Skip to main content

Comparison of serum and whole blood concentrations in quetiapine overdose cases

Abstract

This study aimed to compare whole blood and serum concentrations of quetiapine in acute poisoning cases. Authentic whole blood and respective serum samples were routinely collected from patients diagnosed with blood poisoning at our University Hospital. Accordingly, whole blood and serum paired samples from nine patients (one male and eight female patients) were analyzed for quetiapine using liquid chromatography-mass spectrometry (LC–MS). Quetiapine concentrations in whole blood and serum samples ranged widely from 5.4 to 2780 ng/mL and 9.9 to 2500 ng/mL, respectively. The whole blood/serum concentration ratio was 0.5–1.1 and increased together with an increase in whole blood and serum quetiapine concentrations. The ratio was reversed at around 2500 ng/mL to > 1. Our findings suggest that whole blood concentrations are more useful than serum concentrations in diagnosing quetiapine poisonings.

This is a preview of subscription content, access via your institution.

Fig. 1

References

  1. Baselt RC (2017) Disposition of toxic drugs and chemicals in man, 11th edn. Biomedical Publications, Seal Beach, CA

    Google Scholar 

  2. Moffatt AC (1989) Clarke’s Isolation and Identification of Drugs, 2nd edn. Pharmaceutical Press, London

    Google Scholar 

  3. Saar E, Beyer J, Gerostamoulos D, Drummer OH (2012) The time-dependant post-mortem redistribution of antipsychotic drugs. Forensic Sci Int 222:223–227

    CAS  Article  Google Scholar 

  4. Launiainen T, Ojanperä I (2014) Drug concentrations in post-mortem femoral blood compared with therapeutic concentrations in plasma. Drug Test Anal 6:308–316. https://doi.org/10.1002/dta.1507

    CAS  Article  PubMed  Google Scholar 

  5. Uchimura T, Kato M, Saito T, Kinoshita H (2010) Prediction of human blood-to-plasma drug concentration ratio. Biopharm Drug Dispos 31:286–297. https://doi.org/10.1002/bdd.711

    CAS  Article  PubMed  Google Scholar 

  6. Urban AE, Cubała WJ (2017) Therapeutic drug monitoring of atypical antipsychotics. Psychiatr Pol 51:1059–1077. https://doi.org/10.12740/PP/65307

    Article  PubMed  Google Scholar 

  7. Winter HR, Earley WR, Hamer-Maansson JE, Davis PC, Smith MA (2008) Steady-state pharmacokinetic, safety, and tolerability profiles of quetiapine, norquetiapine, and other quetiapine metabolites in pediatric and adult patients with psychotic disorders. J Child Adolescent Psychopharmacol 18:81–98. https://doi.org/10.1089/cap.2007.0084

    Article  Google Scholar 

  8. Castberg I, Westin AA, Skogvoll E, Spigset O (2017) Effects of age and gender on the serum levels of clozapine, olanzapine, risperidone, and quetiapine. Acta Psychiatr Scand 136:455–464. https://doi.org/10.1111/acps.12794

    CAS  Article  PubMed  Google Scholar 

  9. Devane CL, Nemeroff CB (2001) Clinical pharmacokinetics of quetiapine: An atypical antipsychotic. Clin Pharmacokine 40:509–522. https://doi.org/10.2165/00003088-200140070-00003

    CAS  Article  Google Scholar 

  10. Grimm SW, Richtand NM, Winter HR, Stams KR, Reele SB (2006) Effects of cytochrome P450 3A modulators ketoconazole and carbamazepine on quetiapine pharmacokinetics. Br J Clin Pharmacol 61:58–69. https://doi.org/10.1111/j.1365-2125.2005.02507.x

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  11. Hughes RL (2019) Fatal combination of mitragynine and quetiapine – a case report with discussion of a potential herb-drug interaction. Forensic Sci Med Path 15:110–113. https://doi.org/10.1007/s12024-018-0049-9

    CAS  Article  Google Scholar 

  12. Prozialeck W, Jivan J, Andurkar S (2012) Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc 112:792–799. https://doi.org/10.7556/jaoa.2012.112.12.792

    Article  PubMed  Google Scholar 

  13. Langman LJ, Kaliciak HA, Carlyle S (2004) Fatal overdoses associated with quetiapine. J Anal Toxicol 28:520–525. https://doi.org/10.1093/jat/28.6.520

    CAS  Article  PubMed  Google Scholar 

  14. Skov L, Johansen SS, Linnet K (2015) Postmortem quetiapine reference concentrations in brain and blood. J Anal Toxicol 39:557–561. https://doi.org/10.1093/jat/bkv072

    CAS  Article  PubMed  Google Scholar 

  15. Tracy TS, Venkataramanan R, Glover DD, Caritis SN (2005) Temporal changes in drug metabolism (CYP1A2, CYP2D6 and CYP3A Activity) during pregnancy. Am J Obstet Gynecol 192:633–639. https://doi.org/10.1016/j.ajog.2004.08.030

    CAS  Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by JSPS KAKENHI Grant Numbers JP17K09278. The authors would like to thank Enago (www.enago.jp) for the English language review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Takeshi Saito.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest associated with this manuscript.

Ethical approval

This study was approved by the Ethics Committee of Tokai University School of Medicine, and informed consent was obtained from all patients prior to study participation (17R 028).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Saito, T., Tsuji, T., Namera, A. et al. Comparison of serum and whole blood concentrations in quetiapine overdose cases. Forensic Toxicol 40, 403–406 (2022). https://doi.org/10.1007/s11419-022-00618-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11419-022-00618-w

Keywords

  • Acute quetiapine poisoning
  • Therapeutic drug concentrations
  • Whole blood/serum concentration ratios
  • Diagnosis