Quetiapine

Quetiapine
Systematic (IUPAC) name
2-(2-(4-dibenzo[b,f][1,4]thiazepine- 11-yl- 1-piperazinyl)ethoxy)ethanol
Clinical data
Trade names Seroquel
AHFS/Drugs.com monograph
MedlinePlus a698019
Pregnancy cat. C(US)
Legal status -only (US)
Routes Oral
Pharmacokinetic data
Bioavailability 9%
Metabolism Hepatic
Half-life 6 hours
Excretion Renal
Identifiers
CAS number 111974-69-7 Y
ATC code N05AH04
PubChem CID 5002
IUPHAR ligand 50
DrugBank DB01224
ChemSpider 4827 Y
UNII BGL0JSY5SI Y
KEGG D08456 Y
ChEBI CHEBI:8707 Y
ChEMBL CHEMBL716 Y
Chemical data
Formula C21H25N3O2S 
Mol. mass 383.5099 g/mol
SMILES eMolecules & PubChem
 Y(what is this?)  (verify)

Quetiapine ( /kwɨˈt.əpn/ kwi-ty-ə-peen) (branded as Seroquel, Ketipinor), is an atypical antipsychotic approved for the treatment of schizophrenia, and bipolar disorder.

Annual sales are approximately $5.7 billion worldwide, and $2.9 billion in the United States.[1] The U.S. patent,[2] which was set to expire in 2011, received a pediatric exclusivity extension which pushed its expiration to March 26, 2012.[3] The patent has already expired in Canada. There are now several generic versions of quetiapine, such as Quepin.[4]

Contents

Medical uses

Quetiapine is used to treat either schizophrenia or bipolar disorder.[5]

Schizophrenia

It is debatable whether, as a class, typical or atypical antipsychotics are better.[6] Both have equal drop-out and symptom relapse rates when typicals are used at low to moderate dosages.[7]

Bipolar

In those with bipolar it is used for depressive episodes, acute manic episodes associated with bipolar I disorder (as either monotherapy or adjunct therapy to lithium, valproate or lamotrigine), and maintenance treatment of bipolar I disorder (as adjunct therapy to lithium or divalproex).[8]

Alzheimer's

Quetiapine is ineffective in reducing agitation among people with Alzheimer's, whose usage of the drug once constituted 29% of sales. Quetiapine worsens cognitive functioning in the elderly with dementia[9] and thus is not recommended.

Other

It is sometimes used off-label, often as an augmentation agent, to treat conditions such as obsessive-compulsive disorder, post-traumatic stress disorder, autism, alcoholism, Borderline Personality Disorder, depression,[10] Tourette syndrome,[11] and has been used by physicians as a sedative for those with sleep disorders or anxiety disorders.[12]

Adverse effects

The most common side-effect of quetiapine is somnolence. Other common side-effects include: sluggishness, fatigue, dry mouth, sore throat, dizziness, abdominal pain, constipation, upset stomach, orthostatic hypotension, inflammation or swelling of the sinuses or pharynx, increased appetite, and weight gain.[13]

It is marketed as one of the most sedating of all anti-psychotics, although those claims are contested.[14] Beginning users may feel extremely tired and 'out of it' for the first few days, and sometimes longer. Quetiapine's newest indication, for bipolar depression, usually specifically calls for the entire dose to be taken before bedtime due to its sedative effects. The sedative effects may disappear after some time on the drug, or with a change of dosage, and with possibly different, non-sedative side-effects emerging.

Both typical and atypical antipsychotics can cause tardive dyskinesia.[15] According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.[15] Although Quetiapine and Clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.[16]

Weight gain can be a problem for some patients. Quetiapine has been found to cause more weight gain than fluphenazine, haloperidol, loxapine, molindone, olanzapine, pimozide, risperidone, thioridazine, thiothixene, trifluoperazine, and ziprasidone, but less than chlorpromazine, clozapine, perphenazine, and sertindole when calculated according to a fixed effects model.[17]

Studies conducted on beagles have resulted in the formation of cataracts. While there are reports of cataracts occurring in humans, controlled studies including thousands of patients have not demonstrated a clear causal association between quetiapine therapy and this side-effect. However, the Seroquel website[18] still recommends users have eye examinations every six months.

As with some other anti-psychotics, quetiapine may lower the seizure threshold[19], and should be taken with caution in combination with drugs such as bupropion.

A recent comparative study of anti-psychotics drugs has found that quetiapine mono treatment was associated with increased risk of death relative to the other analyzed treatments.[20]

Discontinuation

Quetiapine should be discontinued gradually to avoid withdrawal symptoms or relapse.

The British National Formulary recommends a gradual withdrawal when discontinuing anti-psychotic treatment to avoid acute withdrawal syndrome or rapid relapse.[21] Due to compensatory changes at dopamine, serotonin, adrenergic and histamine receptor sites in the central nervous system, withdrawal symptoms can occur during abrupt or over-rapid reduction in dosage. Withdrawal symptoms reported to occur after discontinuation of quetiapine include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostasis, tachycardia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety. The present evidence suggests that these symptoms affect a small number of susceptible individuals treated with Quetiapine.[22][23]

Overdosage

Most instances of acute overdosage result only in sedation, hypotension and tachycardia, but cardiac arrythmia, coma and death have occurred in adults. Serum or plasma quetiapine concentrations are usually in the 1–10 mg/L range in overdose survivors, while postmortem blood levels of 10–25 mg/L are generally observed in fatal cases.[24]

Pharmacology

Comparison of affinities (Ki, nM)[25]
Receptor Quetiapine Norquetiapine
D1 428 99.8
D2 626 489
5-HT1A 1040 191
5-HT2A 38 2.9
α1B 14.6 46.4
α2 617 1290
H1 4.41 1.15
M1 1086 38.3
NET >10000 34.8

Quetiapine has the following pharmacological actions:[26][27][28][29]

This means Quetiapine is a dopamine, serotonin, and adrenergic antagonist, and a potent antihistamine with clinically negligible anticholinergic properties. Quetiapine binds strongly to serotonin receptors. Serial PET scans evaluating the D2 receptor occupancy of quetiapine have demonstrated that quetiapine very rapidly disassociates from the D2 receptor.[30] Theoretically, this allows for normal physiological surges of dopamine to elicit normal effects in areas such as the nigrostriatal and tuberoinfundibular pathways, thus minimizing the risk of side-effects such as pseudo-parkinsonism as well as elevations in prolactin.[31] Some of the antagonized receptors (serotonin, norepinephrine) are actually autoreceptors whose blockade tends to increase the release of neurotransmitters.

Norquetiapine is the active metabolite of quetiapine. It has most of the effects of quetiapine with similar potencies, and is also a potent norepinephrine reuptake inhibitor and muscarinic antagonist. Note that the data below is from another source (the official prescribing info for Seroquel), and the measure is different from the above (Ki vs. IC50). There are still order-of-magnitude discrepancies for D1, α1, H1 and M1.

Synthesis

Warawa, E. J.; Migler, B. M.; 1988, U.S. Patent 4,879,288.

Dosage

At very low doses quetiapine acts primarily as a histamine receptor blocker (antihistamine) and α1-adrenergic blocker. When the dose is increased quetiapine activates the adrenergic system and binds strongly to serotonin receptors and autoreceptors. At high doses quetiapine starts blocking significant amounts of dopamine receptors.[32][33] Use of low-dose quetiapine is not recommended except temporarily during drug titration period (less than 30 days).[34]

Due to compensatory changes at dopamine, serotonin, adrenergic and histamine receptor sites in the central nervous system, a gradual reduction in dosage is recommended to minimise or avoid withdrawal symptoms. Withdrawal symptoms reported to occur after discontinuation of quetiapine include: insomnia, nausea, emesis, lightheadedness, diaphoresis, orthostasis, tachycardia, as well as nervousness, dizziness, headache, and anxiety. The present evidence suggests that these symptoms affect a small number of susceptible individuals treated with quetiapine.[22]

The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotic treatment to avoid acute withdrawal syndrome or rapid relapse.[21]

Sustained-release

AstraZeneca submitted a new drug application for a sustained-release version of quetiapine in the United States, Canada, and the European Union in the second half of 2006 for treatment of schizophrenia.[35][36] AstraZeneca will retain the exclusive right to market sustained release quetiapine until 2017. The sustained-release quetiapine is marketed mainly as Seroquel XR. Other marketing names are Seroquel Prolong and Seroquel Depot.

On May 18, 2007, AstraZeneca announced that the FDA approved Seroquel XR for acute treatment of schizophrenia.[37] During its 2007 Q2 earnings conference, AstraZeneca announced plans to launch Seroquel XR in the U.S. during August 2007.[38] However, Seroquel XR has only become available in U.S. pharmacies after the FDA approved Seroquel XR for use as maintenance treatment for schizophrenia, in addition to acute treatment of the illness, on November 16, 2007.[39] The company has not provided a reason for the delay of Seroquel XR's launch.

Health Canada approved sale of Seroquel XR on September 27, 2007.[40]

The FDA approved Seroquel XR for the treatment of bipolar depression and bipolar mania in early October, 2008. According to AstraZeneca, Seroquel XR is "the first medication approved by the FDA for the once-daily acute treatment of both depressive and manic episodes associated with bipolar."

On July 31, 2008, Handa Pharmaceuticals, based in Fremont, California, announced that its abbreviated new drug application (“ANDA”) for quetiapine fumarate extended-release tablets, the generic version of AstraZeneca’s SEROQUEL XR, has been accepted by the FDA.

On December 1, 2008, Biovail announced that the FDA had accepted the company's ANDA to market its own version of sustained-release quetiapine.[41] Biovail's sustained-release tablets will compete with AstraZeneca's Seroquel XR.

On December 24, 2008, AstraZeneca notified shareholders that the FDA had asked for additional information on the company's application to expand the use of sustained-release quetiapine for treatment of depression.[42]

Society and culture

Legal status

Quetiapine received its initial indication from the U.S. Food and Drug Administration for treatment of schizophrenia in 1997.[43] In 2004, it received its second indication for the treatment of mania-associated bipolar disorder.[44] In 2007 and 2008, studies were conducted on quetiapine’s efficacy in treating generalized anxiety disorder and major depression. In April 2009, the Psychopharmacologic Drugs Advisory Committee of the US Food and Drug Administration (FDA) held a public meeting to discuss whether study results supported the FDA's approval for anxiety and depression, with risks of metabolic side-effects and of tardive dyskinesia and sudden cardiac death.[45]

Controversy

AstraZeneca has been sued by the U.S. government over the marketing of quetiapine. A $520 million settlement was reached on October 29, 2009.[46]

Several American soldiers and veterans have died while taking Seroquel for PTSD.[47]

Multiple lawsuits have been filed in relation to quetiapine's side-effects, in particular, diabetes.[48][49][50][51]

In Australia, Professor Patrick McGorry, a key mental health adviser proposed a trial in Melbourne in 2011. It was to investigate whether Seroquel would decrease or delay the risk of people aged between 15 and 40 with early signs of mental illness, developing a later psychotic disorder. However in July 2011 psychiatrists, psychologists and researchers from Australia, New Zealand, Canada, Britain and the US lodged a complaint with the ethics committee of Melbourne Health. They opposed the trial[52] as "unethical" and "dangerous".

Recreational use

Quetiapine is not classified as a controlled substance, "abusive self-administration seems to be driven by quetiapine’s sedative and anxiolytic effects (to help with sleep or to 'calm down') rather than by its antipsychotic properties."[53] Reports of quetiapine abuse have emerged in the medical literature, however, while the drug is usually abused through the crushing and snorting of tablets (insufflation), there have also been reports of intravenous abuse and intravenous co-administration with cocaine.[54] This is commonly referred to as a "Q-Ball".[54] A 2004 letter to the editor of the American Journal of Psychiatry provided an anecdotal estimate that up to 30% of inmates who were seen for psychiatric services in the Los Angeles County Jail were faking psychotic symptoms in an attempt to obtain quetiapine.[55] Also known as "quell", "Snoozeberries", or "Susie-Q", the drug may be more commonly abused in prisons due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances. A letter to the editor that appeared in the January 2007 American Journal of Psychiatry has proposed a “need for additional studies to explore the addiction-potential of quetiapine”. The letter reports that its authors are physicians who work in the Ohio correctional system. They report that “prisoners ... have threatened legal action and even suicide when presented with discontinuation of quetiapine” and that they have “not seen similar drug-seeking behavior with other second-generation antipsychotics of comparable efficacy”. It has also been reported that when Seroquel is used with methadone it causes the user to experience a buzz, or opioid euphoria.[56]

Date rape

Quetiapine has sometimes been used as a date rape drug, causing persons to lose consciousness before a sexual attack, especially when coadministered with alcohol.[57][58]

Nurofen plus error

In August 2011 The UKs Medicines and Healthcare Regulatory Agency (MHRA) issued a class 4 drug alert following reports that some batches of Nurofen plus contained Seroquel XL instead.[59]

Following the issue of the Class 4 Drug Alert, Reckitt Benckiser (UK) Ltd received further reports of rogue blister strips in cartons of two additional batches of Nurofen Plus tablets. One of the new batches contained Seroquel XL 50 mg tablets and one contained the Pfizer product Neurontin 100 mg capsules.

Following discussions with the MHRA's Defective Medicines Report Centre (DMRC), Reckitt Benckiser (UK) Ltd decided to recall all remaining unexpired stock of Nurofen Plus tablets in any pack size leading to a Class 1 Drug Alert.[60]

References

  1. ^ Details for Seroquel
  2. ^ Patent Document, U.S. Patent and Trademark Office
  3. ^ Seroquel patent expiration
  4. ^ "Quepin Full Prescribing Information in Drug Reference Encyclopedia". http://www.theodora.com/drugs/quepin_tablets_specifar.html. Retrieved 2010-04-03. 
  5. ^ "quetiapine-fumarate". The American Society of Health-System Pharmacists. http://www.drugs.com/monograph/quetiapine-fumarate.html. Retrieved 3 April 2011. 
  6. ^ Kane JM, Correll CU. Pharmacologic treatment of schizophrenia. Dialogues Clin Neurosci. 2010;12(3):345–57. PMID 20954430.
  7. ^ Schultz SH, North SW, Shields CG. Schizophrenia: a review. Am Fam Physician. 2007;75(12):1821–9. PMID 17619525.
  8. ^ Thase, M. E.; MacFadden, W.; Weisler, R. H.; Chang, W.; Paulsson, B. ?R.; Khan, A.; Calabrese, J. R.; Bolder Ii Study, G. (2006). "Efficacy of Quetiapine Monotherapy in Bipolar I and II Depression". Journal of Clinical Psychopharmacology 26 (6): 600. doi:10.1097/01.jcp.0000248603.76231.b7. PMID 17110817.  edit
  9. ^ Ballard, C.; Margallo-Lana, M.; Juszczak, E.; Douglas, S.; Swann, A.; Thomas, A.; O'Brien, J.; Everratt, A. et al. (2005). "Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial". BMJ 330 (7496): 874. doi:10.1136/bmj.38369.459988.8F. PMC 556156. PMID 15722369. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=556156.  edit
  10. ^ Croissant, B.; Klein, O.; Gehrlein, L.; Kniest, A.; Hermann, D.; Diehl, A.; Mann, K. (2006). "Quetiapine in relapse prevention in alcoholics suffering from craving and affective symptoms: a case series". European Psychiatry 21 (8): 570. doi:10.1016/j.eurpsy.2006.04.007. PMID 17161284.  edit
  11. ^ Mukaddes, N. M.; Abali, O. (2003). "Quetiapine Treatment of Children and Adolescents with Tourette's Disorder". Journal of Child and Adolescent Psychopharmacology 13 (3): 295. doi:10.1089/104454603322572624. PMID 14642017.  edit
  12. ^ Becker, P. M. (2006). "Treatment of sleep dysfunction and psychiatric disorders". Current Treatment Options in Neurology 8 (5): 367–375. doi:10.1007/s11940-006-0026-6. PMID 16901376.  edit
  13. ^ http://www1.astrazeneca-us.com/pi/Seroquel.pdf
  14. ^ Shankar Vedantam (2009-03-18). "A Silenced Drug Study Creates An Uproar". The Washington Post. http://www.washingtonpost.com/wp-dyn/content/article/2009/03/17/AR2009031703786.html. 
  15. ^ a b Correll, CU; Schenk, EM (2008 Mar). "Tardive dyskinesia and new antipsychotics.". Current opinion in psychiatry 21 (2): 151–6. doi:10.1097/YCO.0b013e3282f53132. PMID 18332662. 
  16. ^ name=Aia, P.G. (2011). "Tardive Dyskinesia". Current treatment options in neurology, 13(3), 231-241.
  17. ^ Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis Am J Psychiatry 1999;156:1686-1696.
  18. ^ Seroquel website
  19. ^ Seroquel Prescribing Information
  20. ^ Tiihonen, J.; Lönnqvist, J.; Wahlbeck, K.; Klaukka, T.; Niskanen, L.; Tanskanen, A.; Haukka, J. (2009). "11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study)" (PDF). The Lancet 374: 620–627. doi:10.1016/S0140-6736(09)60742-X. http://press.thelancet.com/fin11.pdf.  edit
  21. ^ a b Group, BMJ, ed (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. ISBN 0260-535X. "Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse." 
  22. ^ a b Kim, DR.; Staab, JP. (May 2005). "Quetiapine discontinuation syndrome". Am J Psychiatry 162 (5): 1020. doi:10.1176/appi.ajp.162.5.1020. PMID 15863814. http://ajp.psychiatryonline.org/cgi/content/full/162/5/1020. 
  23. ^ Michaelides, C.; Thakore-James, M.; Durso, R. (Jun 2005). "Reversible withdrawal dyskinesia associated with quetiapine". Mov Disord 20 (6): 769–70. doi:10.1002/mds.20427. PMID 15747370. 
  24. ^ R. Baselt, Disposition of Toxic Drugs and Chemicals in Man, 8th edition, Biomedical Publications, Foster City, CA, 2008, pp. 1355–1357.
  25. ^ AstraZeneca Pharmaceuticals LP (March 2011). "SEROQUEL (quetiapine fumarate) tablet, extended release". DailyMed. National Library of Medicine. Section 12.2: Pharmacodynamics. http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=41375#section-15.2. Retrieved 2011-04-26. 
  26. ^ AstraZeneca (PDF). Seroquel (quietapine fumarate) tablets. 276521. http://www1.astrazeneca-us.com/pi/Seroquel.pdf. 
  27. ^ Richelson E, Souder T (November 2000). "Binding of antipsychotic drugs to human brain receptors focus on newer generation compounds". Life Sciences 68 (1): 29–39. doi:10.1016/S0024-3205(00)00911-5. PMID 11132243. http://linkinghub.elsevier.com/retrieve/pii/S0024320500009115. 
  28. ^ Davis, Kenneth L; Neuropsychopharmacology, American College of (2002). Neuropsychopharmacology: the fifth ... - Google Books. ISBN 9780781728379. http://books.google.com/?id=BKwkonZwZD0C&pg=PA778#v=onepage&q=. 
  29. ^ http://www.drugs.com/pro/seroquel.html
  30. ^ Kapur, S.; Seeman, P (2001). "Does fast dissociation from the dopamine d(2) receptor explain the action of atypical antipsychotics?:a new hypothesis". American Journal of Psychiatry 158 (3): 360–369. doi:10.1176/appi.ajp.158.3.360. PMID 11229973. http://ajp.psychiatryonline.org/cgi/content/abstract/158/3/360. 
  31. ^ Seeman P (2002). "Atypical antipsychotics: mechanism of action". Can J Psychiatry 47 (1): 27–38. PMID 11873706. 
  32. ^ E. Richelson and T. Souder (November 2000). "Binding of antipsychotic drugs to human brain receptors focus on newer generation compounds". Life Sciences 68 (1): 29–39. doi:10.1016/S0024-3205(00)00911-5. PMID 11132243. 
  33. ^ O Gefvert, T Lundberga, I-M Wieselgrenb, M Bergströmc, B Långströmc, F-A Wieselb and L Lindström (April 2001). "D2 and 5HT2A receptor occupancy of different doses of quetiapine in schizophrenia: a PET study". European Neuropsychopharmacology 11 (2): 105–110. doi:10.1016/S0924-977X(00)00133-4. PMID 11313155. 
  34. ^ Oregon State University Drug Use Evaluation: Low-Dose Quetiapine (Seroquel, Seroquel XR) PDF
  35. ^ "AstraZeneca Submits an NDA For Sustained Release Formulation Seroquel XR. For the treatment of schizophrenia." (Press release). AstraZeneca. 2006-07-18. http://www.astrazeneca.com/pressrelease/5256.aspx. Retrieved 2007-01-01. 
  36. ^ "AstraZeneca Submits EU and Canadian Regulatory Filings for Sustained Release Formulation SEROQUEL XR for the Treatment of Schizophrenia" (Press release). AstraZeneca. 2006-10-19. http://www.astrazeneca.com/pressrelease/5275.aspx. Retrieved 2007-01-01. 
  37. ^ "FDA Approves AstraZeneca’s Once-Daily SEROQUEL XR Extended-Release Tablets For The Treatment Of Schizophrenia" (Press release). AstraZeneca. 2007-05-18. http://www.astrazeneca.com/pressrelease/5330.aspx. Retrieved 2007-08-02. 
  38. ^ "Second Quarter and Half Year Results 2007" (Press release). AstraZeneca. 2007-07-26. http://www.astrazeneca.com/pressrelease/5341.aspx. Retrieved 2007-08-02. 
  39. ^ "Seroquel XR Receives Approval from FDA for Maintenance Treatment of Schizophrenia" (Press release). AstraZeneca. 2007-11-16. http://www.astrazeneca.com/pressrelease/5360.aspx. Retrieved 2007-12-03. 
  40. ^ Notice of Compliance Information - Seroquel XR September 27, 2007, retrieved December 3, 2007
  41. ^ "Biovail Announces Filing of ANDA for Quetiapine XR Tablets" (Press release). Biovail. 2008-12-28. http://www.biovail.com/english/Investor%20Relations/Latest%20News/default.asp?s=1&state=showrelease&releaseid=1230930. 
  42. ^ "AstraZeneca Receives FDA Complete Response Letter on Seroquel XR for Major Depressive Disorder" (Press release). AstraZeneca. 2008-12-24. http://www.astrazeneca.com/media/latest-press-releases/seroquel-MDD-FDA-response?itemId=4477598. Retrieved 2008-12-28. 
  43. ^ "QUETIAPINE FUMARATE". Electronic Orange Book. Food and Drug Administration. April 2007. http://www.accessdata.fda.gov/scripts/cder/ob/docs/obdetail.cfm?Appl_No=020639&TABLE1=OB_Rx. Retrieved 2007-05-24. 
  44. ^ "AstraZeneca Receives FDA Approval for SEROQUEL in Bipolar Mania" (Press release). AstraZeneca. 2004-01-13. http://www.prnewswire.co.uk/cgi/news/release?id=115109. 
  45. ^ "April 7–8, 2009: Psychopharmacologic Drugs Advisory Committee Meeting Announcement". http://www.fda.gov/AdvisoryCommittees/Calendar/ucm136250.htm. Retrieved 2009-08-27. 
  46. ^ Wilson, Duff (2009-10-29). "AstraZeneca Pays Millions to Settle Seroquel Cases". New York Times. http://www.nytimes.com/2009/10/30/business/30drug.html. Retrieved 2010-03-09. 
  47. ^ Matthew Perrone (August 30, 2010). "Questions loom over drug given to sleepless vets". Associate Press. http://health.yahoo.net/news/s/ap/us_veterans_sleep_drug. Retrieved November 28, 2010. 
  48. ^ Ann Knef (2007-08-02). "Seroquel suit claims 'so much' is poured into marketing and away from research". The Madison St. Clair Record. http://www.madisonrecord.com/news/198781-seroquel-suit-claims-so-much-is-poured-into-marketing-and-away-from-research. 
  49. ^ Phil Milford (2009-03-11). "AstraZeneca May Link Seroquel, Diabetes, Doctor Says". Bloomberg.com (Bloomberg L.P.). http://www.bloomberg.com/apps/news?pid=newsarchive&sid=ayzJsK2HlF6s. 
  50. ^ http://www.fiercepharma.com/story/astrazeneca-wins-bellwether-seroquel-case/2010-03-19
  51. ^ "AstraZeneca pays out million dollar damages". The Local. 2010-08-09. http://www.thelocal.se/28260/20100809/. 
  52. ^ Sydney Morning Herald
  53. ^ Joseph M. Pierre, M.D., Igor Shnayder, M.D., Donna A. Wirshing, M.D., and William C. Wirshing, M.D.. "Intranasal Quetiapine Abuse". American Psychiatric Association. http://ajp.psychiatryonline.org/cgi/content/full/161/9/1718. 
  54. ^ a b Brian M. Waters and Kaustubh G. Joshi (January 2007). "Intravenous Quetiapine-Cocaine Use ("Q-Ball")". Am J Psychiatry (American Psychiatric Association) 164 (1): 173–a–174. doi:10.1176/appi.ajp.164.1.173-a. PMID 17202567. http://ajp.psychiatryonline.org/cgi/content/full/164/1/173-a. 
  55. ^ Joseph M. Pierre, Igor Shnayder, Donna A. Wirshing, and William Wirshing (September 2004). "Intranasal Quetiapine Abuse". Am J Psychiatry (American Psychiatric Association) 161 (9): 1718. doi:10.1176/appi.ajp.161.9.1718. PMID 15337673. http://ajp.psychiatryonline.org/cgi/content/full/161/9/1718. 
  56. ^ Pinta, E. R.; Taylor, R. E. (2007). "Quetiapine Addiction?". American Journal of Psychiatry 164 (1): 174. doi:10.1176/appi.ajp.164.1.174. PMID 17202569.  edit
  57. ^ "East Stroudsburg man convicted of drugging, raping girl". The Pocono Record. 2011-09-20. http://www.poconorecord.com/apps/pbcs.dll/article?AID=/20110920/NEWS/110929978/-1/NEWS. 
  58. ^ "Provo man arrested for date rape". KSL Newsradio. http://www.ksl.com/?nid=148&sid=9734473. 
  59. ^ http://www.mhra.gov.uk/NewsCentre/Pressreleases/CON126226
  60. ^ http://www.mhra.gov.uk/Publications/Safetywarnings/DrugAlerts/CON126268

External links