Is There a Potential of Misuse for Quetiapine?: Literature Review and Analysis of the European Medicines Agency/European Medicines Agency Adverse Drug Reactions' Database
type: Article
item type: journalArticle
is part of: Journal of Clinical Psychopharmacology
authors: Person
  surname: Chiappini
  given name: Stefania
authors: Person
  surname: Schifano
  given name: Fabrizio
link: PubMed entry
subject: Adult
subject: Female
subject: Humans
subject: Male
subject: Middle Aged
subject: Young Adult
subject: Adolescent
subject: Adverse Drug Reaction Reporting Systems
subject: Antipsychotic Agents
subject: Benzodiazepines
subject: Child
subject: Databases, Factual
subject: European Union
subject: Olanzapine
subject: Prescription Drug Misuse
subject: Quetiapine Fumarate
subject: Substance Withdrawal Syndrome
subject: Substance-Related Disorders
abstract: PURPOSE/BACKGROUND: A recent years' increase in both prescribing and availability of second-generation antipsychotics (SGAs) has been observed. According to the literature, typically made up by case studies/series, quetiapine seems to be the most commonly misused SGA, with both intranasal and intravenous intake modalities having been described. Another SGA that has been anecdotally reported to be misused is olanzapine. For these molecules, both a previous history of drug misuse and being an inmate have been described as factors associated with misuse. Hence, while providing here an updated literature review of the topic, we aimed at assessing all cases of quetiapine misuse/abuse/dependence/withdrawal as reported to the European Medicines Agency's EudraVigilance (EV) database; this was carried out in comparison with the reference drug olanzapine. METHODS: All spontaneous, European Medicines Agency database reports relating to both quetiapine (2005-2016) and olanzapine (2004-2016) misuse/abuse/dependence/withdrawal issues were retrieved, and a descriptive analysis was performed. RESULTS: From the EV database, 18,112 (8.64% of 209,571) and 4178 (7.58% of 55,100) adverse drug reaction reports of misuse/abuse/dependence/withdrawal were associated with quetiapine and olanzapine, respectively. The resulting proportional reporting ratio values suggested that the misuse/abuse-, dependence-, and withdrawal-related adverse drug reactions were more frequently reported for quetiapine (1.07, 1.01, and 5.25, respectively) in comparison with olanzapine. CONCLUSIONS: Despite data collection limitations, present EV data may suggest that, at least in comparison with olanzapine, quetiapine misuse may be a cause for concern.
date: 2018-02
language: eng
short title: Is There a Potential of Misuse for Quetiapine?
library catalog: PubMed
description: PMID: 29210868
pages: 72-79

Journal of Clinical Psychopharmacology
type: Journal
volume: 38
identifier: DOI 10.1097/JCP.0000000000000814
number: 1
alternative: J Clin Psychopharmacol
identifier: ISSN 1533-712X

PubMed entry
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item type: attachment
date submitted: 2023-02-17 21:36:26
link mode: 3
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Quetiapine Fumarate Market 2022: Market Size, Top Countries Data - WICZ
type: Document
item type: webpage
is part of: Website
link: Quetiapine Fumarate Market 2022: Market Size, Top Countries Data - WICZ
date submitted: 2023-02-17 21:40:56

Quetiapine Fumarate Market 2022: Market Size, Top Countries Data - WICZ
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item type: attachment
date submitted: 2023-02-17 21:41:29
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020639s061lbl.pdf
type: Attachment
item type: attachment
date submitted: 2023-02-17 21:43:57
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type: application/pdf

Impact of FDA Black Box Advisory on Antipsychotic Medication Use
type: Article
item type: journalArticle
is part of: Archives of internal medicine
authors: Person
  surname: Dorsey
  given name: E. Ray
authors: Person
  surname: Rabbani
  given name: Atonu
authors: Person
  surname: Gallagher
  given name: Sarah A.
authors: Person
  surname: Conti
  given name: Rena M.
authors: Person
  surname: Alexander
  given name: G. Caleb
link: PubMed Central Full Text PDF
link: PubMed Central Link
abstract: Background In April 2005, the US Food and Drug Administration (FDA) issued an advisory and subsequent black box warning regarding the risks of atypical anti-psychotic use among elderly patients with dementia. The impact of these warnings on atypical drug use is unknown. Methods We used quasi-experimental, interrupted time-series analyses to examine nationally representative data from IMS Health’s National Disease and Therapeutic Index from January 2003 through December 2008. The primary measurement from this audit of office-based physicians was the use of an atypical antipsychotic agent. We quantified the impact of the advisory on atypical anti-psychotic use among all individuals and those 65 years or older with dementia. Results From January 2003 to March 2005, mentions of total atypical antipsychotic drugs increased at an annual rate of 34%, and among patients with dementia, 16%. In the year prior to the FDA advisory, there were approximately 13.6 million atypical drug mentions, including 0.8 million among those with dementia. In the year following the advisory, atypical drug mentions fell 2% overall and 19% among those with dementia. In 2004, 19% (0.8 of 4.1 million) of drug mentions for dementia were for an atypical agent. By 2008, this proportion decreased to 9% (0.4 of 4.3 million). Atypical drug use slowed for both FDA-approved and off-label indications and declined through 2008 for all populations examined. Conclusion The FDA advisory was associated with decreases in the use of atypical antipsychotics, especially among elderly patients with dementia.
date: 2010-1-11
library catalog: PubMed Central
date submitted: 2023-02-17 21:48:43
description: PMID: 20065205 PMCID: PMC4598075
pages: 96-103

Archives of internal medicine
type: Journal
volume: 170
identifier: DOI 10.1001/archinternmed.2009.456
number: 1
alternative: Arch Intern Med
identifier: ISSN 0003-9926

PubMed Central Full Text PDF
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date submitted: 2023-02-17 21:48:50
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PubMed Central Link
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item type: attachment
date submitted: 2023-02-17 21:48:45
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How common is off-label prescription of quetiapine? - PubMed
type: Document
item type: webpage
is part of: Website
link: How common is off-label prescription of quetiapine? - PubMed
date submitted: 2023-02-17 21:53:05

How common is off-label prescription of quetiapine? - PubMed
type: Attachment
item type: attachment
date submitted: 2023-02-17 21:53:13
link mode: 1
type: text/html

Evaluation of the use of low-dose quetiapine and the risk of metabolic consequences: A retrospective review
type: Article
item type: journalArticle
is part of: The Mental Health Clinician
authors: Person
  surname: Carr
  given name: Chelsea N.
authors: Person
  surname: Lopchuk
  given name: Shruti
authors: Person
  surname: Beckman
  given name: Mary E.
authors: Person
  surname: Baugh
  given name: Terrence Bradley
link: PubMed Central Link
link: Texto completo
abstract: Introduction: Quetiapine fumarate is an atypical antipsychotic approved for the treatment of schizophrenia, major depressive disorder, and bipolar disorder. Due to the sedative effects observed at low doses, prescribers use quetiapine to aid patients with sleep disturbances. Current evidence has established that quetiapine can cause negative changes in metabolic parameters, but it is unknown if these consequences also occur at low doses. Due to the use of quetiapine for sleep, the purpose of this study is to identify if metabolic effects are also a risk with the use of low-dose quetiapine. Methods: Eligible subjects were identified through the Veterans Affairs electronic medical records as having an active prescription for quetiapine from June 30, 2012, through September 1, 2013. Subjects were then evaluated using inclusion and exclusion criteria for determination of study entrance. Descriptive statistics and t tests were utilized to identify clinical and statistical differences in outcomes. Results: A total of 403 subjects were included in the final analysis. The average dose of quetiapine was 116.8 mg and average duration of therapy was 44 months. Increases were observed in systolic blood pressure (+1.95 mmHg; P = .036), diastolic blood pressure (+1.97 mmHg; P = .001), body mass index (+0.52; P = .001), weight (+1.88 kg; P = .002), and fasting blood glucose (+6.71 mg/dL; P = .002). Conversely, a decrease in total cholesterol (−10.06 mg/dL; P < .001) was recognized. Discussion: As a result of the findings, there may be negative metabolic consequences with the use of low-dose quetiapine. Routine prescribing of low doses for sleep as a first-line medication should be avoided.
date: 2016-11-3
short title: Evaluation of the use of low-dose quetiapine and the risk of metabolic consequences
library catalog: PubMed Central
date submitted: 2023-02-17 22:03:22
description: PMID: 29955487 PMCID: PMC6007538
pages: 308-313

The Mental Health Clinician
type: Journal
volume: 6
identifier: DOI 10.9740/mhc.2016.11.308
number: 6
alternative: Ment Health Clin
identifier: ISSN 2168-9709

PubMed Central Link
type: Attachment
item type: attachment
date submitted: 2023-02-17 22:03:24
link mode: 3
type: text/html

Texto completo
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date submitted: 2023-02-17 22:03:41
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Concerns about quetiapine - Australian Prescriber
type: Document
item type: webpage
is part of: Website
link: Concerns about quetiapine - Australian Prescriber
date submitted: 2023-02-17 22:08:03

Concerns about quetiapine - Australian Prescriber
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item type: attachment
date submitted: 2023-02-17 22:08:12
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Quetiapine for primary insomnia: Consider the risks | Cleveland Clinic Journal of Medicine
type: Document
item type: webpage
is part of: Website
link: 286.long
date submitted: 2023-02-17 22:11:44

286.long
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item type: attachment
date submitted: 2023-02-17 22:11:54
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Quetiapine for primary insomnia: Consider the risks
type: Article
item type: journalArticle
is part of: Cleveland Clinic Journal of Medicine
authors: Person
  surname: Modesto-Lowe
  given name: Vania
authors: Person
  surname: Harabasz
  given name: Agata K.
authors: Person
  surname: Walker
  given name: Sophia A.
link: Full Text PDF
link: PubMed entry
abstract: The second-generation antipsychotic drug quetiapine (Seroquel) is increasingly being used off-label for treating insomnia in the general population, possibly to avoid standard medications with known addictive qualities and adverse side effects. However, evidence to support using it in this way is scant, and quetiapine is associated with weight gain and other metabolic effects. It must be used cautiously and with appropriate monitoring for adverse effects and abuse.
date: 2021/05/01
language: en
short title: Quetiapine for primary insomnia
library catalog: www.ccjm.org
date submitted: 2023-02-17 22:11:58
rights: Copyright © 2021 The Cleveland Clinic Foundation. All Rights Reserved.
description: Publisher: Cleveland Clinic Journal of Medicine Section: Review PMID: 33941603
pages: 286-294

Cleveland Clinic Journal of Medicine
type: Journal
volume: 88
identifier: DOI 10.3949/ccjm.88a.20031
number: 5
alternative: CCJM
identifier: ISSN 0891-1150, 1939-2869

Full Text PDF
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item type: attachment
date submitted: 2023-02-17 22:12:02
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date submitted: 2023-02-17 22:12:03
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Efficacy of quetiapine for delirium prevention in hospitalized older medical patients: a randomized double-blind controlled trial
type: Article
item type: journalArticle
is part of: BMC geriatrics
authors: Person
  surname: Thanapluetiwong
  given name: Saran
authors: Person
  surname: Ruangritchankul
  given name: Sirasa
authors: Person
  surname: Sriwannopas
  given name: Orapitchaya
authors: Person
  surname: Chansirikarnjana
  given name: Sirintorn
authors: Person
  surname: Ittasakul
  given name: Pichai
authors: Person
  surname: Ngamkala
  given name: Tipanetr
authors: Person
  surname: Sukumalin
  given name: Lalita
authors: Person
  surname: Charernwat
  given name: Piangporn
authors: Person
  surname: Saranburut
  given name: Krittika
authors: Person
  surname: Assavapokee
  given name: Taweevat
link: PubMed entry
link: Texto completo
subject: Aged
subject: Humans
subject: Double-Blind Method
subject: Antipsychotic Agents
subject: Quetiapine Fumarate
subject: Delirium
subject: Haloperidol
subject: Hospitalized
subject: Older
subject: Prevention
subject: Quetiapine
subject: Thailand
abstract: BACKGROUND: Delirium is a common disorder among hospitalized older patients and results in increased morbidity and mortality. The prevention of delirium is still challenging in older patient care. The role of antipsychotics in delirium prevention has been limited. Therefore, we conducted a trial to investigate the efficacy of quetiapine use to prevent delirium in hospitalized older medical patients. METHODS: This study was a randomized double-blind controlled trial conducted at Ramathibodi Hospital, Bangkok, Thailand. Patients aged ≥65 years hospitalized in the internal medicine service were randomized to quetiapine 12.5 mg or placebo once daily at bedtime for a maximum 7-day duration. The primary end point was delirium incidence. Secondary end points were delirium duration, length of hospital stay, ICU admission, rehospitalization and mortality within 30 and 90 days. RESULTS: A total of 122 patients were enrolled in the study. Eight (6.6%) left the trial before receiving the first dose of the intervention, whereas 114 (93.4%) were included in an intention-to-treat analysis allocated to the quetiapine or placebo group (n = 57 each). The delirium incidence rates in the quetiapine and placebo groups were 14.0 and 8.8% (OR = 1.698, 95% CI 0.520-5.545, P = 0.381), respectively. Other endpoints in the quetiapine and placebo groups were the median length of hospital stay, 6 (4-8) days versus 5 (4-8) days (P = 0.133), respectively; delirium duration, 4 (2.3-6.5) versus 3 (1.5-4.0) days (P = 0.557), respectively; ICU admission, 3 (5.3%) patients from both groups (P = 1.000); and mortality in the quetiapine and placebo groups, 1 (1.8%) versus 2 (3.5%) at 30 days (P = 0.566) and 7 (12.3%) versus 9 (15.8%) days at 90 days (P = 0.591). There were no significant differences in other outcomes. None of the participants reported adverse events. CONCLUSIONS: Quetiapine prophylaxis did not reduce delirium incidence in hospitalized older medical patients. The use of quetiapine to prev…
date: 2021-03-31
language: eng
short title: Efficacy of quetiapine for delirium prevention in hospitalized older medical patients
library catalog: PubMed
description: PMID: 33789580 PMCID: PMC8010962
pages: 215

BMC geriatrics
type: Journal
volume: 21
identifier: DOI 10.1186/s12877-021-02160-7
number: 1
alternative: BMC Geriatr
identifier: ISSN 1471-2318

PubMed entry
type: Attachment
item type: attachment
date submitted: 2023-02-17 22:13:03
link mode: 3
type: text/html

Texto completo
type: Attachment
item type: attachment
date submitted: 2023-02-17 22:13:16
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Quetiapine withdrawal: A systematic review
type: Article
item type: journalArticle
is part of: The Australian and New Zealand Journal of Psychiatry
authors: Person
  surname: Monahan
  given name: Katherine
authors: Person
  surname: Cuzens-Sutton
  given name: Jaimie
authors: Person
  surname: Siskind
  given name: Dan
authors: Person
  surname: Kisely
  given name: Steve
link: PubMed entry
subject: Humans
subject: Quetiapine Fumarate
subject: Substance Withdrawal Syndrome
subject: Quetiapine
subject: Anxiety Disorders
subject: discontinuation
subject: discontinuation symptoms
subject: Psychomotor Agitation
subject: Psychotic Disorders
subject: withdrawal
abstract: OBJECTIVE: Withdrawal from psychoactive medication such as quetiapine is a well-documented phenomenon. Despite the extensive use of quetiapine, there have been few studies into the presence of discontinuation symptoms. We therefore performed a systematic review of published literature for evidence of quetiapine withdrawal or symptoms associated with discontinuation. METHODS: We searched PubMed, Embase, CINAHL, Medline, Web of Science, PsycINFO for articles containing the terms 'Quetiapine' AND 'withdraw$' OR 'discontinue$'. We included all study types that reported on somatic withdrawal symptoms and had no language restrictions. We excluded studies where there was withdrawal from multiple medications or any other psychoactive substance, or where the only symptoms were psychological such as rebound psychosis or craving. RESULTS: We included 13 papers, all of which were individual case reports. The quality of the individual case reports was sub-optimal, as assessed by the CARE Case Report Guidelines. There was an association between rapid cessation of quetiapine and onset of somatic symptoms such as nausea, vomiting, agitation, restlessness, diaphoresis, irritability, anxiety, dysphoria, sleep disturbance, insomnia, tachycardia, hypertension and dizziness. Three studies also reported the onset of a withdrawal dyskinesia characterised by abnormal choreiform movements as well as confusion and speech disturbance in some cases. However, these findings were limited by the number and quality of case reports identified. CONCLUSION: Discontinuation symptoms are an uncommon side effect of quetiapine cessation, which may have clinical implications. Clinicians should therefore be alert to the possibility of quetiapine withdrawal in individuals who present with somatic symptoms or choreiform movements. However, large prospective studies are required to clarify this association.
date: 2021-08
language: eng
short title: Quetiapine withdrawal
library catalog: PubMed
description: PMID: 33059460
pages: 772-783

The Australian and New Zealand Journal of Psychiatry
type: Journal
volume: 55
identifier: DOI 10.1177/0004867420965693
number: 8
alternative: Aust N Z J Psychiatry
identifier: ISSN 1440-1614

PubMed entry
type: Attachment
item type: attachment
date submitted: 2023-02-17 22:14:42
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Antipsychotics: History, Science, and Issues
type: Book
item type: book
authors: Person
  surname: Jeffrey Kerner
authors: Person
  surname: Bridget McCoy M.D
date: 2017-01-01
archive: eBook Academic Collection (EBSCOhost)
coverage: 1447091
date submitted: 2023-03-17
identifier: ISBN 978-1-4408-3988-7

Quetiapine Misuse and Abuse: Is it an Atypical Paradigm of Drug Seeking Behavior? - PMC
type: Document
item type: webpage
is part of: Website
link: Quetiapine Misuse and Abuse: Is it an Atypical Paradigm of Drug Seeking Behavior? - PMC
date submitted: 2023-03-17 20:01:38

Quetiapine Misuse and Abuse: Is it an Atypical Paradigm of Drug Seeking Behavior? - PMC
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date submitted: 2023-03-17 20:01:48
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WMA - The World Medical Association-Declaración de Helsinki de la AMM – Principios éticos para las investigaciones médicas en seres humanos
type: Document
item type: blogPost
is part of: Blog
link: Snapshot
language: es-ES
date submitted: 2023-05-01 03:28:35

Snapshot
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item type: attachment
date submitted: 2023-05-01 03:29:00
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Resolución 8430 de 1993 - Colombia
type: Document
item type: webpage
is part of: www.redjurista.com
authors: Person
  surname: SAS
  given name: Redjurista
link: Snapshot
abstract: <%=Documento.descripcion%>
language: es-CO
date submitted: 2023-05-01 03:31:08

Snapshot
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date submitted: 2023-05-01 03:31:15
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Resolución 8430 de 1993 - Colombia
type: Document
item type: webpage
is part of: www.redjurista.com
authors: Person
  surname: SAS
  given name: Redjurista
link: Snapshot
abstract: <%=Documento.descripcion%>
language: es-CO
date submitted: 2023-05-01 03:34:23

Snapshot
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item type: attachment
date submitted: 2023-05-01 03:34:29
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Antipsychotic prescription patterns in patients affiliated to the Social Security Health System in Colombia
type: Article
item type: journalArticle
is part of: Biomédica
authors: Person
  surname: Machado-Alba
  given name: Jorge E.
authors: Person
  surname: Morales-Plaza
  given name: Cristhian David
link: Full Text PDF
subject: Colombia
subject: antipsicóticos
subject: clozapina
subject: esquizofrenia
subject: farmacoepidemiología
subject: haloperidol
subject: prescripciones de medicamentos
abstract: Introduction: Schizophrenia alters individual perception, thought, affection and behavior. Drug therapy can improve these manifestations.Objective: To determine prescription patterns of antipsychotic drugs in a group of patients affiliated to the Social Security Health System in Colombia.Materials and methods: This was a descriptive study with a 6.2 million people database. We selected 3,075 patients medicated with antipsychotics, of both sexes, and all ages, with continuous treatment from March to June, 2012, and residing in 57 Colombian cities. We designed a database on drug consumption, obtained by the company that distributes the drugs to the patients.Results: A total of 3,075 patients were studied, with an age mean of 55.8 ± 21.5 years; 50.3% of the participants were women. Of all patients, 81.9% were receiving monotherapy and 18.1% two or more antipsychotics. Prescription order was 77.1% atypical and 31.9% conventional. The most frequently used drugs were: quetiapine (on 30.3% of the patients), clozapine (23.7%), levomepropamize (18.4%),and risperidone (14.9%). The most common combinations were: haloperidol + levomepromazine (n=67,12.1%), clozapine + pipotiazine (n=54, 9.7%), clozapine + risperidone (n=45, 8.1%), and quetiapine +levomepromazine (n=40, 7.2%). The most prescribed co-medications were: antidepressants (n=998,32.5%), anxiolytic (n=799, 26.0%), statins (n=672, 21.9%); antiparkinsonians (n=341, 11.1%), and antidiabetic drugs (n=327, 10.6%).Conclusions: The practice of prescribing drugs with a high therapeutic value predominates mainly inantipsychotic monotherapy. Most agents were used in higher doses than recommended. This raises the need to design educational strategies to address these prescribing habits and research for evaluating the effectiveness of the treatment. doi: http://dx.doi.org/10.7705/biomedica.v33i3.1529
date: 2013-09-01
language: en
library catalog: revistabiomedica.org
date submitted: 2024-03-25 20:54:00
rights: Derechos de autor
description: Number: 3
pages: 418-28

Biomédica
type: Journal
volume: 33
identifier: DOI 10.7705/biomedica.v33i3.1529
number: 3
identifier: ISSN 2590-7379

Full Text PDF
type: Attachment
item type: attachment
date submitted: 2024-03-25 20:54:01
link mode: 1
type: application/pdf

Investigación con población vulnerable
type: Article
item type: journalArticle
is part of: Journal
authors: Person
  surname: Meerbeke
  given name: Alberto Vélez Van
link: Meerbeke - Investigación con población vulnerable.pdf
language: es
library catalog: Zotero

Meerbeke - Investigación con población vulnerable.pdf
type: Attachment
item type: attachment
date submitted: 2024-04-29 22:40:12
link mode: 1
type: application/pdf

ICMJE | Recommendations | Defining the Role of Authors and Contributors
type: Document
item type: webpage
is part of: Website
link: ICMJE | Recommendations | Defining the Role of Authors and Contributors
date submitted: 2024-04-29 22:40:32

ICMJE | Recommendations | Defining the Role of Authors and Contributors
type: Attachment
item type: attachment
date submitted: 2024-04-29 22:40:38
link mode: 1
type: text/html

Abuse and misuse of second-generation antipsychotics: An analysis using VigiBase, the World Health Organisation pharmacovigilance database
type: Article
item type: journalArticle
is part of: British Journal of Clinical Pharmacology
authors: Person
  surname: Roy
  given name: Sophie
authors: Person
  surname: Charreteur
  given name: Robin
authors: Person
  surname: Peries
  given name: Marianne
authors: Person
  surname: Kheloufi
  given name: Farid
authors: Person
  surname: Eiden
  given name: Céline
authors: Person
  surname: Nagot
  given name: Nicolas
authors: Person
  surname: Donnadieu-Rigole
  given name: Hélène
authors: Person
  surname: Micallef
  given name: Joëlle
authors: Person
  surname: Peyrière
  given name: Hélène
link: Full Text PDF
link: Snapshot
subject: abuse
subject: disproportionality analysis
subject: misuse
subject: second-generation antipsychotics
abstract: The study aim was to assess the abuse/misuse potential of second-generation antipsychotics (SGAPs) using VigiBase data. We extracted individual case safety reports of “Drug abuse, dependence and withdrawal” involving SGAPs up to June 2018. We assessed disproportionate reporting by calculating the information component, considering the lower end of the 95% credibility interval for the information component (IC025), and the proportional reporting ratio. We identified 1683 individual case safety reports recorded as “abuse, dependence and withdrawal” involving SGAPs, mainly quetiapine (n = 1089) and olanzapine (n = 209). The disproportional reporting indicators highlighted an association between “Drug abuse and dependence”, and quetiapine, olanzapine and ziprasidone, as indicated by the IC025 (2.263, 0.259 and 1.051, respectively) and proportional reporting ratio values (3.929, 1.020 and 1.334, respectively). The abuse/misuse potential is confirmed for quetiapine and olanzapine and highlighted for the first time for ziprasidone. Physicians should consider these risks when prescribing these antipsychotics, especially to patients with history of drug abuse.
date: 2022
language: en
short title: Abuse and misuse of second-generation antipsychotics
library catalog: Wiley Online Library
date submitted: 2024-04-29 22:46:01
rights: © 2022 British Pharmacological Society.
description: _eprint: https://onlinelibrary.wiley.com/doi/pdf/10.1111/bcp.15420
pages: 4646-4653

British Journal of Clinical Pharmacology
type: Journal
volume: 88
identifier: DOI 10.1111/bcp.15420
number: 10
identifier: ISSN 1365-2125

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date submitted: 2024-04-29 22:46:05
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INCREASING OFF-LABEL USE OF ANTIPSYCHOTIC MEDICATIONS IN THE UNITED STATES, 1995-2008
type: Article
item type: journalArticle
is part of: Pharmacoepidemiology and drug safety
authors: Person
  surname: Alexander
  given name: G. Caleb
authors: Person
  surname: Gallagher
  given name: Sarah A.
authors: Person
  surname: Mascola
  given name: Anthony
authors: Person
  surname: Moloney
  given name: Rachael M.
authors: Person
  surname: Stafford
  given name: Randall S.
link: PubMed Central Full Text PDF
link: PubMed Central Link
abstract: Objective To evaluate patterns of antipsychotic use. Design, setting, and measurements We used nationally representative data from the IMS Health National Disease and Therapeutic Index to describe outpatient antipsychotic use. The primary outcome was the volume of visits where antipsychotics were used for specific indications (treatment visits). We also quantified use without U.S. Food and Drug Administration approval (off-label use) and off-label use with compendium data suggesting an uncertain evidence base. Results Antipsychotic use increased from 6.2 million (M) treatment visits (95% CI, 5.4-7.0) in 1995 to 16.7M visits (15.5-18.2) in 2006, then declined to 14.3M visits (13.0-15.6) by 2008. A shift occurred from typical agents in 1995 (84% of all antipsychotic visits) to atypical agents by 2008 (93%). As they declined, typical medications shifted towards use in schizophrenia (30% in 1995 to 48% 2008). In contrast, use of atypical agents expanded for bipolar affective disorder (10% to 34%), remained stable for depression (12% to 14%), and declined for schizophrenia (56% to 23%). Overall, antipsychotic use for indications without FDA approval increased from 4.4M visits in 1995 to 9.0M in 2008. The estimated cost associated with off-label use in 2008 was US$6.0 billion. Conclusions Atypical use has grown far beyond substitution for the now infrequently used typical agents. Antipsychotics are increasingly used for conditions where FDA approval and associated clinical evidence is less certain. Despite the value of innovation, the benefits of widening atypical antipsychotic use should be weighed against their cost, regulatory status, and incomplete nature of available evidence.
date: 2011-2
library catalog: PubMed Central
date submitted: 2024-04-29 22:49:49
description: PMID: 21254289 PMCID: PMC3069498
pages: 177-184

Pharmacoepidemiology and drug safety
type: Journal
volume: 20
identifier: DOI 10.1002/pds.2082
number: 2
alternative: Pharmacoepidemiol Drug Saf
identifier: ISSN 1053-8569

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Metabolic Consequences of Using Low-Dose Quetiapine for Insomnia in Psychiatric Patients
type: Article
item type: journalArticle
is part of: Community Mental Health Journal
authors: Person
  surname: Cates
  given name: Marshall E.
authors: Person
  surname: Jackson
  given name: Cherry W.
authors: Person
  surname: Feldman
  given name: Jacqueline M.
authors: Person
  surname: Stimmel
  given name: Amanda E.
authors: Person
  surname: Woolley
  given name: Thomas W.
subject: Quetiapine
subject: Body mass index
subject: Insomnia
subject: Psychiatry
subject: Weight gain
abstract: Quetiapine is frequently prescribed for insomnia that is comorbid with psychiatric disorders, but there has been no documentation of metabolic adverse effects associated with this practice. The objective of this study was to document changes in weight, body mass index, and waist circumference that occurred when low-dose quetiapine was used at bedtime for insomnia. The study was a retrospective chart review conducted at a community mental health center. Patients were non-elderly (19–65 years old) psychiatric patients who received quetiapine at ≤200 mg at bedtime for the explicit indication of insomnia. Forty-three patients were included in the study. Weight and BMI increased by an average of 4.9 lb. (P = 0.037) and 0.8 points (P = 0.048), respectively. Males experienced statistically significant increases in weight and BMI, and Caucasians experienced a statistically significant increase in BMI. There were no significant differences between baseline and endpoint metabolic parameters when examined by baseline BMI, age category, psychiatric diagnosis, or concomitant psychotropic medication. Despite the low doses typically used when quetiapine is prescribed for insomnia, metabolic adverse effects can occur and should be considered in the overall benefit to risk analysis.
date: 2009-08-01
language: en
library catalog: Springer Link
date submitted: 2024-04-29 22:55:46
pages: 251-254

Community Mental Health Journal
type: Journal
volume: 45
identifier: DOI 10.1007/s10597-009-9200-0
number: 4
alternative: Community Ment Health J
identifier: ISSN 1573-2789

Inappropriate long-term use of antipsychotic drugs is common among people with dementia living in specialized care units
type: Article
item type: journalArticle
is part of: BMC Pharmacology & Toxicology
authors: Person
  surname: Gustafsson
  given name: Maria
authors: Person
  surname: Karlsson
  given name: Stig
authors: Person
  surname: Lövheim
  given name: Hugo
link: PubMed Central Full Text PDF
link: PubMed Central Link
abstract: Background Antipsychotic drugs are widely used for the treatment of Behavioral and Psychological Symptoms of Dementia (BPSD), despite their limited efficacy and concerns about safety. The aim of this study was to describe antipsychotic drug therapy among people with dementia living in specialized care units in northern Sweden. Methods This study was conducted in 40 specialized care units in northern Sweden, with a total study population of 344 people with dementia. The study population was described in regard to antipsychotic drug use, ADL function, cognitive function and BPSD, using the Multi-Dimensional Dementia Assessment Scale (MDDAS). These data were collected at baseline and six months later. Detailed data about antipsychotic prescribing were collected from prescription records. Results This study showed that 132 persons (38%) in the study population used antipsychotic drugs at the start of the study. Of these, 52/132 (39%) had prescriptions that followed national guidelines with regard to dose and substance., After six months, there were 111 of 132 persons left because of deaths and dropouts. Of these 111 people, 80 (72%) were still being treated with antipsychotics, 63/111 (57%) with the same dose. People who exhibited aggressive behavior (OR: 1.980, CI: 1.515-2.588), or passiveness (OR: 1.548, CI: 1.150-2.083), or had mild cognitive impairment (OR: 2.284 CI: 1.046-4.988), were at increased risk of being prescribed antipsychotics. Conclusion The prevalence of antipsychotic drug use among people with dementia living in specialized care units was high and inappropriate long-term use of antipsychotic drugs was common.
date: 2013-2-8
library catalog: PubMed Central
date submitted: 2024-04-29 22:59:24
description: PMID: 23391323 PMCID: PMC3575309
pages: 10

BMC Pharmacology & Toxicology
type: Journal
volume: 14
identifier: DOI 10.1186/2050-6511-14-10
alternative: BMC Pharmacol Toxicol
identifier: ISSN 2050-6511

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date submitted: 2024-04-29 22:59:28
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date submitted: 2024-04-29 22:59:26
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Behavioral and Psychological Symptoms of Dementia
type: Article
item type: journalArticle
is part of: Frontiers in Neurology
authors: Person
  surname: Cerejeira
  given name: J.
authors: Person
  surname: Lagarto
  given name: L.
authors: Person
  surname: Mukaetova-Ladinska
  given name: E. B.
link: PubMed Central Full Text PDF
link: PubMed Central Link
abstract: Behavioral and psychological symptoms of dementia (BPSD), also known as neuropsychiatric symptoms, represent a heterogeneous group of non-cognitive symptoms and behaviors occurring in subjects with dementia. BPSD constitute a major component of the dementia syndrome irrespective of its subtype. They are as clinically relevant as cognitive symptoms as they strongly correlate with the degree of functional and cognitive impairment. BPSD include agitation, aberrant motor behavior, anxiety, elation, irritability, depression, apathy, disinhibition, delusions, hallucinations, and sleep or appetite changes. It is estimated that BPSD affect up to 90% of all dementia subjects over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long-term hospitalization, misuse of medication, and increased health care costs. Although these symptoms can be present individually it is more common that various psychopathological features co-occur simultaneously in the same patient. Thus, categorization of BPSD in clusters taking into account their natural course, prognosis, and treatment response may be useful in the clinical practice. The pathogenesis of BPSD has not been clearly delineated but it is probably the result of a complex interplay of psychological, social, and biological factors. Recent studies have emphasized the role of neurochemical, neuropathological, and genetic factors underlying the clinical manifestations of BPSD. A high degree of clinical expertise is crucial to appropriately recognize and manage the neuropsychiatric symptoms in a patient with dementia. Combination of non-pharmacological and careful use of pharmacological interventions is the recommended therapeutic for managing BPSD. Given the modest efficacy of current strategies, there is an urgent need to identify novel pharmacological targets and develop new non-pharmacological approaches to improve the adverse outcomes associated with BP…
date: 2012-5-07
library catalog: PubMed Central
date submitted: 2024-04-29 23:01:26
description: PMID: 22586419 PMCID: PMC3345875
pages: 73

Frontiers in Neurology
type: Journal
volume: 3
identifier: DOI 10.3389/fneur.2012.00073
alternative: Front Neurol
identifier: ISSN 1664-2295

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Diagnosis and treatment of insomnia
type: Article
item type: journalArticle
is part of: American Journal of Health-System Pharmacy
authors: Person
  surname: Passarella
  given name: Stacy
authors: Person
  surname: Duong
  given name: Minh-Tri
link: Snapshot
abstract: Purpose. The diagnostic criteria and treatment of insomnia are reviewed.Summary. Insomnia is most often described as a subjective complaint of poor sleep quality or quantity despite adequate time for sleep, resulting in daytime fatigue, irritability, and decreased concentration. Insomnia is classified as idiopathic or comorbid. Comorbid insomnias are associated with psychiatric disorders, medical disorders, substance abuse, and specific sleep disorders. Idiopathic insomnia is essentially a diagnosis of exclusion. A wide array of terminology exists for defining the duration of insomnia symptoms, which may add to the confusion regarding insomnia classification. Acute insomnia refers to sleep problems lasting from one night to a few weeks, whereas chronic insomnia refers to sleep problems lasting at least three nights weekly for at least one month. Diagnostic tools for identifying insomnia are multifactorial. Nonpharmacologic interventions for insomnia include sleep-hygiene education, stimulus-control therapy, relaxation therapy, and sleep-restriction therapy. The most effective pharmacologic therapies for insomnia are benzodiazepines, benzodiazepine-receptor agonists, melatonin-receptor agonists, and antidepressants. Choice of a specific agent should be based on patient-specific factors, including age, proposed length of treatment, primary sleep complaint, history of drug or alcohol abuse, and cost.Conclusion. Many treatment options are available for patients with insomnia. Behavioral therapies should be initiated as first-line treatment in most patients. For patients who require the addition of pharmacologic therapy, the drugs with the most evidence for benefit include benzodiazepines, benzodiazepine-receptor agonists, melatonin-receptor agonists, and antidepressants. Selection of a specific agent must take into account numerous patient-specific factors.
date: 2008-05-15
library catalog: Silverchair
date submitted: 2024-04-29 23:03:48
pages: 927-934

American Journal of Health-System Pharmacy
type: Journal
volume: 65
identifier: DOI 10.2146/ajhp060640
number: 10
alternative: American Journal of Health-System Pharmacy
identifier: ISSN 1079-2082

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item type: attachment
date submitted: 2024-04-29 23:03:56
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After the black box warning: predictors of psychotropic treatment choices for older patients with dementia
type: Article
item type: journalArticle
is part of: Psychiatric Services (Washington, D.C.)
authors: Person
  surname: Kim
  given name: Hyungjin Myra
authors: Person
  surname: Chiang
  given name: Claire
authors: Person
  surname: Kales
  given name: Helen C.
link: PubMed entry
subject: Aged
subject: Female
subject: Humans
subject: Male
subject: Retrospective Studies
subject: Cohort Studies
subject: Aged, 80 and over
subject: Choice Behavior
subject: Contraindications
subject: Dementia
subject: Drug Labeling
subject: Practice Patterns, Physicians'
subject: Psychotropic Drugs
subject: United States
subject: United States Department of Veterans Affairs
subject: United States Food and Drug Administration
abstract: OBJECTIVES: This study aimed to evaluate factors associated with the selection of pharmacological treatments often given as first-line treatments to elderly patients with neuropsychiatric symptoms associated with dementia. It also evaluated patterns of medication usage over time in the year preceding and three years after the U.S. Food and Drug Administration issued a black box warning for antipsychotic usage. METHODS: A retrospective cohort consisted of 19,517 Veterans Affairs patients with diagnosed dementia and a new outpatient start with an antipsychotic agent (haloperidol, olanzapine, quetiapine, or risperidone) or valproic acid and its derivatives between May 1, 2004, and September 30, 2008. Patient and facility characteristics were examined for their association with the new starts of these medications. RESULTS: Trends in the rate of fills for psychotropic medications varied, with yearly increases in the use of quetiapine, haloperidol, and valproic acid and decreasing use of olanzapine and risperidone. Predictors of haloperidol use included a new start in nonpsychiatric settings, prior benzodiazepine use, and any prior-year hospitalization. Anxiety disorder and major depression were predictive of not receiving haloperidol. Parkinson's disease was predictive of quetiapine use, whereas bipolar disorder was predictive of valproic acid use. Older age was predictive of use of antipsychotics rather than valproic acid. Urban facilities were less likely to use olanzapine, and significant regional variations were seen. CONCLUSIONS: Important patient and facility characteristics were associated with initiating different psychotropic agents among elderly dementia patients. In addition, the rate of use and the factors predictive of use varied across the study years.
date: 2011-10
language: eng
short title: After the black box warning
library catalog: PubMed
description: PMID: 21969648
pages: 1207-1214

Psychiatric Services (Washington, D.C.)
type: Journal
volume: 62
identifier: DOI 10.1176/ps.62.10.pss6210_1207
number: 10
alternative: Psychiatr Serv
identifier: ISSN 1557-9700

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item type: attachment
date submitted: 2025-04-07 20:33:18
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International trends in antipsychotic use: A study in 16 countries, 2005–2014
type: Article
item type: journalArticle
is part of: European Neuropsychopharmacology
authors: Person
  surname: Hálfdánarson
  given name: Óskar
authors: Person
  surname: Zoëga
  given name: Helga
authors: Person
  surname: Aagaard
  given name: Lise
authors: Person
  surname: Bernardo
  given name: Miquel
authors: Person
  surname: Brandt
  given name: Lena
authors: Person
  surname: Fusté
  given name: Anna Coma
authors: Person
  surname: Furu
  given name: Kari
authors: Person
  surname: Garuoliené
  given name: Kristina
authors: Person
  surname: Hoffmann
  given name: Falk
authors: Person
  surname: Huybrechts
  given name: Krista F.
authors: Person
  surname: Kalverdijk
  given name: Luuk J.
authors: Person
  surname: Kawakami
  given name: Koji
authors: Person
  surname: Kieler
  given name: Helle
authors: Person
  surname: Kinoshita
  given name: Takuya
authors: Person
  surname: Litchfield
  given name: Melisa
authors: Person
  surname: López
  given name: Soffy C.
authors: Person
  surname: Machado-Alba
  given name: Jorge E.
authors: Person
  surname: Machado-Duque
  given name: Manuel E.
authors: Person
  surname: Mahesri
  given name: Mufaddal
authors: Person
  surname: Nishtala
  given name: Prasad S.
authors: Person
  surname: Pearson
  given name: Sallie-Anne
authors: Person
  surname: Reutfors
  given name: Johan
authors: Person
  surname: Saastamoinen
  given name: Leena K.
authors: Person
  surname: Sato
  given name: Izumi
authors: Person
  surname: Schuiling-Veninga
  given name: Catharina C. M.
authors: Person
  surname: Shyu
  given name: Yu-Chiau
authors: Person
  surname: Skurtveit
  given name: Svetlana
authors: Person
  surname: Verdoux
  given name: Hélène
authors: Person
  surname: Wang
  given name: Liang-Jen
authors: Person
  surname: Yahni
  given name: Corinne Zara
authors: Person
  surname: Bachmann
  given name: Christian J.
link: ScienceDirect Snapshot
link: Texto completo
subject: Adult
subject: Aged
subject: Internationality
subject: Antipsychotic agents
subject: Minors
subject: Pharmacoepidemiology
abstract: The objective of this study was to assess international trends in antipsychotic use, using a standardised methodology. A repeated cross-sectional design was applied to data extracts from the years 2005 to 2014 from 16 countries worldwide. During the study period, the overall prevalence of antipsychotic use increased in 10 of the 16 studied countries. In 2014, the overall prevalence of antipsychotic use was highest in Taiwan (78.2/1000 persons), and lowest in Colombia (3.2/1000). In children and adolescents (0–19 years), antipsychotic use ranged from 0.5/1000 (Lithuania) to 30.8/1000 (Taiwan). In adults (20–64 years), the range was 2.8/1000 (Colombia) to 78.9/1000 (publicly insured US population), and in older adults (65+ years), antipsychotic use ranged from 19.0/1000 (Colombia) to 149.0/1000 (Taiwan). Atypical antipsychotic use increased in all populations (range of atypical/typical ratio: 0.7 (Taiwan) to 6.1 (New Zealand, Australia)). Quetiapine, risperidone, and olanzapine were most frequently prescribed. Prevalence and patterns of antipsychotic use varied markedly between countries. In the majority of populations, antipsychotic utilisation and especially the use of atypical antipsychotics increased over time. The high rates of antipsychotic prescriptions in older adults and in youths in some countries merit further investigation and systematic pharmacoepidemiologic monitoring.
date: 2017-10-01
short title: International trends in antipsychotic use
library catalog: ScienceDirect
date submitted: 2025-04-07 20:33:27
pages: 1064-1076

European Neuropsychopharmacology
type: Journal
volume: 27
identifier: DOI 10.1016/j.euroneuro.2017.07.001
number: 10
alternative: European Neuropsychopharmacology
identifier: ISSN 0924-977X

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date submitted: 2025-04-07 20:33:32
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date submitted: 2025-04-07 20:33:48
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Effects of quetiapine on sleep: A systematic review and meta-analysis of clinical trials
type: Article
item type: journalArticle
is part of: European Neuropsychopharmacology
  type: Journal
  volume: 67
  identifier: DOI 10.1016/j.euroneuro.2022.11.008
  alternative: European Neuropsychopharmacology
  identifier: ISSN 0924-977X
authors: Person
  surname: Lin
  given name: Che-Yin
authors: Person
  surname: Chiang
  given name: Cheng-Hen
authors: Person
  surname: Tseng
  given name: Mei-Chih Meg
authors: Person
  surname: Tam
  given name: Ka-Wai
authors: Person
  surname: Loh
  given name: El-Wui
link: ScienceDirect Snapshot
subject: antipsychotic
subject: dosage
subject: insomnia
subject: quetiapine
subject: side effects
subject: sleep quality
abstract: Quetiapine is a common off-label antipsychotic drug for treating insomnia. Its effects in different disease conditions and dosages remain unclear. We conducted a systematic review and meta-analysis in clinical trials examining the efficacy of low-dose quetiapine in sleep. We obtained 21 clinical trials. Mean difference (MD), standard mean difference (SMD), and odds ratio (OR) were used to estimate the effect sizes using a random-effects model. The pooled results showed that quetiapine improved sleep quality compared with placebo (SMD: -0.57 [95%CI: -0.75, -0.4]). The SMD of sleep quality was correlated with age (coefficient: -0.0174) and sex (coefficient: -0.012). The significant effects were observed in the general anxiety disorder (SMD: -0.59 [95%CI: -0.92, -0.27]), major depressive disorder (SMD: -0.47 [95%CI: -0.66, -0.28]), and healthy (SMD: -1.33, [95%CI [-2.12, -0.54]) subgroups, at the dosage of 50 mg (SMD: -0.36 [95%CI: -0.36, -0.11]), 150 mg (SMD: -0.4 [95%CI: -0.52, -0.29]), and 300 mg (SMD: -0.17 [95%CI: -0.31,-0.04]). Quetiapine increased total sleep time compared with placebo (MD: 47.91 [95%CI: 28.06, 67.76]) but not when compared with other psychiatric drugs (MD: -4.19 [95%CI: -19.43, 11.05]). Adverse events (AEs) and discontinuation due to AEs were common among the quetiapine users. Quetiapine is effective as a sleep-helping drug. Precaution is suggested when interpreting the results on the elderly due to the high heterogeneity caused by incorporating patients over 66 years in the meta-analyses. We recommend an initial dosage of 50-150 mg/day with priority consideration for the elderly with GAD or MDD while monitoring its potential AEs.
date: 2023-02-01
short title: Effects of quetiapine on sleep
library catalog: ScienceDirect
date submitted: 2025-04-07 21:55:07
pages: 22-36

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