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Pharmacokinetic Study Comparing Topical, Rectal, and Oral Quetiapine

Overview

About this study

Quetiapine, a second generation antipsychotic, is only available as oral tablets. However, topical and rectal formulations have been produced in compounding pharmacies. There is no data available suggesting that topical or rectal formulations provide serum levels similar to oral medication. In the clinical setting, when oral administration of quetiapine is not possible (for example, when a patient is extremely ill physically or mentally or both), clinicians and pharmacists have collaborated in such cases and have at times had to administer quetiapine compounded in other dosage formulations such as rectal or topical formulations. Despite clinical effectiveness of these "other" formulations, there are no available studies that have investigated blood levels of the drug other than the oral form. The investigators are therefore designing this pharmacokinetic study to evaluate the the systemic absorption of quetiapine in oral, rectal and topical formulations. If the investigators are able to demonstrate detectable levels from rectal and topical quetiapine formulations compared to the oral form, this knowledge will enhance clinical psychiatric practice by providing a more broad route of administration for quetiapine which is a commonly used drug for psychiatric symptoms.

Participation eligibility

Participant eligibility includes age, gender, type and stage of disease, and previous treatments or health concerns. Guidelines differ from study to study, and identify who can or cannot participate. There is no guarantee that every individual who qualifies and wants to participate in a trial will be enrolled. Contact the study team to discuss study eligibility and potential participation.

Inclusion Criteria:

  • Healthy adult volunteers (18‐65 years old) willing to undergo a general health screen consisting of blood pressure, heart rate, respiratory rate, height, weight, temperature, and electrocardiogram will be identified.
  • The below parameters must be met to be consider an adult healthy to volunteer for inclusion in this study:
  • Blood pressure less than 160/99 mmHg and greater than 105/50 mmHg
    • Heart rate between 50‐100 beats per minutes
    • Respiratory rate between 10‐30 breaths per minute
    • Temperature between 34 °C and 37.5°F
    • Corrected QT interval of < 470 msec
    • Liver function tests less than 1.5 times the upper limit of normal
    • Estimated creatinine clearance (estimated by Cockcroft Gault formulation) greater than 60 mL/min
    • Female participants will complete a urine pregnancy test that must result in a negative finding

Exclusion Criteria:

  1. Allergy to quetiapine, Lipoderm or polyethylene glycol
  2. Currently taking quetiapine
  3. Pregnant, planning to become pregnant or breast feeding
  4. Over or under 30% of ideal body weight
  5. History of or active cardiovascular disease (except hypertension meeting the inclusion criteria for blood pressure), severe kidney disease (i.e. needing dialysis), or liver disease
  6. History of schizophrenia, bipolar disorder, substance use disorders (but excluding nicotine use disorders and stable unipolar depression (See below))
  7. Unstable unipolar depression, defined as hospitalization for depression within 1 year or changes to an antidepressant regimen within 6 months
  8. History of seizure or seizure disorder
  9. Parkinson's disease, Huntington's disease, tardive dyskinesia or other diagnosed movement disorder
  10. History of/or active hematologic/oncologic illness
  11. Dementia
  12. Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome
  13. History of organ transplant
  14. History of gastric bypass
  15. Contraindications for suppository administration
  16. With Ostomy, chronic diarrhea
  17. Diabetes, type 1 or type 2
  18. Prolong corrected QT interval (>470 msec) or history of congenital long QT syndrome
  19. Open wound(s) or unhealed wound(s) at topical medication application site (anterior forearm)
  20. Active or latent tuberculous and currently prescribed pharmacotherapy treatments
  21. QTc prolonging medications:
    • Antipsychotics
    • Vaughan Williams Class IA, IB, IC, III antiarrhythmics
    • Anti-infective agents (excluding topical agents, oral penicillins, oral cephalosporins)
    • Antiemetics
    • Methadone
    • Cisapride
    • Cimetidine
    • Divalproex sodium/valproic acid
    • Tetrabenazine
    • Solifenacin
    • Tricyclic antidepressants
    • Tizanidine
    • Fingolimod

  22. Increase quetiapine concentrations, not previously mentioned

    • Paroxetine
    • Fluoxetine
    • Fluvoxamine
    • Non-dihydropyridine calcium channel blockers (verapamil, diltiazem)
    • Tamoxifen
    • Cyclosporin (excluding ophthalmic formulation)
    • Nefazodone

  23. Decrease quetiapine levels, not previously mentioned

    • Bosentan
    • Carbamazepine
    • Glucocorticoids
    • Modafinil
    • Primidone
    • St. John's wort
    • Barbiturates
    • Phenytoin
  24. Vulnerable populations will be excluded (i.e. prisoners, wards of the state, emancipated minors, children, pregnant women)
  25. Inability to receive telephone calls for the purpose of post-intervention follow-up
  26. Inability or unwillingness of individual to give written informed consent
  27. Non-English speaking populations

Participating Mayo Clinic locations

Study statuses change often. Please contact the study team for the most up-to-date information regarding possible participation.

Mayo Clinic Location Status

Rochester, Minn.

Mayo Clinic principal investigator

Jonathan Leung, Pharm.D., R.Ph.

Closed for enrollment

More information

Publications

Publications are currently not available

More about research at Mayo Clinic

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CLS-20117996

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