From the FDA Drug Label
Quetiapine fumarate tablets can cause serious side effects, including: • high blood sugar (hyperglycemia). High blood sugar can happen if you have diabetes already or if you have never had diabetes High blood sugar could lead to: o build up of acid in your blood due to ketones (ketoacidosis) o coma o death
Metabolic Acidosis is not directly mentioned in the context of quetiapine side effects, but ketoacidosis is mentioned as a possible consequence of high blood sugar.
- Ketoacidosis is a form of metabolic acidosis. Therefore, quetiapine can indirectly cause metabolic acidosis through ketoacidosis, a complication of hyperglycemia 1, 1.
From the Research
Yes, Seroquel (quetiapine) can potentially cause metabolic acidosis, though this is not among its most common side effects. Metabolic acidosis occurs when the body produces excessive acid or when the kidneys cannot remove enough acid from the body. Quetiapine, like other atypical antipsychotics, can affect metabolic processes in the body, particularly glucose metabolism. This medication can lead to hyperglycemia (high blood sugar) and in some cases, diabetic ketoacidosis, a serious form of metabolic acidosis. The risk is higher in patients with pre-existing diabetes or risk factors for diabetes. Additionally, Seroquel can cause lactic acidosis in rare cases, particularly when combined with other medications that affect metabolism or in patients with liver dysfunction. Patients taking Seroquel should be monitored for symptoms of metabolic acidosis such as rapid breathing, confusion, fatigue, and nausea. Regular blood tests to check glucose levels and kidney function are important for those on long-term Seroquel therapy, especially for patients with diabetes or kidney disease. If metabolic acidosis is suspected, immediate medical attention is necessary as it can become life-threatening if left untreated, as seen in a study on drug-related pyroglutamic acidosis 2. It is also worth noting that quetiapine's pharmacokinetics do not appear to be altered by renal impairment, but its clearance declines with age 3. Furthermore, a survey of reports of quetiapine-associated hyperglycemia and diabetes mellitus found that most cases appeared within 6 months of quetiapine initiation, and the severity of cases ranged from mild glucose intolerance to diabetic ketoacidosis or hyperosmolar coma 4. However, the most recent and highest quality study on the topic of drug-induced acid-base disorders does not specifically mention quetiapine as a cause of metabolic acidosis, but it does discuss the importance of analyzing acid-base disorders in a standardized manner and the various categories of drug-induced acid-base disorders 5. In terms of management, discontinuing the offending drug, administering bicarbonate, and using acetylcysteine may be necessary, as seen in the treatment of pyroglutamic acidosis 2. Some key points to consider when prescribing quetiapine include:
- Monitoring patients for symptoms of metabolic acidosis
- Regular blood tests to check glucose levels and kidney function
- Being aware of the potential for quetiapine to cause hyperglycemia and diabetic ketoacidosis
- Considering the patient's age and potential decline in clearance
- Being cautious when combining quetiapine with other medications that affect metabolism.