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Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report

We report two cases of patients who developed severe adverse drug reactions including persistent movement disorders, nausea, and vertigo during treatment with quetiapine at maximum daily doses ranging between 300 and 400 mg. The extensive hepatic metabolism of quetiapine is mainly attributed to cyto...

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Autores principales: Stäuble, Céline K., Lampert, Markus L., Mikoteit, Thorsten, Hatzinger, Martin, Hersberger, Kurt E., Meyer zu Schwabedissen, Henriette E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233787/
https://www.ncbi.nlm.nih.gov/pubmed/34204223
http://dx.doi.org/10.3390/ijms22126480
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author Stäuble, Céline K.
Lampert, Markus L.
Mikoteit, Thorsten
Hatzinger, Martin
Hersberger, Kurt E.
Meyer zu Schwabedissen, Henriette E.
author_facet Stäuble, Céline K.
Lampert, Markus L.
Mikoteit, Thorsten
Hatzinger, Martin
Hersberger, Kurt E.
Meyer zu Schwabedissen, Henriette E.
author_sort Stäuble, Céline K.
collection PubMed
description We report two cases of patients who developed severe adverse drug reactions including persistent movement disorders, nausea, and vertigo during treatment with quetiapine at maximum daily doses ranging between 300 and 400 mg. The extensive hepatic metabolism of quetiapine is mainly attributed to cytochrome P450 3A4 (CYP3A4). However, there is recent evidence supporting the idea of CYP2D6 playing a role in the clearance of the quetiapine active metabolite norquetiapine. Interestingly, both patients we are reporting of are carriers of the CYP2D6*4 variant, predicting an intermediate metabolizer phenotype. Additionally, co-medication with a known CYP2D6 inhibitor and renal impairment might have further affected quetiapine pharmacokinetics. The herein reported cases could spark a discussion on the potential impact of a patient’s pharmacogenetic predisposition in the treatment with quetiapine. However, further studies are warranted to promote the adoption of pharmacogenetic testing for the prevention of drug-induced toxicities associated with quetiapine.
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spelling pubmed-82337872021-06-27 Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report Stäuble, Céline K. Lampert, Markus L. Mikoteit, Thorsten Hatzinger, Martin Hersberger, Kurt E. Meyer zu Schwabedissen, Henriette E. Int J Mol Sci Case Report We report two cases of patients who developed severe adverse drug reactions including persistent movement disorders, nausea, and vertigo during treatment with quetiapine at maximum daily doses ranging between 300 and 400 mg. The extensive hepatic metabolism of quetiapine is mainly attributed to cytochrome P450 3A4 (CYP3A4). However, there is recent evidence supporting the idea of CYP2D6 playing a role in the clearance of the quetiapine active metabolite norquetiapine. Interestingly, both patients we are reporting of are carriers of the CYP2D6*4 variant, predicting an intermediate metabolizer phenotype. Additionally, co-medication with a known CYP2D6 inhibitor and renal impairment might have further affected quetiapine pharmacokinetics. The herein reported cases could spark a discussion on the potential impact of a patient’s pharmacogenetic predisposition in the treatment with quetiapine. However, further studies are warranted to promote the adoption of pharmacogenetic testing for the prevention of drug-induced toxicities associated with quetiapine. MDPI 2021-06-17 /pmc/articles/PMC8233787/ /pubmed/34204223 http://dx.doi.org/10.3390/ijms22126480 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Stäuble, Céline K.
Lampert, Markus L.
Mikoteit, Thorsten
Hatzinger, Martin
Hersberger, Kurt E.
Meyer zu Schwabedissen, Henriette E.
Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report
title Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report
title_full Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report
title_fullStr Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report
title_full_unstemmed Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report
title_short Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report
title_sort severe adverse drug reactions to quetiapine in two patients carrying cyp2d6*4 variants: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233787/
https://www.ncbi.nlm.nih.gov/pubmed/34204223
http://dx.doi.org/10.3390/ijms22126480
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