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

Pamela Chia

Pamela Chia

Division of Anaesthesiology and Perioperative Sciences, Singapore General Hospitaloutram, Singapore
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Chia, Pamela
, 
Lim Chuan Poh

Lim Chuan Poh

Department of Pharmacy, Singapore General Hospitaloutram, Singapore
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Chuan Poh, Lim
, 
John Ong

John Ong

  • Department of Medicine, National University of Singaporeoutram, Singapore
  • Department of Engineering, University of CambridgeCambridge, United Kingdom
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Ong, John
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Sharon Ong

Sharon Ong

  • Department of Surgical Intensive Care, Singapore General Hospitaloutram, Singapore
  • Department of Surgical Intensive Care, Sengkang General Hospitaloutram, Singapore
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Ong, Sharon
  
07 lis 2020
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Kategoria artykułu: Case Report
Data publikacji: 07 lis 2020
Zakres stron: 253 - 258
Otrzymano: 30 cze 2020
Przyjęty: 06 paź 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]
Język:
Angielski
Częstotliwość wydawania:
4 razy w roku
Dziedziny czasopisma:
Medycyna, Medycyna kliniczna, Medycyna wewnętrzna, Medycyna wewnętrzna, inne, Chirurgia, Chirurgia, inne, Anestezjologia, Medycyna ratunkowa i intensywna opieka medyczna
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