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Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome?

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Quetiapine and other antipsychotics combined with opioids in legal autopsy cases : A random finding or cause of fatal outcome? / Andersen, Freja Drost; Simonsen, Ulf; Andersen, Charlotte Uggerhøj.

I: Basic and Clinical Pharmacology and Toxicology, Bind 128, Nr. 1, 01.2021, s. 66-79.

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avisReviewForskningpeer review

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@article{cf7da59b63104575a59e0745791b26a7,
title = "Quetiapine and other antipsychotics combined with opioids in legal autopsy cases: A random finding or cause of fatal outcome?",
abstract = "Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk of fatal opioid poisoning by enhancing sedation, respiratory depression, hypotension and QT prolongation. We systematically searched for studies of acute toxicity of quetiapine or other antipsychotics combined with morphine or methadone. Case reports describing toxicity of quetiapine combined with morphine or methadone were also included. We retrieved one human study that observed pharmacokinetic interaction between quetiapine and methadone, and 16 other human studies. Fourteen investigated the combination of droperidol and morphine in treatment doses, and some indicated an additive sedative effect. Five animal studies with acepromazine in combination with morphine or methadone were located and indicated an additive effect on sedation and hypotension. Six forensic case reports in which death could have been caused solely by quetiapine, the opioid, or other drugs were found. Thus, acute toxicity of quetiapine combined with morphine or methadone has not been studied. Because of quetiapine's effects on alpha-adrenoceptors, muscarinic and histamine receptors, human ether-a-go-go-channels and methadone kinetics, we suggest further research to clarify if the indicated additive effects of opioids and droperidol or acepromazine are also true for quetiapine.",
keywords = "antipsychotics, drug addicts, forensic, opioids, pharmacology, PATIENT-CONTROLLED ANALGESIA, MORPHINE, LOW-DOSE METHADONE, QT INTERVAL, POSTOPERATIVE NAUSEA, PAIN-CONTROL, DROPERIDOL, SEDATION, DOUBLE-BLIND, POSTMORTEM QUETIAPINE",
author = "Andersen, {Freja Drost} and Ulf Simonsen and Andersen, {Charlotte Uggerh{\o}j}",
note = "{\textcopyright} 2020 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).",
year = "2021",
month = jan,
doi = "10.1111/bcpt.13480",
language = "English",
volume = "128",
pages = "66--79",
journal = "Basic & Clinical Pharmacology & Toxicology",
issn = "1742-7843",
publisher = "Wiley-Blackwell Publishing Ltd.",
number = "1",

}

RIS

TY - JOUR

T1 - Quetiapine and other antipsychotics combined with opioids in legal autopsy cases

T2 - A random finding or cause of fatal outcome?

AU - Andersen, Freja Drost

AU - Simonsen, Ulf

AU - Andersen, Charlotte Uggerhøj

N1 - © 2020 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

PY - 2021/1

Y1 - 2021/1

N2 - Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk of fatal opioid poisoning by enhancing sedation, respiratory depression, hypotension and QT prolongation. We systematically searched for studies of acute toxicity of quetiapine or other antipsychotics combined with morphine or methadone. Case reports describing toxicity of quetiapine combined with morphine or methadone were also included. We retrieved one human study that observed pharmacokinetic interaction between quetiapine and methadone, and 16 other human studies. Fourteen investigated the combination of droperidol and morphine in treatment doses, and some indicated an additive sedative effect. Five animal studies with acepromazine in combination with morphine or methadone were located and indicated an additive effect on sedation and hypotension. Six forensic case reports in which death could have been caused solely by quetiapine, the opioid, or other drugs were found. Thus, acute toxicity of quetiapine combined with morphine or methadone has not been studied. Because of quetiapine's effects on alpha-adrenoceptors, muscarinic and histamine receptors, human ether-a-go-go-channels and methadone kinetics, we suggest further research to clarify if the indicated additive effects of opioids and droperidol or acepromazine are also true for quetiapine.

AB - Opioid poisoning is a frequent cause of death in drug addicts and occurs with opioid treatment. Quetiapine is often found in forensic autopsies and may increase the risk of fatal opioid poisoning by enhancing sedation, respiratory depression, hypotension and QT prolongation. We systematically searched for studies of acute toxicity of quetiapine or other antipsychotics combined with morphine or methadone. Case reports describing toxicity of quetiapine combined with morphine or methadone were also included. We retrieved one human study that observed pharmacokinetic interaction between quetiapine and methadone, and 16 other human studies. Fourteen investigated the combination of droperidol and morphine in treatment doses, and some indicated an additive sedative effect. Five animal studies with acepromazine in combination with morphine or methadone were located and indicated an additive effect on sedation and hypotension. Six forensic case reports in which death could have been caused solely by quetiapine, the opioid, or other drugs were found. Thus, acute toxicity of quetiapine combined with morphine or methadone has not been studied. Because of quetiapine's effects on alpha-adrenoceptors, muscarinic and histamine receptors, human ether-a-go-go-channels and methadone kinetics, we suggest further research to clarify if the indicated additive effects of opioids and droperidol or acepromazine are also true for quetiapine.

KW - antipsychotics

KW - drug addicts

KW - forensic

KW - opioids

KW - pharmacology

KW - PATIENT-CONTROLLED ANALGESIA

KW - MORPHINE

KW - LOW-DOSE METHADONE

KW - QT INTERVAL

KW - POSTOPERATIVE NAUSEA

KW - PAIN-CONTROL

KW - DROPERIDOL

KW - SEDATION

KW - DOUBLE-BLIND

KW - POSTMORTEM QUETIAPINE

U2 - 10.1111/bcpt.13480

DO - 10.1111/bcpt.13480

M3 - Review

C2 - 33245632

AN - SCOPUS:85090216460

VL - 128

SP - 66

EP - 79

JO - Basic & Clinical Pharmacology & Toxicology

JF - Basic & Clinical Pharmacology & Toxicology

SN - 1742-7843

IS - 1

ER -