Time course of central nervous dopamine-D2 and 5-HT2 receptor blockade and plasma drug concentrations after discontinuation of quetiapine (Seroquel®) in patients with schizophrenia |
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Authors: | O Gefvert M Bergström B Långström T Lundberg L Lindström R Yates |
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Institution: | Psychiatric Research Unit, V?ster?s Central Hospital, S-721 89 V?ster?s, Sweden Fax (+46) 21173733, SE Uppsala University PET Centre, S-75185 Uppsala, Sweden, SE ZENECA Pharmaceuticals, Alderley Edge, Macclesfield, UK, GB
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Abstract: | Quetiapine (Seroquel) is a novel antipsychotic with an atypical profile in animal models and a relatively short plasma half-life
of 2.5–5 h. In the present study, we used PET to compare the time course of blockade of dopamine D2 and serotonin 5HT2 receptors of quetiapine using C11-raclopride and C11-N-methyl-spiperone as ligands, parallel to monitoring plasma drug concentrations. It was an open study in 11 schizophrenic
men using a fixed dose of 450 mg quetiapine. Eight men completed the 29 days treatment, followed by four PET scans performed
over a 26-h period after withdrawal of the compound. Quetiapine was shown to bind to dopamine D2 receptors in striatum and 2 h (tmax) after the last dose, 44% receptor occupancy was calculated. After 26 h it had dropped to the same level as was found in
untreated healthy volunteers. Serotonin 5HT2 receptor blockade in the frontal cortex was 72% after 2 h, which declined to 50% after 26 h. The terminal plasma half-life
of quetiapine was 5.3 h. Clinically, our eight patients had good antipsychotic effect without any extrapyramidal side-effects.
Our data shows that quetiapine has a relatively low affinity for dopamine D2 receptors, with an occupancy half-life (10 h), which was about twice as long as that for plasma. A more prolonged blockade
of the serotonin 5HT2 receptors was found in the frontal cortex, with receptor occupancy half-life of 27 h. Compared to clozapine, as demonstrated
in other studies, quetiapine has much the same ratio of D2/5HT2 occupancy. This could suggest that the combination of D2/5HT2 receptor blockade contributes to the antipsychotic effect and a low incidence of EPS seen with quetiapine in comparative
phase three trials. Our results also confirm the clinical data that quetiapine can be administered twice daily.
Received: 13 December 1996/Final version: 13 June 1997 |
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Keywords: | PET Pharmacokinetics Dopamine D2 receptor Serotonin 5HT2 receptor Atypical antipsychotic Quetiapine |
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