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Cardiopulmonary Arrest Following a Single 25 mg Dose of Quetiapine: A Case Report

Pamela Chia
Pamela Chia
, 
Lim Chuan Poh
Lim Chuan Poh
, 
John Ong
John Ong
 e 
Sharon Ong
Sharon Ong
   | 07 nov 2020
The Journal of Critical Care Medicine's Cover Image
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Article Category: Case Report
Pubblicato online: 07 nov 2020
Pagine: 253 - 258
Ricevuto: 30 giu 2020
Accettato: 06 ott 2020
DOI: https://doi.org/10.2478/jccm-2020-0035
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© 2020 Pamela Chia, Lim Chuan Poh, John Ong, Sharon Ong, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Drugs used for ICU Delirium

HaloperidolQuetiapineDexmedetomidineOlanzapine
Mechanism of actionNonselective blockade of postsynaptic dopaminergic D2 receptors in the brain [9]Antagonism of serotonin 5-HT2 and dopamine D2 receptors [9]Selective α2- adrenergic receptor agonist [9]Potent antagonist of serotonin 5-HT2A and 5-HT2C, histamine H1, dopamine D1-4, and alpha1-adrenergic receptors. Moderate antagonist of muscarinic M1-5, and 5-HT3 receptors [9]
Half lifeDecanoate: 21 days Lactate: 20 hours (Intramuscular (IM)) 14-26 hours (IV) 14-37 hours (oral) [9]6 hours [10]Up to 3 hours, significantly prolonged with severe hepatic impairment [9]Oral and IM: 30 hours; approximately 1.5 times greater in elderly [9]
MetabolismMainly hepatic metabolism to inactive metabolites [9]Metabolised by liver to active metabolites with low activity levels [10]Hepatic metabolism [9]Mainly hepatic metabolism with 40% removed via first pass metabolism [9]
Effect with hepatic impairmentNo dosage adjustment needed but concentration may increase in patients with hepatic impairment [9]Higher plasma levels are expected in the hepatically impaired population, and dosage adjustment may be needed [11]No dosage adjustment recommended but consider dose reduction in patients with hepatic impairment [9]No dosage adjustment needed. Use with caution in patients with hepatic impairment [9]
Effect with renal impairmentNo dosage adjustment needed [9]Renal insufficiency does not need dosage adjustments. However, in severe renal impairment, alterations in protein binding of quetiapine may affect its pharmacokinetics [10,11]No dosage adjustment needed [9]No dosage adjustment needed [9]
Peak concentrationDecanoate: 6 days Lactate: 20 minutes (IM) 2-6 hours (oral) [9]1-2h [10]IV loading dose: 15-30 minutes [9]Short acting injection: 15-45 minutes Extended release injection: ~7 days Oral: ~6 hours [9]
AdvantagesLow treatment cost [9]Low risk of EPS (extrapyramidal symptoms) and QTc prolongation compared to typical antipsychotics [1,7]Analgesia and sedation with minimal respiratory depression [12]No QTc prolongation [13]
Side effectsQTc prolongation, drowsiness, hypotension and EPS [9]Somnolence, orthostatic hypotension, and tachycardia [9]Bradycardia, hypotension [9]Orthostatic hypotension, EPS, weight gain, drowsiness, transaminitis [9]
eISSN:
2393-1817
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Internal Medicine, other, Surgery, Anaesthesiology, Emergency Medicine and Intensive-Care Medicine
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