Quetiapine with Mitotane Interaction Details
Brand Names Associated with Quetiapine
- Quetiapine
- Seroquel®
- Seroquel® XR
Brand Names Associated with Mitotane
- Lysodren®
- Mitotane
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 29, 2023
Interaction Effect
Decreased quetiapine exposure
Interaction Summary
Use caution when coadministering quetiapine with strong CYP3A4 inducers as this may reduce quetiapine exposure. The coadministration of phenytoin (a strong CYP3A4 inducer) with quetiapine resulted in a 5-fold increase in quetiapine clearance . When quetiapine is used concomitantly with chronic treatment with a strong CYP3A4 inducer (for more than 7 to 14 days), increase the original quetiapine dose up to 5-fold. When the strong CYP3A4 inducer is discontinued, decrease the quetiapine dose to the original level within 7 to 14 days .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of quetiapine with strong CYP3A4 inducers may reduce quetiapine exposure. When quetiapine is used concomitantly with chronic treatment with a strong CYP3A4 inducer (for more than 7 to 14 days), increase the original quetiapine dose up to 5-fold. When the strong CYP3A4 inducer is discontinued, decrease the quetiapine dose to the original level within 7 to 14 days.
Mechanism Of Interaction
Induction of CYP3A4-mediated quetiapine metabolism
Literature Reports
A) The coadministration of phenytoin with quetiapine significantly decreased the plasma concentration-time profile for quetiapine, resulting in a 5-fold increase in oral clearance in patients with DSM-IV-diagnosed schizophrenia, schizoaffective disorder, or bipolar disorder. Seventeen patients participated in an open-label, nonrandomized, multiple-dose study that compared the pharmacokinetics and tolerability of quetiapine when administered alone or in combination with phenytoin. Patients received escalating doses of quetiapine from 25 to 250 mg 3 times daily on days 3 to 10. Maintenance doses of quetiapine were administered on days 11 to 22. Phenytoin 100 mg 3 times daily was administered between days 13 and 22. The AUC from 0 to 8 hours after dosing at steady-state with quetiapine versus quetiapine plus phenytoin was 3642 nanograms (ng) x hr/mL and 728 ng x hr/mL, respectively. The steady-state Cmax for quetiapine versus quetiapine plus phenytoin was 1048 nanograms/mL (2733 nanomol/L) and 359 nanograms/mL (936 nanomol/L), respectively. Clearance of quetiapine alone versus quetiapine plus phenytoin was 80.3 L/hr and 440 L/hr, respectively .
Quetiapine Overview
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Quetiapine tablets and extended-release (long-acting) tablets are used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions). Quetiapine tablets and extended-release tablets are also used alone or with other medications to treat episodes of mania (frenzied, abnormally excited or irritated mood) or depression in patients with bipolar disorder (manic depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). In addition, quetiapine tablets and extended-release tablets are used with other medications to prevent episodes of mania or depression in patients with bipolar disorder. Quetiapine extended-release tablets are also used along with other medications to treat depression. Quetiapine tablets may be used as part of a treatment program to treat bipolar disorder and schizophrenia in children and teenagers. Quetiapine is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.
Mitotane Overview
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Mitotane is used to treat cancer of the adrenal gland that can not be treated with surgery. Mitotane is in a class of medications called antineoplastic agents. It works by slowing growth or reducing the size of the tumor.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.