Quetiapine
| Evidence Level: L5 | Predicted Indications: 10 |
Table of Contents
Quetiapine: Retinal dystrophy with or without extraocular anomalies
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. This is a prediction from the TxGNN model (deep learning) only, so the recommendation is to hold.
Quick Overview
| Item | Content |
|---|---|
| Original Indication | Not recorded in the local data |
| Predicted New Indication | Retinal dystrophy with or without extraocular anomalies |
| TxGNN Prediction Score | 0.9957 |
| Evidence Level | L5 |
| Australia Market Status | Listed on the PBS Schedule (1 of 1 items) – TGA (ARTG) registration status is not included in this data |
| Number of PBS Items | 1 (valid: 1) |
| Recommended Decision | Hold |
Why is This Prediction Reasonable?
Currently, detailed mechanism of action data is not available. Quetiapine is known to act as an antagonist at several receptors (5-HT2A, D2, H1 and alpha-1), and its efficacy in schizophrenia and bipolar disorder is established.
For the top-ranked prediction, no plausible link was identified between this receptor pharmacology and the pathophysiology of inherited retinal dystrophy. The very high TxGNN score (0.9957) comes from the TxGNN model (deep learning) and may reflect similarities the model learned between related diseases, not biological evidence. It is not supported by any mechanistic or clinical data compiled for this report.
Other predictions reviewed. The remaining top-ten predictions are also model-only, with no trials or literature, and no mechanistic rationale was found for them:
- Congenital disorder of glycosylation with defective fucosylation
- Hydranencephaly
- Distal 17p13.3 microdeletion syndrome
- Polymicrogyria, perisylvian, with cerebellar hypoplasia and arthrogryposis
- X-linked myopia, syndromic myopia, and myopia 26 (X-linked, female-limited)
- Charcot-Marie-Tooth disease, demyelinating, type 1G
Trichotillomania (rank 8) is the only prediction with a plausible rationale and some literature. It is an obsessive-compulsive-spectrum, body-focused repetitive behaviour disorder. Quetiapine’s 5-HT2A and D2 antagonism is a reasonable basis for modulating compulsive behaviours, and atypical antipsychotics are used as augmentation in OCD-spectrum conditions. It is therefore the most credible research question from this list, though the evidence is limited to case reports and reviews. Its TxGNN score is 0.9938, with evidence level L4 and a “Research Question” status.
Clinical Trial Evidence
Currently no related clinical trials registered for the top-ranked prediction (retinal dystrophy). No trials were found for trichotillomania either.
Literature Evidence
Currently no related literature available for the top-ranked prediction (retinal dystrophy).
For reference, the literature found for the best-supported alternative, trichotillomania, is shown below. It is all low-tier evidence (case reports and reviews).
| PMID | Year | Type | Journal | Key Findings |
|---|---|---|---|---|
| 12405081 | 2002 | Review / case report | Psychiatry | Overview of trichotillomania, with a favourable response to quetiapine in a 33-year-old woman |
| 19142421 | 2008 | Case report | Rev Bras Psiquiatr | Quetiapine for the treatment of trichotillomania (no abstract available) |
| 38797877 | 2025 | Review | Int J Dermatol | Review of pharmacological treatment for trichotillomania; no common treatment strategy exists |
| 11212595 | 2001 | Case report | J Psychiatry Neurosci | Quetiapine exacerbated obsessive-compulsive symptoms in a patient with OCD and trichotillomania; includes a review of atypical antipsychotic-induced OCS |
| 20833945 | 2010 | Case report | Psychosomatics | Recurrent Rapunzel syndrome and trichotillomania: case report and literature review |
| 27840761 | 2016 | Case report | Case Rep Psychiatry | Trichotillomania as a manifestation of dementia (not specific to quetiapine) |
Note that one case report (PMID 11212595) describes quetiapine worsening obsessive-compulsive symptoms, so the evidence is mixed.
Australia Market Information
| ARTG Number | Product Name | Dosage Form | Approved Indication |
|---|---|---|---|
| ARTG 5458G | Seroquel XR | Tablet (modified release) 150 mg (as fumarate) | Not available in the data compiled for this report |
Safety Considerations
Contraindications / conditions of concern (from the knowledge graph, not label text): The knowledge graph links quetiapine to the following conditions as contraindications. These should be verified against the Product Information.
- Cardiovascular: long QT syndrome (including familial), torsades de pointes, orthostatic hypotension, postural orthostatic tachycardia syndrome, multiple system atrophy, hypertension, myocardial infarction
- Metabolic: diabetes mellitus, diabetic ketoacidosis, hyperglycaemia, hyperlipidaemia (including familial), hypertriglyceridaemia, obesity, potassium deficiency
- Endocrine: hypothyroidism, myxedema, congenital hypothyroidism
- Haematological: neutropenia, agranulocytosis
- Neurological: epilepsy, basal ganglia disease, focal hand dystonia, blepharospasm
- Other: liver disease, gallbladder disease, female breast carcinoma
Drug Interactions: 100 interactions were identified; the 20 reviewed include two rated Major:
- Major: bupropion, morphine
- Moderate (examples): antidiabetic agents (metformin, pioglitazone, acarbose, alogliptin, canagliflozin, albiglutide, chlorpropamide), anticholinergics (atropine, hyoscyamine, glycopyrronium, clidinium), epinephrine, famotidine, loperamide, aprepitant, dexamethasone, lorcaserin, bisacodyl
Label-based warnings and contraindications were not available. Please refer to the TGA-approved Product Information (PI) for full safety information.
Conclusion and Next Steps
Decision: Hold
Rationale: The top-ranked prediction (retinal dystrophy) rests solely on a TxGNN model (deep learning) score, which may reflect similarities the model learned between related diseases, not biological evidence, with no trials, no literature and no plausible mechanistic link to quetiapine. The same applies to most other top-ten predictions. Quetiapine also carries a substantial safety profile (QT prolongation, metabolic effects, haematological risks) that argues against pursuing unsupported indications.
To proceed, the following is needed:
- Mechanism of action data (MOA), which is currently missing
- Label-based warnings and contraindications from the Product Information, and the approved indication text for the Australian entry
- A plausible biological rationale for retinal dystrophy, supported by preclinical data
- If a lead is wanted from this list, trichotillomania is the most credible research question. It would need controlled studies (randomised trials), with a safety assessment covering metabolic effects, sedation and QT risk
Disclaimer
This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.