The Misuse of Quetiapine

A lot of medication gets misused, as is the right expression, meaning not used for the intention or indication it was developed for in the first place. This reminded me of one of my first publications on the abuse of anticholinergics.

From case reports it appears that quetiapine is sought after for recreational use and inappropriate use such as intranasal and intravenous administration. Quetiapine is also for sale on the street, symptom malingering to obtain the drug and higher dosage requests. It’s always important to recognize such misuse of medication because in the case of quetiapine it can induce weight gain, glucose intolerance, in rare cases movement disorders. Moreover, these drugs are very expensive and will cost society more money when misused.

In a recent publication a case report and a review of previous case reports is discussed. The patients mostly seek the “dreamy”, calming, or soporific state with quetiapine. Most patients had a prior drug or alcohol problem and the misuse was often connected to a forensic setting.

Moreover, the authors present possible mechanism as explanation for it’s misuse. First it has an anticholinergic activity which has been described previously with other drugs as cause for misuse. Anticholinergic agents usually cause an euphoric and stimulatory state in patients which doesn’t match with the accounts of patients misusing quetiapine. The authors suggest that the antihistaminic property of questiapine is responsible for it’s misuse.

The misuse potential of quetiapine is likely related to its histaminic blockade coupled with its comparatively mild action at dopamine receptors. Accordingly, quetiapine substitutes for sedating agents and individuals with a history of alcohol, benzodiazepine, or opiate abuse are particularly at risk.

Fischer, B., & Boggs, D. (2010). The role of antihistaminic effects in the misuse of quetiapine: A case report and review of the literature Neuroscience & Biobehavioral Reviews, 34 (4), 555-558 DOI: 10.1016/j.neubiorev.2009.11.003