Measurement of quetiapine and four quetiapine metabolites in human plasma by LC-MS/MS

There is interest in monitoring plasma concentrations of N-desalkylquetiapine in relation to antidepressant effect. A simple LC-MS/MS method for quetiapine and four metabolites in human plasma (50 μL) has been developed to measure concentrations of these compounds attained during therapy. Analytes and internal standard (quetiapine-d8) were extracted into butyl acetate–butanol (10:1, v/v) and a portion of the extract analysed by LC-MS/MS (100 × 2.1 mm i.d. Waters Spherisorb S5SCX; eluent: 50 mmol/L methanolic ammonium acetate, pH* 6.0; flow-rate 0.5 mL/min; positive ion APCI-SRM, two transitions per analyte). Assay calibration (human plasma calibrators) was linear across the ranges studied (quetiapine and N-desalkylquetiapine 5–800, quetiapine sulfoxide 100–15,000, others 2–100 µg/L). Assay validation was as per FDA guidelines. Quetiapine sulfone was found to be unstable and to degrade to quetiapine sulfoxide. In 47 plasma samples from patients prescribed quetiapine (prescribed dose 200–950 mg/day), the (median, range) concentrations found (µg/L) were: quetiapine 83 (7–748), N-desalkylquetiapine, 127 (7–329), O-desalkylquetiapine 12 (2–37), 7-hydroxyquetiapine 3 (<1–48), and quetiapine sulfoxide 3,379 (343–21,704). The analyte concentrations found were comparable to those reported by others except that the concentrations of the sulfoxide were markedly higher. The reason for this discrepancy in unclear.