Patients who were participating in a clinical trial during the study period or who were being treated in forensic care were excluded. The primary outcome was to evaluate the antipsychotic use of quetiapine XR and IR in patients with schizophrenia. Patients who received a total daily dose of at least mg were regarded as being treated with quetiapine mainly for antipsychotic reasons, whilst those on a total daily dose of less than mg were regarded as having been treated with quetiapine as an add-on to other antipsychotics.
All analyses were prespecified in a statistical analysis plan and performed using the SAS software, version 9.
The percentage of patients treated with concomitant drugs was calculated using a Poison regression with length of hospital stay as offset variable.
The statistical null hypothesis was that the groups had the same average value or proportion and p values for rejecting this hypothesis were calculated.
A p value below 0. Demographic data were equal for the two treatment groups Table 1. The mean number of concomitant medications was 3. Patients receiving quetiapine IR were to a higher degree treated with other antipsychotics both short and long term than those on quetiapine XR Table 3.
Most concomitant antipsychotic and antidepressant medications were long term, while drugs for mood stabilization, anxiety or sleep disorders were short term. There was no significant difference in the number of concomitant medications at discharge 2. Patients on quetiapine XR had a numerically longer duration of hospitalization than those in the quetiapine IR group Patient comorbidities and reasons for treatment were recorded for psychiatric conditions other than schizophrenia, as well as for somatic reasons.
There were a number of reasons for treating other disorders, including insomnia, psychosis, anxiety, and schizophrenia per se. There was no significant difference between the groups with respect to insomnia or sedation as reasons for treatment. A total of 33 patients used both quetiapine XR and quetiapine IR during hospitalization. Four were taking both quetiapine XR and IR when admitted to the hospital, 18 Among the 18 patients who used both quetiapine formulations in combination, 14 patients used a higher mean dose of quetiapine XR Table 5.
This naturalistic study investigated the clinical use of quetiapine XR and quetiapine IR in hospitalized patients with schizophrenia in 14 psychiatric clinics in Sweden. The primary finding was that quetiapine XR was used in considerably higher doses than quetiapine IR. This finding supports the interpretation that quetiapine XR more often is used as the main antipsychotic drug, whereas quetiapine IR is more often used as an add-on medication in schizophrenia.
Overall, patients had two or more — and in some cases up to seven or eight — antipsychotic medications during hospitalization, reflecting the typical situation faced by physicians of severely ill patients. The most common historical combination of medications in this setting is that of a typical plus an atypical antipsychotic [ Bingefors et al.
This was also the case here, the most common typical antipsychotics being zuclopenthixol and haloperidol when used for at least 7 days. Patients with comorbid substance abuse were significantly more likely to receive treatment with quetiapine XR than IR.
Also, patients treated with quetiapine XR were reported to have more somatic disease than those on quetiapine IR. Further, significant differences in the reported reasons for treatment between quetiapine XR and IR were seen.
Patients on quetiapine XR were more often treated for schizophrenia per se and those on quetiapine IR more often for psychosis, although this result should be interpreted with caution as reported reasons for treatment may not be consistent across prescribers and patients. Further, although statistically not significant, lower GAF scores at hospital admission, longer duration of hospitalization, and higher use of ECT was reported for patients receiving quetiapine XR compared with IR.
Taken together, the present study points to a different use of quetiapine XR compared with quetiapine IR in this setting. Medication adherence should arguably increase in importance with disease severity. In fact, adherence is a considerable challenge in schizophrenia [ Goff et al. However, any improvement in adherence will improve patient outcomes [ Ascher-Svanum et al.
Please see additional information within the full Prescribing Information. By finding a treatment that works for you, and taking it regularly, you may experience improvement in your symptoms. Be patient and follow the directions of your health care professional. Elderly patients with dementia-related psychosis having lost touch with reality due to confusion and memory loss treated with this type of medicine are at an increased risk of death, compared to placebo sugar pill.
Stop SEROQUEL XR and call your doctor right away if you have some or all of the following symptoms: high fever; excessive sweating; stiff muscles; confusion; changes in pulse, heart rate, and blood pressure.
These may be symptoms of a rare, but very serious and potentially fatal, side effect called neuroleptic malignant syndrome NMS. If you develop symptoms of high blood sugar or diabetes, such as excessive thirst or hunger, increased urination, or weakness, contact your doctor. Complications from diabetes can be serious and even life threatening. Your doctor should check your weight regularly.
Tell your doctor about any movements you cannot control in your face, tongue, or other body parts, as they may be signs of a serious condition called tardive dyskinesia TD.
Other risks include feeling dizzy or lightheaded upon standing, falls which may cause serious injuries , trouble swallowing, or decreases in white blood cells which can be fatal. Fever, flu-like symptoms, or any other infection could be a result of a very low white blood cell count. Tell your healthcare provider as soon as possible if you experience any of these.
Before starting treatment, tell your doctor about all prescription and nonprescription medicines you are taking. Also tell your doctor if you have or have had low white blood cell count, seizures, abnormal thyroid tests, high prolactin levels, heart or liver problems, trouble emptying your bladder, enlarged prostate, constipation, increased pressure inside your eyes, or cataracts.
Several of these antipsychotic medications, including quetiapine Seroquel , have become particularly popular for use in treating depression. Known as atypical or second-generation antipsychotics, quetiapine and others in this class are approved by the Food and Drug Administration FDA to treat schizophrenia and, in most cases, bipolar disorder.
But their off-label use for depression, anxiety, and other non-psychotic disorders has become so widespread that antipsychotic medications are now the top revenue-producing class of drugs in the U. Three of them-aripiprazole Abilify , olanzapine combined with an antidepressant and sold as Symbyax , and now the extended-release version of quetiapine Seroquel XR - recently gained FDA approval for the treatment of depression that hasn't responded to an antidepressant alone.
With quetiapine as the most recent addition to the list, is it a good idea to add this drug to your antidepressant treatment regimen? Most of the evidence for the use of quetiapine to treat depression consists of short-term studies. That's why an FDA advisory committee in voted not to recommend it as a stand-alone treatment for depression, citing concerns about potential long-term risks in a large population, especially when safer drugs are available.
But the committee found enough evidence in two six-week trials to recommend quetiapine for limited use as an add-on drug for "resistant depression. Goodman, M.
Physicians should be aware of the side effects and try other options first. Metabolic problems. Chronic use may cause weight gain and increases in cholesterol, triglycerides, and blood-sugar levels, which are components of metabolic syndrome - a disorder that increases the risk of diabetes , heart disease , and stroke. Movement disorders. Long-term use may lead to repetitive, uncontrollable movements of the face, tongue, and other parts of the body, and those symptoms tardive dyskinesia may be irreversible.
Sudden cardiac death. A large study, published in The New England Journal of Medicine, suggests that users of some atypical antipsychotics, including quetiapine, may have a greater risk of cardiac arrest than nonusers. Black-box warning the most serious kind issued by the FDA. Children, teenagers, and young adults who use quetiapine for depression may have an increased risk of suicidal thinking, and older adults undergoing treatment for dementia may have an increased risk of death.
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Advocacy State Fact Sheets. Advocacy Public Policy Reports. Quetiapine Seroquel. Know the warning signs Learn the common signs of mental illness in adults and adolescents. Mental health conditions Learn more about common mental health conditions that affect millions. Symptoms of schizophrenia include: Hallucinations — imagined voices or images that seem real Delusions — beliefs that are not true e.
Quetiapine is also FDA approved for the following indications: Acute treatment of manic episodes of bipolar disorder Acute treatment of depressive episodes of bipolar disorder Maintenance long-term treatment of bipolar disorder when used alone or with lithium or valproate Adjunctive treatment of major depressive disorder. This means quetiapine is used in addition to an antidepressant to help treat depression.
Missing doses of quetiapine may increase your risk for a relapse in your symptoms. Caution is advised with breastfeeding since quetiapine does pass into breast milk. Symptoms of your condition that bother you the most If you have thoughts of suicide or harming yourself Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects If you ever had muscle stiffness, shaking, tardive dyskinesia, neuroleptic malignant syndrome, or weight gain caused by a medication If you experience side effects from your medications, discuss them with your provider.
Some side effects may pass with time, but others may require changes in the medication. Any psychiatric or medical problems you have, such as heart rhythm problems, long QT syndrome, heart attacks, diabetes, high cholesterol, or seizures If you have a family history of diabetes or heart disease All other medications you are currently taking including over the counter products, herbal and nutritional supplements and any medication allergies you have Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment.
Your provider can explain how these different treatments work with the medication. If you are pregnant, plan to become pregnant, or are breast-feeding If you smoke, drink alcohol, or use illegal drugs How Should I Take Quetiapine? A specific treatment to reverse the effects of quetiapine does not exist.
Hallucinations, disorganized thinking, and delusions may improve in the first weeks Sometimes these symptoms do not completely go away Motivation and desire to be around other people can take at least weeks to improve Symptoms continue to get better the longer you take quetiapine It may take months before you get the full benefit of quetiapine Summary of FDA Black Box Warnings Increased mortality in elderly patients with dementia-related psychosis Both first generation typical and second generation atypical antipsychotics are associated with an increased risk of mortality in elderly patients when used for dementia related psychosis.
Although there were multiple causes of death in studies, most deaths appeared to be due to cardiovascular causes e. Antipsychotics are not indicated for the treatment of dementia-related psychosis.
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