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Suicide attempt during late pregnancy with quetiapine: nonfatal outcome despite severe intoxication.

CASE REPORT For the majority of psychotropic drugs, clinical experience is still lacking in regard to their safety in pregnancy. However, children of mothers with untreated or inadequately treated psychiatric diseases such as depression or psychosis might be at risk for future psychopathology or intrauterine growth retardation or even subject to maternal suicidal behavior due to uncontrolled symptoms. Available data suggest that quetiapine use during pregnancy is not associated with an increased risk of major malformations presumably because of a relatively low placental passage ratio (ratio of umbilical cord to maternal serum concentrations) at steady-state conditions with defined daily doses. Nonetheless, little is known about the direct toxic effects of high doses of quetiapine on the fetus that might occur during maternal suicidal acts. Recommended drug concentrations for the treatment of psychosis are defined to be within a range of 100 to 500 ng/mL, and a so-called laboratory alert level is defined at 1000 ng/mL quetiapine in serum or plasma. Clinical features of severe quetiapine overdoses include drowsiness or coma, tachycardia, hypotension, seizures, and arrhythmia. In a retrospective cohort study in 20 patients with median peak serum concentrations of more than 3000 ng/mL, quetiapine overdoses were associated with a significant toxicity and a fairly high number of complications. Yet, another study, where blood concentrations ranged from 1100 to 8800 ng/mL, did not show comparable findings with similar clinical features. In every case of pregnant women with psychiatric diseases, prescribers are rightly concerned about potential adverse effects on the fetus. While balancing the risks, one has to take into account that every pregnancy outcome is influenced by the natural course of the untreated disease on the one hand and by the potential negative effects of drug intake on the other. We report a case of a suicide attempt in the context of a pharmacologically untreated psychosis during pregnancy, after ingestion