Quetiapine
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Quetiapine: From Schizophrenia and Bipolar Disorder to Retinal Dystrophy
One-Sentence Summary
Quetiapine is an atypical antipsychotic originally used to treat schizophrenia and bipolar disorder. The TxGNN model's top-ranked prediction is retinal dystrophy with or without extraocular anomalies, but there are 0 clinical trials and 0 publications supporting it, so it rests on model prediction alone. The best-supported candidate in the data compiled for this report is trichotillomania (rank 8), which has 6 publications (case reports, case series and reviews) but no controlled trials.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Schizophrenia, bipolar disorder, major affective disorder, manic bipolar affective disorder (the Singapore licence records contain no indication text, so these come from the knowledge graph) |
| Predicted New Indication | Retinal dystrophy with or without extraocular anomalies (rank 1) |
| TxGNN Prediction Score | 99.57% |
| Evidence Level | L5 (model prediction only) |
| Singapore Market Status | ✓ Marketed |
| Number of Registrations | 20 |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available. Based on known information, quetiapine is an atypical antipsychotic that mainly acts on dopamine and serotonin receptors. Its efficacy in schizophrenia and bipolar disorder is established.
For the top-ranked prediction, retinal dystrophy, no mechanistic link is established in the data compiled for this report. The high score is a computational prediction only. The same applies to the other top-ranked candidates (congenital disorder of glycosylation, hydranencephaly, 17p13.3 microdeletion syndrome, polymicrogyria, X-linked myopia, Charcot-Marie-Tooth type 1G). These are genetic or structural conditions with no apparent connection to quetiapine's receptor pharmacology.
The one exception is trichotillomania (rank 8, score 99.38%). It is an obsessive-compulsive spectrum disorder, and atypical antipsychotics are used as augmentation in such conditions. Dopamine D2 and serotonin 5-HT2A antagonism offers a plausible link. The available evidence is limited to case reports and reviews. Study designs were inferred from titles and abstracts and not confirmed.
Clinical Trial Evidence
Currently no related clinical trials registered.
Literature Evidence
No literature is available for the top-ranked prediction. The table below covers trichotillomania, the best-supported candidate.
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 12405081 | 2002 | Review with case report | Psychiatry | Overview of trichotillomania, with a favourable response to quetiapine in a 33-year-old female veteran |
| 19142421 | 2008 | Case report/series (inferred from title) | Rev Bras Psiquiatr | Quetiapine for the treatment of trichotillomania; no abstract available |
| 38797877 | 2025 | Review | Int J Dermatol | Review of pharmacological treatment options for trichotillomania and the lack of guidelines |
| 11212595 | 2001 | Case report and review | J Psychiatry Neurosci | Quetiapine exacerbated obsessive-compulsive symptoms in one patient with OCD and trichotillomania; reviews atypical antipsychotic-induced OCS |
| 20833945 | 2010 | Case report and review | Psychosomatics | Treatment of recurrent Rapunzel syndrome and trichotillomania |
| 27840761 | 2016 | Case report | Case Rep Psychiatry | Trichotillomania as a manifestation of dementia |
Note that one report (PMID 11212595) describes quetiapine worsening obsessive-compulsive symptoms, which runs against the proposed mechanism. Two of the six papers (PMIDs 27840761 and 20833945) are not specific to quetiapine.
Singapore Market Information
Twenty valid single-ingredient registrations exist; five are shown below. The records contain no approved indication text.
| Authorization Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| SIN09767P | SEROQUEL TABLET 100 mg | Film-coated tablet | Not recorded |
| SIN13502P | Seroquel XR Tablet 50mg | Extended-release tablet | Not recorded |
| SIN13769P | Ketipinor Tablet 200 mg | Film-coated tablet | Not recorded |
| SIN14342P | APO-QUETIAPINE TABLET 25MG | Film-coated tablet | Not recorded |
| SIN16689P | SAQUIN SR PROLONGED-RELEASE TABLETS 50MG | Extended-release tablet | Not recorded |
All products are oral formulations (immediate-release and extended-release tablets).
Safety Considerations
Package insert warnings and contraindications were not available. Please refer to the package insert for safety information.
- Contraindications flagged in the knowledge graph (not label text): the drug-disease links include cardiovascular conditions (long QT syndrome, torsades de pointes, orthostatic hypotension, hypertension, myocardial infarction), metabolic conditions (diabetes mellitus, diabetic ketoacidosis, hyperglycaemia, hyperlipidaemia, hypertriglyceridaemia, obesity, hypothyroidism), haematological conditions (neutropenia, agranulocytosis), and others (epilepsy, liver disease, gallbladder disease, basal ganglia disease, breast carcinoma, potassium deficiency). These should be verified against the official label.
- Drug interactions: 100 interactions were found in total. Two are rated Major: bupropion and morphine. Examples rated Moderate include antidiabetic agents (metformin, pioglitazone, alogliptin, acarbose, canagliflozin, albiglutide, chlorpropamide), anticholinergics (atropine, hyoscyamine, glycopyrronium, clidinium), epinephrine, dexamethasone, famotidine, aprepitant, loperamide, bisacodyl and lorcaserin.
Conclusion and Next Steps
Decision: Hold
Rationale: The top-ranked prediction, retinal dystrophy, has no clinical trials, no literature and no identified mechanistic link, so the evidence level is L5. Trichotillomania (L4) is the only candidate with any supporting literature. That literature consists of case reports and reviews, with no controlled trials. Quetiapine also carries a notable metabolic and cardiac risk profile in the knowledge graph.
To proceed, the following is needed:
- Package insert warnings and contraindications from HSA (currently a blocking gap for safety screening)
- Mechanism of action data from DrugBank
- For trichotillomania: a full-text review of the quetiapine-specific case reports and a search for controlled trials, including a benefit-risk comparison against established treatments
- For the top-ranked rare genetic conditions: a mechanistic rationale and preclinical data before any further consideration
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.