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Volume 22
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10.3390/ijms22126480
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Background:
Case Report

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

by
Céline K. Stäuble
1,2,3,*,
Markus L. Lampert
2,3,
Thorsten Mikoteit
4,
Martin Hatzinger
4,
Kurt E. Hersberger
2 and
Henriette E. Meyer zu Schwabedissen
1
1
Biopharmacy, Department of Pharmaceutical Sciences, University of Basel, 4056 Basel, Switzerland
2
Pharmaceutical Care, Department of Pharmaceutical Sciences, University of Basel, 4001 Basel, Switzerland
3
Institute of Hospital Pharmacy, Solothurner Spitäler, 4600 Olten, Switzerland
4
Psychiatric Services Solothurn, Solothurner Spitäler and Department of Medicine, University of Basel, 4503 Solothurn, Switzerland
*
Author to whom correspondence should be addressed.
Int. J. Mol. Sci. 2021, 22(12), 6480; https://doi.org/10.3390/ijms22126480
Submission received: 20 May 2021 / Revised: 11 June 2021 / Accepted: 14 June 2021 / Published: 17 June 2021
(This article belongs to the Special Issue Pharmacogenomics 2.0)
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Abstract

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.
Keywords: pharmacogenetics; pharmaceutical care; psychiatry; depression; neuroleptics; antipsychotics; quetiapine; CYP2D6; CYP3A4; adverse drug reaction pharmacogenetics; pharmaceutical care; psychiatry; depression; neuroleptics; antipsychotics; quetiapine; CYP2D6; CYP3A4; adverse drug reaction

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MDPI and ACS Style

Stäuble, C.K.; Lampert, M.L.; Mikoteit, T.; Hatzinger, M.; Hersberger, K.E.; Meyer zu Schwabedissen, H.E. Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report. Int. J. Mol. Sci. 2021, 22, 6480. https://doi.org/10.3390/ijms22126480

AMA Style

Stäuble CK, Lampert ML, Mikoteit T, Hatzinger M, Hersberger KE, Meyer zu Schwabedissen HE. Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report. International Journal of Molecular Sciences. 2021; 22(12):6480. https://doi.org/10.3390/ijms22126480

Chicago/Turabian Style

Stäuble, Céline K., Markus L. Lampert, Thorsten Mikoteit, Martin Hatzinger, Kurt E. Hersberger, and Henriette E. Meyer zu Schwabedissen. 2021. "Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report" International Journal of Molecular Sciences 22, no. 12: 6480. https://doi.org/10.3390/ijms22126480

APA Style

Stäuble, C. K., Lampert, M. L., Mikoteit, T., Hatzinger, M., Hersberger, K. E., & Meyer zu Schwabedissen, H. E. (2021). Severe Adverse Drug Reactions to Quetiapine in Two Patients Carrying CYP2D6*4 Variants: A Case Report. International Journal of Molecular Sciences, 22(12), 6480. https://doi.org/10.3390/ijms22126480

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