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quetiapine Quetiapine is an antipsychotic. It may increase the risk of death when used to treat mental problems caused by dementia in elderly patients. Most of the deaths were linked to heart problems or infection. Quetiapine is not approved to treat mental problems caused by dementia. A Cochrane Review comparing quetiapine to other atypical antipsychotic agents tentatively concluded that it may be less efficacious than olanzapine and risperidone; produce fewer movement related side effects than paliperidone, aripiprazole, ziprasidone, risperidone and olanzapine; and produce weight gain similar to risperidone, clozapine and aripiprazole. A second Cochrane Review comparing quetiapine to typical antipsychotics concluded that quetiapine Quetiapine is used to relieve the symptoms of schizophrenia, bipolar disorder, and other similar mental health problems. Schizophrenia is a serious mental health condition that causes disordered ideas, beliefs and experiences. Such symptoms include hearing, seeing, or sensing things that are not real, having mistaken beliefs, and feeling unusually suspicious. Quetiapine will help ease these symptoms. How to take quetiapine Constipation, drowsiness, upset stomach, tiredness, weight gain, blurred vision, or dry mouth may occur. If any of these effects persist or worsen, tell your doctor promptly. Dizziness or lightheadedness may occur, especially when you first start or increase your dose of this drug. To reduce the risk of dizziness and lightheadedness, get up slowly when rising from a sitting or lying position. What is the most important information I should know about quetiapine (Seroquel, Seroquel XR)? Quetiapine fumarate is the generic name for this medicine. It is available as the following brands. Please select one of the medicines below for information about Quetiapine fumarate. Never take quetiapine in larger amounts, or for longer than recommended by your doctor. High doses or long-term use of quetiapine can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include tremors or other uncontrollable muscle movements. Quetiapine is not for use in psychotic conditions related to dementia. Quetiapine may cause heart failure, sudden death, or pneumonia in older adults with dementia-related conditions. Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication. Quetiapine (Seroquel and generics) has been available in Canada since 1998. It is approved for schizophrenia, bipolar disorder and, as of 2010, for major depressive disorder (MDD) refractory to treatment with antidepressants.1 It is widely prescribed in low doses for management of sleep disorders, despite lacking approval for this use.2 In 2010 almost $20 million was spent on quetiapine in British Columbia, placing it 21st in cost, ahead of pantoprazole and amlodipine. At almost 1 million prescriptions, quetiapine was the 9th most frequently prescribed drug in B.C., leading rabeprazole and citalopram and close behind zopiclone and metformin. Given the wide range of drugs available for psychosis and mood disorders, these indications likely account for a minority of quetiapine’s use in 2010. This is supported by the fact that 58% of B.C. quetiapine prescriptions were for the 25 mg tablet, whereas the recommended dose range for the approved disorders is 150 to 800 mg/day. Similarly in the United States, up to 70% of newer antipsychotic prescribing is for conditions other than psychosis.3 This letter examines efficacy and safety evidence about use of low dose quetiapine for sleep disorders. What is quetiapine? Quetiapine is a dibenzothiazapine derivative which antagonizes multiple receptors, including serotonin (5HT1A and 5HT2), dopamine (D1 and D2), histamine H1 and adrenergic alpha 1 and alpha 2 receptors, but the mechanism of action for any use is unknown. At least one metabolite, norquetiapine, may also be pharmacologically active, including antagonism of muscarinic M1 receptors (anti-cholinergic).1 Pharmacokinetics and cost Quetiapine is eliminated by metabolism in the liver with average half-life of 6-7 hours. This is prolonged in people > 65 years. Norquetiapine is present at lower concentrations, but has a longer half-life.1 Quetiapine 25 to 50 mg daily costs $0.32-$0.64 per day in B.C. Evidence for use in primary insomnia Two published randomized controlled trials evaluated quetiapine’s effect on sleep in patients not suffering from other medical conditions or psychiatric illness.4,5 Only one studied patients suffering from primary insomnia5; the other was in healthy subjects without insomnia4. The healthy subject study evaluated 14 males using a randomized, double-blind, crossover, placebo-controlled, single-center design. Placebo or quetiapine at 25 and 100 mg doses were given on 3 consecutive nights with a 4-day washout period before crossover. Polysomnographic recordings were made nightly and subjective sleep-rating questionnaires completed each morning. Both doses of quetiapine produced statistically significant improvements in objective and subjective ratings of sleep, including total sleep time, sleep efficiency, sleep latency and duration of stage 2 sleep. The 100 mg dose increased periodic leg movements and decreased REM sleep. Two out of 14 subjects taking quetiapine withdrew from the study because of symptomatic orthostatic hypotension.4 In the primary insomnia study, 25 patients were randomized to quetiapine 25 mg or placebo. Patients were asked to record a sleep diary for one week before and two weeks after initiation of treatment. No statistically significant improvements were found in the primary outcomes of total sleep time, sleep latency, daytime alertness and sleep satisfaction.5 Potential adverse effects Very few data are available concerning adverse effects of low dose quetiapine. Two out of 14 healthy males using 25 or 100 mg withdrew due to orthostatic hypotension during short-term use.