additivity alone (Wang and Woolverton, 2007).…”

Section: Discussionmentioning

confidence: 75%

Evaluation of the Reinforcing Effect of Quetiapine, Alone and in Combination with Cocaine, in Rhesus Monkeys

Brutcher

Nader

2015

Journal of Pharmacology and Experimental Therapeutics

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There are several case reports of nonmedicinal quetiapine abuse, yet there are very limited preclinical studies investigating quetiapine self-administration. The goal of this study was to investigate the reinforcing effects of quetiapine alone and in combination with intravenous cocaine in monkeys. In experiment 1, cocaine-experienced female monkeys (N 5 4) responded under a fixed-ratio (FR) 30 schedule of food reinforcement (1.0-g banana-flavored pellets), and when responding was stable, quetiapine (0.003-0.1 mg/kg per injection) or saline was substituted for a minimum of five sessions; there was a return to food-maintained responding between doses. Next, monkeys were treated with quetiapine (25 mg, by mouth, twice a day) for approximately 30 days, and then the quetiapine selfadministration dose-response curve was redetermined. In experiment 2, male monkeys (N 5 6) self-administered cocaine under a concurrent FR schedule with food reinforcement (three food pellets) as the alternative to cocaine (0.003-0.3 mg/kg per injection) presentation. Once choice responding was stable, the effects of adding quetiapine (0.03 or 0.1 mg/kg per injection) to the cocaine solution were examined. In experiment 1, quetiapine did not function as a reinforcer, and chronic quetiapine treatment did not alter these effects. In experiment 2, cocaine choice increased in a dose-dependent fashion. The addition of quetiapine to cocaine resulted in increases in lowdose cocaine choice and number of cocaine injections in four monkeys, while not affecting high-dose cocaine preference. Thus, although quetiapine alone does not have abuse potential, there was evidence of enhancement of the reinforcing potency of cocaine. These results suggest that the use of quetiapine in cocaine-addicted patients should be monitored.

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Section: Discussionmentioning

confidence: 75%

Evaluation of the Reinforcing Effect of Quetiapine, Alone and in Combination with Cocaine, in Rhesus Monkeys

Brutcher

Nader

2015

Journal of Pharmacology and Experimental Therapeutics

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“…There is a need to consider quetiapine as a potential candidate to be classified as a scheduled controlled substance if there are robust research findings in the future. [2742]…”

Section: Discussion: Public Health Implicationmentioning

confidence: 99%

“…In addition, polydrug users who were prescribed numerous psychoactive drugs are associated with illegally obtaining quetiapine in combination with other drugs. [272829]…”

Section: Quetiapine Off-label Usementioning

confidence: 99%

Quetiapine misuse and abuse: Is it an atypical paradigm of drug seeking behavior?

et al. 2017

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Recent case reports in medical literatures suggest that more and more second-generation atypical antipsychotics (AAs) have been prescribed for off-label use; quetiapine (Brand name: Seroquel®) showed increase in its trend for off-label use. Little is known about the reasons behind this trend, although historical sedative and hypnotic prescription patterns suggest that despite relatively superior safety profiles of quetiapine (especially for movement disorders), it may be used for treating substance abuse disorder. In addition, recent studies have shown a strong potential for misuse and abuse (MUA) of quetiapine beyond Food and Drug Administration-approved indications. This includes drug-seeking behaviors, such as feigning symptoms, motivated by quetiapine and use of quetiapine in conjunction with alcohol. Quetiapine appears to be the most documented AA with street values bartered illicitly on the street. A recent report from the Drug Abuse Warning Network has shown a high prevalence of quetiapine-related emergency department visits involving MUA. Several other case studies have found that quetiapine causes seeking behaviors observed in substance use disorder. In fact, the majority of quetiapine MUA involved patients diagnosed with substance use disorder. In the absence of a definitive mechanism of action of quetiapine's reinforcing properties, it is imperative to gather robust evidence to support or refute increasing off-label use of AAs.

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“…1,7,12,14 While its mechanisms of action are unclear, the antihistaminic and anticholinergic effects of quetiapine offer a possible explanation for its misuse potential. 13 In most case reports, quetiapine misuse seems to be motivated by self-medication of insomnia, 7 anxiety, 5,7,11 or depressed mood 5 rather than obtaining euphoric or ''mindaltering'' 15 effects. However, misuse of quetiapine has yet to be systematically investigated in a larger sample.…”

Section: Characteristics Of Quetiapine Misuse Among Clients Of a Commmentioning

confidence: 99%

“…Past research suggests that individuals with an extensive substance use history are at an elevated risk for misusing sedative or anxiolytic medications, 16 which may increase risk for misusing quetiapine specifically. 13,17 Quetiapine has been reported to increase plasma concentrations of methadone, 18 suggesting another possible motive for its misuse among individuals receiving methadone treatment.…”

Section: Characteristics Of Quetiapine Misuse Among Clients Of a Commmentioning

confidence: 99%

Characteristics of Quetiapine Misuse Among Clients of a Community-Based Methadone Maintenance Program

McLarnon

Fulton

MacIsaac

et al. 2012

Journal of Clinical Psychopharmacology

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The role of antihistaminic effects in the misuse of quetiapine: A case report and review of the literature

Cited by 30 publications

References 34 publications

Evaluation of the Reinforcing Effect of Quetiapine, Alone and in Combination with Cocaine, in Rhesus Monkeys

Evaluation of the Reinforcing Effect of Quetiapine, Alone and in Combination with Cocaine, in Rhesus Monkeys

Quetiapine misuse and abuse: Is it an atypical paradigm of drug seeking behavior?

Characteristics of Quetiapine Misuse Among Clients of a Community-Based Methadone Maintenance Program

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