Is There a Potential of Misuse for Quetiapine?

Abstract

Despite data collection limitations, present EV data may suggest that, at least in comparison with olanzapine, quetiapine misuse may be a cause for concern.

Is There a Potential of Misuse for Venlafaxine and Bupropion?

“…After a formal request to EMA, we were allowed to access and analyze the EV ADRs database, relating to all venlafaxine- and bupropion-related case reports submitted spontaneously up to mid-July 2016; for a thorough description of the EV database refer to Chiappini and Schifano ( 2016 , 2018 ). In order to focus on misuse; abuse; dependence; and withdrawal issues, in the two datasets we selected and identified the following ADRs: “dependence,” “drug abuse,” “drug abuse(r),” “drug dependence,” “drug diversion,” “drug withdrawal headache,” “drug withdrawal syndrome,” “intentional product misuse,” “intentional product use issue,” “substance abuse,” “substance dependence,” and “withdrawal syndrome.” Specifically, “misuse” was here meant to be the “intentional and inappropriate use of a product other than as prescribed or not in accordance with the authorized product information.” Conversely, “abuse” was here defined as the “intentional non-therapeutic use of a product for a perceived reward or desired non-therapeutic effect including, but not limited to, getting high/euphoria” (MedDRA, 2012 ).…”

“…ADRs' numbers differed from those referring to case reports, since different reporters/senders could have independently flagged the same ADR to EMA. We included here those ADRs which were listed as the “suspect drug,” meaning that the reporter suspected this drug, and not the concomitant medicine(s), to have caused the index ADR (Chiappini and Schifano, 2018 ). To more properly assess current data, the proportional reporting ratio (PRR) approach was considered, here defined as: “the ratio between the frequency with which a specific adverse event is reported for the drug of interest (relative to all adverse events reported for the drug) and the frequency with which the same adverse event is reported for the drug(s) in the comparison group (relative to all adverse events for drugs in the comparison group; EMA, 2008 ).…”

“…The misuse or abuse of prescription drugs is a recently emerging issue, becoming a reason of public concern (Schifano et al, 2015 ). Intentional misuse of prescribing medications involves gabapentinoids (Chiappini and Schifano, 2016 ); anticholinergics (Schifano and di Costanzo, 1991 ); a range of stimulants (Schifano et al, 2015 ); performance- and image-enhancing drugs (Schifano et al, 2015 ); and a few antipsychotics (Chiappini and Schifano, 2018 ). Although a worldwide rise of antidepressant (ADs) consumption (Kantor et al, 2015 ; OECD Indicators, 2015 ) has been described, there are only a few studies relating to the AD potential of misuse and withdrawal.…”

“…To better define the context for change in ADRs over time, it may be important to consider bupropion and venlafaxine prescription rates' historical information. Although, for a range of reasons, the worldwide prescription figures for these molecules are not available (Chiappini and Schifano, 2018 ), England-based data from the Prescription Cost Analysis (Data.gov.uk, 2016 ) were here taken into account as a reference, hence serving as a general indication of prescription trends. When considering the available January 2009-December 2016 time-frame, the number of venlafaxine prescription items dispended increased over time, from 2.51 (2009) to 3.9 million (2016).…”

Focus on Clozapine Withdrawal- and Misuse-Related Cases as Reported to the European Medicines Agency (EMA) Pharmacovigilance Database

“…Due to clozapine's effectiveness, there has been support for considering the molecule in limiting substance use in patients with schizophrenia [26], to achieve both a reduction in substance use [27,28] and an improvement in positive/negative schizophrenia symptoms [29]. Additionally, differently from other antipsychotics, such as quetiapine, which has showed in recent years to be a strong potential for misuse and abuse [30][31][32][33], the recreational use of clozapine has not been noted in the literature. Conversely, clozapine withdrawal is a phenomenon which has already been described, even at therapeutic dosages [9].…”