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Seroquel (Quetiapine) Abuse

NEW YORK STATE OFFICE OF ALCOHOLISM AND SUBTANCE ABUSE SERVICES
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Addiction Medicine FYI

Seroquel (Quetiapine) Abuse

Quetiapine which is marketed by AstraZeneca as Seroquel has been approved for the treatment of schizophrenia and acute episodes of bipolar disorder. It has also been used as an augmentor for the maintenance treatment of depression.

The common side effects include: sluggishness, fatigue, dry mouth, sore throat, dizziness, abdominal pain, constipation, upset stomach, sudden drop in blood pressure upon standing, inflammation or swelling of the sinuses or pharynx, increased appetite, and weight gain. However, it is the most common side effect - somnolence (the state of near sleep) - that has caused most of the misuse of this medication.

Quetiapine is not a controlled substance, though reports have emerged of misuse through the crushing and snorting of tablets, to the use of this medication intravenously either alone or in combination with cocaine. The combined use has been referred to as a “Q-Ball”. Other names that have been used for the medication alone are: “quell”, “snoozeberries”, and “Susie-Q”.

Misuse has also been reported in some jail and prison systems where psychotic symptoms were faked in an attempt to obtain this medication. Olanzapine (Zyprexa) has also been reported being sought for its sedative qualities.

Some facts to consider with normal use of Quetiapine:

  • It is important to also be aware of false positive urine drug screens for methadone when quetiapine is used. Quetiapine is extensively metabolized by the cytochrome P450 3A4 isoenzyme, resulting in 2 major metabolites (sulfoxide and the carboxylic acid parent metabolite). Of a given dose, 73 percent is metabolized and excreted in the urine. Therefore, it is postulated that these renally excreted metabolites could be structurally similar enough to the tertiary structure of methadone to induce a cross-reactivity-related artifact in the methadone urine drug screen.
  • Risk of Suicidality: A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants ('mood elevators') such as quetiapine during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant. Children younger than 18 years of age should not normally take quetiapine, but in some cases, a doctor may decide that quetiapine is the best medication to treat a child's condition (PubMed Health - U.S. National Library of Medicine, National Institutes of Health – March 2010)
  • No matter what your age, before you take an antidepressant, you should talk to your doctor about the risks and benefits of treating your condition with an antidepressant or with other treatments. You should also talk about the risks and benefits of not treating your condition. Talk to your doctor about your condition, symptoms, and personal and family medical history (including history of substance use disorders). You and your doctor will decide what type of treatment is right for you.

Taking medications as prescribed by doctors is a lot different than self medicating with alcohol and drugs to suppress feelings or avoid reality. However, it is important to remember that many patients with alcohol dependence or substance use disorders may react differently to medication; whether it's a prescribed medication, an illegal street drug, or an over the counter medicine.

2/2011

Note: NYS OASAS in partnership with NYS DOH will be convening a workgroup to look at responsible medication prescribing with the plan to issue guidelines and regulatory suggestions.