Because the active drug component has a primary effect on the central nervous system, it is necessary to carefully combine it with other drugs that are effective for this system. It is also necessary to refrain from drinking alcohol.
Combined medication with liver enzyme inducers (eg, carbamazepine) can significantly reduce the systemic effects of quetiapine.
It is necessary to use with particular attention the use of drugs that extend the QT interval (among them neuroleptics, antiarrhythmic drugs (categories IA and III), mesoridazine with halofantrine, pimozide with levometadil acetate, thioridazine, moxifloxacin and gatifloxacin with sparfloxacin, and mefloquine , cisapride, dolansetron mesylate and sertindole).
Caution is required when taking concomitantly with risperidone, as well as medications provoking electrolyte imbalance (thiazide diuretics - development of hypokalemia), because they increase the likelihood of arrhythmia in malignant form.
The process of biotransformation of the active component of the drug in the hemoprotein system 450 is mainly carried out using an enzyme type P450 SURCA4. The combination of 25 mg of quetiapine with the ketoconazole inhibitor of the SURCA4 element promoted an increase (in 5-8 times) of the AUC level. Because of this, combining the drug with inhibitors of the SURCA4 element is prohibited. You can not also take quetiapine, squeezed grapefruit juice.
To determine the pharmacokinetic properties of quetiapine in people taking the medicine many times, it was given before treatment with carbamazepine (is an inducer of microsomal hepatic enzymes), and also during the course itself. Because of the increased clearance, the level of Quetiapine AUC, which was applied singly, decreased to 13% (mean), but this indicator was more significant in individual patients. As a result of this interaction, its plasma values have decreased, which can also affect the effectiveness of Nantarid.
When combining drugs with phenytoin (is another inducer of microsomal hepatic enzymes), significantly (by 450%) increases the clearance rate of quetiapine.
People who use inductor drugs of microsomal hepatic enzymes are allowed to use Nantarid exclusively in cases when the attending physician believes that the possible use of his use will exceed the need to cancel the use of the inductor. It is also necessary to take into account that any changes in the therapy process with the help of the microsomal inducer are carried out gradually. If necessary, you need to replace it with a medicine that does not have similar properties (eg, use sodium valproate).
Combined use with individual antidepressants (imipramine, which is an inhibitor of element CUR2D6, as well as fluoxetine - an inhibitor of SURCA4 elements, as well as CYP2D6), has no significant effect on the pharmacokinetic properties of quetiapine.
There was no noticeable effect on the pharmacokinetics of drugs, and when combined with the following antipsychotics, haloperidol and risperidone. However, in the case of combination with thioridazine, the quetiapine clearance rates increased by 70%.
No changes in the pharmacokinetic characteristics of quetiapine were observed in the case of simultaneous administration with lithium and cimetidine.
The combination with sodium valproate has little effect on the pharmacokinetic properties of both of these drugs (from a drugically significant point of view).