Refractory hypotension secondary to chronic treatment with high doses of quetiapine

Quetiapine is an atypical antipsychotic used in the treatment of depressive, schizophrenic, or bipolar disorders. It acts on dopamine D₁ and D₂, histamine, and 5HT_1A and 5HT₂ receptors. However, it also acts as an antagonist for α₁ receptors causing cardiovascular side effects, including hypotension. We present the case of a patient chronically medicated with Quetiapine who developed hypotension refractory to vasoconstrictors and intraoperative fluid therapy. Noradrenalin has a strong α₁ effect with lower affinity for β₂ receptors unlike adrenalin. This translates into peripheral vasoconstriction and an improved clinical picture. Therefore, it should be considered the vasoactive drug of choice in patients on high doses of Quetiapine.