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HWN Suggests

One of America’s most popular drugs — first aimed at schizophrenia — reveals the issues of ‘off-label’ use

These days, the powerful antipsychotic is used for an expansive array of ills, including insomnia, post-traumatic stress disorder and agitation in patients with dementia. Many of the doctors who turn to it for off-label uses are physicians with minimal training in psychiatry and, medical experts say, too little understanding of the potential downsides...

In the meantime, a pill that medical experts say can cause diabetes, heart arrhythmia and potentially irreversible movement disorders continues to be prescribed to many Americans who are only seeking a good night’s sleep or less anxiety by day. Many are probably not aware that it is a drug originally aimed at the delusions and paranoia…

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 Explainer: what is Seroquel and should you take it for insomnia?

Doctors prescribe quetiapine off-label for various conditions, including anxiety, autism, post-traumatic stress disorder, substance abuse and obsessive compulsive disorder. It is also increasingly prescribed off-label for insomnia, usually at lower doses of 100mg or less a day.

 From Wonder Drug to Catastrophe: My Seroquel Story

At first, it was a love story. It was the winter of 2004. After more than three years of getting a minuscule amount of broken sleep every night and trying every insomnia remedy possible – from herbal and nutritional supplements to Ayurvedic medicine to prescription drugs known to be sedating, such as the antidepressant Remeron (mirtazapine) – a VA psychiatrist decided to prescribe me, off-label, the atypical antipsychotic Seroquel (quetiapine). A specialist in psychopharmacology, he quickly titrated me up to 400 mg and informed me that this was the highest effective dose for insomnia. The results were miraculous. Sleep became easy; I slept a solid eight hours every night and I thought that would be the simple, joyful end of my quest for sleep.

Articles of Interest

Abilify® vs Seroquel®: Which Medication Is Right for You?

Abilify® and Seroquel® are both atypical antipsychotic medications used to treat mental health disorders such as schizophrenia, bipolar disorder, and major depressive disorder. Abilify (aripiprazole) is a partial agonist at dopamine and serotonin receptors, while Seroquel (quetiapine) has antagonist effects on these receptors. Both medications have similar indications for use, but Abilify also has a unique indication for treating irritability associated with autistic disorder.

Concerns about quetiapine

Quetiapine has proven safety and efficacy when used for its approved indications. However, there are concerning increases in the rates of off-label prescribing for indications with limited evidence. Adverse outcomes are most likely to occur in already vulnerable populations such as older people, those with mental health problems and substance misusers.

Heart Warning Added to Label on Popular Antipsychotic Drug

AstraZeneca is adding a new heart warning to the labels of Seroquel, its blockbuster antipsychotic drug, at the request of the Food and Drug Administration, company and agency officials said on Monday. The revised label, posted without fanfare last week on the F.D.A. Web site, says Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines linked to a heart arrhythmia that can cause sudden cardiac arrest.

Quetiapine (Seroquel®)

This sheet is about exposure to quetiapine in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare providers.

Quetiapine Misuse and Abuse: Is it an Atypical Paradigm of Drug Seeking Behavior?

There is a growing concern within the medical community in regard to the potential harm from prescribing quetiapine for its off-label use as well as dependence potential. In addition, there have been a number of international high-profile court cases in the media regarding quetiapine-related death involving either drug-drug interactions or overdose. Little is known about the reasons for off-label prescribing, but a historical perspective of sedative and hypnotic prescribing trends may explain this escalating use.

Role of quetiapine beyond its clinical efficacy in bipolar disorder: From neuroprotection to the treatment of psychiatric disorders

Quetiapine is a pleiotropic agent that affects multiple neurotransmitter and non-transmitter targets. This drug may therefore exhibit efficacy for the management of a wide range of mental disorders.

Seroquel: 7 things you should know

Seroquel (quetiapine) is known to act on numerous receptors in the brain but the exact way it works is unknown; however, some experts believe its mood-calming effects may be through the antagonism of dopamine and serotonin receptors. Seroquel may also affect histamine receptors (responsible for its side effect of sedation) and adrenergic alpha1 receptors (responsible for the fall in blood pressure when standing).

Should We Be Worried About Australia's Off-Label Drug Prescriptions?

First-hand accounts from both patients and medical professionals, provided to VICE on background, indicate that antipsychotics and anti-epileptics have found space in the void created by crackdowns on benzodiazepines and prescription opioids. Australians across varying demographics are being prescribed them off-label, or using them non-medically, to treat anxiety, sleeplessness, or chronic pain.

Resources

NAMI

Quetiapine is a medication that works in the brain to treat schizophrenia. It is also known as a second-generation antipsychotic (SGA) or atypical antipsychotic. Quetiapine rebalances dopamine and serotonin to improve thinking, mood, and behavior.

StatPearls

Quetiapine has a strong affinity for the 5-HT2 receptor. Although quetiapine has many complex mechanisms, it mediates its pharmacological effect mainly via its 5HT2 antagonistic action. It also acts on dopaminergic D1 and D2 receptors.