Abstract
Among atypical antipsychotics, quetiapine is commonly prescribed and considered to have a favorable side effect and safety profile. Here, we report the case of a patient who developed a generalized tonic-clonic seizure 28 hours following ingestion of 1,400 mg of quetiapine. Review of the literature identifies delayed-onset seizure as a potential complication of quetiapine overdose. Unique to this case, delayed-onset seizures occurred in a patient with a relatively low dose of quetiapine and no obvious toxidrome, suggesting that this reaction may be an important consideration in the management of quetiapine overdose. The pharmacokinetics and pharmacodynamics of quetiapine may explain this unusual phenomenon.
Highlights
Quetiapine is an atypical antipsychotic that possesses low to moderate antagonist activity at multiple neurotransmitter receptors, including serotonergic 5-hydroxytryptamine (5HT2A) receptors, dopaminergic (D1 and D2) receptors, histaminergic (H1) receptors, and adrenergic α1 and α2 receptors, and partial agonism at 5-HT1A receptors [1]
Quetiapine has become widely used for a variety of indications because of its favorable side effect and safety profile, notably with decreased incidence of extrapyramidal symptoms compared to other antipsychotics
Delayed or late-onset seizure is a rare complication of quetiapine overdose and has been reported in two previous case studies
Summary
Quetiapine is an atypical antipsychotic that possesses low to moderate antagonist activity at multiple neurotransmitter receptors, including serotonergic 5-hydroxytryptamine (5HT2A) receptors, dopaminergic (D1 and D2) receptors, histaminergic (H1) receptors, and adrenergic α1 and α2 receptors, and partial agonism at 5-HT1A receptors [1]. Quetiapine has become widely used for a variety of indications because of its favorable side effect and safety profile, notably with decreased incidence of extrapyramidal symptoms compared to other antipsychotics. Patients with an acute overdose of quetiapine may demonstrate central nervous system depression, sinus tachycardia, prolonged QTc interval, hypotension, coma, and seizures [2,3,4]. We report a case of quetiapine overdose accompanied by a delayed-onset seizure, a rare and poorly understood complication
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