Metabolic Consequences of Using Low-Dose Quetiapine for Insomnia in Psychiatric Patients

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 < or =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.

Atypical antipsychotics for insomnia: a systematic review

“…Daytime somnolence was reported in three of the five studies while dry mouth was reported in one, consistent with adverse events found by Tassniyom et al (14). Uncontrolled retrospective chart reviews have suggested that low doses (around 100mg nightly) of quetiapine used for insomnia may lead to weight gain in younger (36-45 year old) males with psychiatric disorders (20,21). It is difficult to draw firm conclusions surrounding benefits or harms of atypical antipsychotics from these small, uncontrolled studies.…”

Dispensed prescriptions for quetiapine and other second-generation antipsychotics in Canada from 2005 to 2012: a descriptive study

“…Quetiapine is well recognized for its ability to exacerbate cardiovascular risk factors, including hypertension, dyslipidemia and obesity, even when used at lower doses for insomnia. 4,9,38 Less well recognized are risks of severe hepatitis, potentially chronic movement disorders, pneumonia, hypothyroidism and confusion. 4,9,[39][40][41][42] Norquetiapine, the major metabolite of quetiapine, is anticholinergic and can produce blurred vision and dry mouth among other anticholinergic side effects.…”

Indications of atypical antipsychotics in the elderly

“…These are symptoms that commonly affect the elderly. The use of quetiapine does have some appeal, as there is evidence to suggest that quetiapine has efficacy for these symptoms [15,[23][24][25][26], but it must be noted that its use can lead to significant short-and long-term side effects, which include sedation (potentially beneficial depending on the indication it is used for), weight gain (even at low doses), type two diabetes mellitus, raised lipids and sudden cardiac death [14,[27][28][29].…”