What should I do after accidentally taking 800mg quetiapine and 250mg Lyrica (pregabalin)?

Emergency Management of Quetiapine and Pregabalin Overdose

You need to seek immediate medical attention by calling emergency services (911) or going to the nearest emergency department after accidentally taking 800mg quetiapine and 250mg pregabalin, as this combination can cause severe central nervous system depression requiring medical intervention.

Immediate Concerns

The combination of high-dose quetiapine (800mg) and pregabalin (250mg) presents significant risks:

• Quetiapine overdose: Can cause severe central nervous system depression, respiratory depression, hypotension, tachycardia, and potentially seizures 1
• Pregabalin overdose: Can cause reduced consciousness, confusion, agitation, and restlessness 2
• Combined effect: The sedative effects of both medications can potentiate each other, increasing risk of respiratory depression

Severity Assessment

The severity of this overdose is concerning:

• Quetiapine doses >3g are associated with higher risk of ICU admission and longer hospital stays, but even 800mg can cause significant CNS depression 1
• The reported dose of 250mg pregabalin exceeds typical therapeutic dosing and adds to the CNS depressant effects
• No antidote exists for either medication 2

What To Expect at the Hospital

Medical providers will likely:

1. Assess vital signs: Monitoring for hypotension, tachycardia, respiratory depression
2. Perform cardiac monitoring: Quetiapine can cause QTc prolongation (though this is often due to tachycardia) 1
3. Obtain laboratory tests: Including drug levels if available
4. Provide supportive care:
   • Airway management if needed
   • IV fluids for hypotension
   • Possible gastric lavage if presentation is early

Treatment Approach

Treatment is primarily supportive as there are no specific antidotes for either medication 2:

• Airway management: May require intubation in severe cases
• Cardiovascular support: IV fluids for hypotension
• Monitoring: Continuous cardiac and respiratory monitoring
• Elimination: Hemodialysis can remove pregabalin (approximately 50% in 4 hours) but is generally reserved for severe cases 2

Important Considerations

• Time factor: Seek help immediately as symptoms may worsen over time
• Avoid other sedatives: Do not take any other medications, especially other CNS depressants
• Full disclosure: Inform medical providers of exact doses and timing of ingestion
• Medical history: Inform providers of any pre-existing conditions, especially cardiac issues

Prognosis

With prompt medical attention, the prognosis is generally favorable:

• Most quetiapine overdoses do not result in death when appropriate medical care is provided 1
• The combination with pregabalin increases risk but is still manageable with proper medical care
• Length of hospital stay may be 24-48 hours based on severity of symptoms

Do not delay seeking medical attention, as this combination of medications at these doses requires professional evaluation and management.