Pharmacodynamics
The mechanism of action of quetiapine is not yet fully understood. The antischizophrenic effect probably results from the interaction of the drug with dopamine type 2 (D2) and serotonin 2A (5HT2A) receptors. In bipolar depression and major depression, the effects of quetiapine could be attributed to the binding of this drug or its metabolite to the norepinephrine transporter. Additional effects of quetiapine, including somnolence, orthostatic hypotension, and anticholinergic effects, may result from antagonism of H1 receptors, adrenergic α1-receptors, and muscarinic M1-receptors, respectively.
Pharmacokinetics
The highest plasma concentration of quetiapine occurs 1.5 hours after oral administration. Plasma protein binding of quetiapine is 83%. The major active metabolite of quetiapine is norquetiapine (N-desalkylquetiapine). Quetiapine has an elimination half-life of 6 to 7 hours. Its metabolite, norquetiapine, has a half-life of 9 to 12 hours. Quetiapine is excreted after hepatic metabolism primarily via the kidneys (73%) and in the feces (20%), with the remainder (1%) excreted as the drug in its unmetabolized form.