Quetiapine Fluoxetine

Conventional antipsychotic drugs such as chlorpromazine and haloperidol have long been used in the treatment of acute mania. More recently, atypical antipsychotic drugs including aripiprazole, olanzapine, quetiapine, risperidone, and ziprasi-done have been approved for the treatment of bipolar mania or mixed mood episodes as monotherapy or in combination with mood-stabilizing drugs.25 Aripiprazole and olanzapine are also approved for maintenance therapy. The combination of olanzapine and fluoxetine is approved for treatment of bipolar depression. Quetiapine is approved for treatment of... 

Quetiapine 3A4 2D6, 2C9 Carbamazepine and phenytoin topiramate prednisolone. Fluvoxamine fluoxetine sertraline (high dose) CYP3A4 substrates grapefruit juice. 

Antidepressants tricyclics, fluoxetine, paroxetine, sertraline, mirtazepine, venlafaxine, mianserin Antipsychotics phenothiazines, haloperidol, clozapine, olanzapine, quetiapine... 

CypP450 3A3 /4 Antidepressants tricyclics, nefazodone, fluoxetine, fluvoxamine, citalopram, mirtazepine, venlafaxine Antipsychotics chlorpromazine, clozapine, pimozide, quetiapine, risperidone... 

Another group of mood-stabilizing drugs that are also anticonvulsant agents have become more widely used than lithium. These include carbamazepine and valproic acid for the treatment of acute mania and for prevention of its recurrence. Lamotrigine is approved for prevention of recurrence. Gabapentin, oxcarbazepine, and topiramate are sometimes used to treat bipolar disorder but are not approved by FDA for this indication. Aripiprazole, chlorpromazine, olanzapine, quetiapine, risperidone, and ziprasidone are approved by FDA for the treatment of manic phase of bipolar disorder. Olanzapine plus fluoxetine in combination and quetiapine are approved for the treatment of bipolar depression. 

The depressive phase of manic-depressive disorder often requires concurrent use of an antidepressant drug (see Chapter 30). Tricyclic antidepressant agents have been linked to precipitation of mania, with more rapid cycling of mood swings, although most patients do not show this effect. Selective serotonin reuptake inhibitors are less likely to induce mania but may have limited efficacy. Bupropion has shown some promise but—like tricyclic antidepressants—may induce mania at higher doses. As shown in recent controlled trials, the anticonvulsant lamotrigine is effective for many patients with bipolar depression. For some patients, however, one of the older monoamine oxidase inhibitors may be the antidepressant of choice. Quetiapine and the combination of olanzapine and fluoxetine has been approved for use in bipolar depression. 

Cyt 3A3/4 metabolizes clozapine, sertindole, quetiapine common substrates -tricyclic antidepressants, nefazodone, sertraline, carbamazepine, ethosuximide, terfenadine, benzodiazepines, diltiazem, nifedipine, verapamil, erythromycin, cyclosporine, lidocaine, quinidine, cisapride, paracetamol. Common inhibitors -nefazodone, fluvoxamine, fluoxetine, ketoconazole. 

After single-dose administration, the mean bioavailability of quetiapine is 9% with significant interindividual variation. If a CYP 3A4 inhibitor (e.g., cimetidine, ketoconazole, nefazodone, grapefruit juice, or erythromycin) is added to quetiapine, increased side effects (e.g., sedation or orthostasis) may occur. Fluoxetine may also decrease clearance of a medication such as quetiapine metabolized through CYP 3A4. However, with fluoxetine, it is the long-acting metabolite norfluoxetine, and not fluoxetine, that is the primary inhibitor of 3 A4 metabolism. If an enzyme inducer such as carbamazepine or St. lohn s wort is added to quetiapine, then decreased antipsychotic effects may occur. ... 

Fluoxetine (Prozac) PHENOTHIAZINES Risperidone, Aripiprazole Clozapine, Quetiapine, Ziprasidone ... 

Quetiapine dose not appear to interact to a clinically relevant extent with cimetidine, fluoxetine, imipramine or lorazepam. Isolated cases of adverse outcomes have been reported with diphenhydramine, iovastatin and mirtazapine. 

Fluoxetine 60 mg daily or imipramine 75 mg twice daily for 5 days had no clinically significant effect on the steady-state plasma levels of quetiapine 300 mg twice daily. No special precautions would therefore appear to be necessary if either of these drugs and quetiapine are used concurrently. 

Po in SG, Thyrum FT, Alva G, Carreon D, Yeh C, Kalali TV Arvanitis LA Effect of fluoxetine and imipramine on the pharmacokinetics and tolerability of die antipsychotic quetiapine. J Clin Psychopharmacol (2002) 22,174-82. 

Thieme, D. Sachs, H. Improved screening capabilities in forensic toxicology by application of liquid chromatography-tandem mass spectrometry, Anal.ChimActa, 2003, 492, 171-186. [hair LC-MS alprazolam dothiepin piritramide cocaine lorazepam lormetazepam clonazepam flimitrazepam bromazepam midazolam flurazepam nitrazepam temazepam medazepam nordazepam diazepam methylclonazepam triazolam oxazepam haloperidol benperidol sulpiride amisulpride mirtazapine citalopram olanzapine paroxetine fluoxetine sertraline zopiclone zolpidem risperidone quetiapine fentanyl pipamperone meperidine buprenorphine propoxyphene pentazocine phenazocine EDDP ... 

Endocrine A case of a 16-year-old female presenting with galactorrhoea and normal prolactin levels 3 days after being switched from fluoxetine and ziprasidone to fluoxetine and quetiapine is reported [219 ]. Another case of a 45-year-old female who developed euprolactin galactorrhoea after 2 months treatment with quetiapine is reported [220 ]. 

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