Quetiapine for Sleep in Patients with Dementia

Dolder, Christian R.; McKinsey, Jonathan

doi:10.4140/tcp.n.2010.676

Cited by 17 publications

(9 citation statements)

References 15 publications

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“…Quetiapine is commonly used off-label for a variety of conditions, one of which is insomnia (Hartung et al 2008; Philip et al 2008; Wine et al 2009; Dolder and McKinsey 2010), although results from a meta-analysis described quetiapine efficacy as inconclusive (Maher et al 2011). There are, however, several studies showing positive results of quetiapine for treating insomnia (Robert et al 2005; Wiegand et al 2008; Tassniyom et al 2010; Endicott et al 2012; Sheehan et al 2012).…”

Section: Discussionmentioning

confidence: 99%

Effects of quetiapine treatment on cocaine self-administration and behavioral indices of sleep in adult rhesus monkeys

Brutcher

Nader

2014

Psychopharmacology

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Rationale Clinical literature suggests a link between substance abuse and sleep disturbances. Quetiapine, an atypical antipsychotic has shown efficacy in treating sleep disturbances, with clinical studies showing promise for quetiapine as a treatment for cocaine abuse. Objective The goal of this study was to examine the effects of quetiapine on cocaine self-administration and behavioral indices of sleep in monkeys. Methods Seven adult male rhesus monkeys, fitted with Actical® activity monitors, were trained to respond under a choice paradigm of food (1.0-g pellets) and cocaine (0.003–0.3 mg/kg per injection) presentation. First, monkeys received acute pretreatment (45 min) with quetiapine (25–75 mg, p.o.) prior to choice sessions; three cocaine doses were studied in combination with quetiapine. Next, the effect of chronic (14–16 days) quetiapine treatment (25–250 mg, p.o., BID) was examined in combination with the lowest preferred cocaine dose (≥ 80% cocaine choice). Behavioral indices of sleep, based on activity measures obtained during lights-out, were recorded throughout the study. Results Acute quetiapine decreased cocaine choice in four of the seven monkeys. Chronic quetiapine treatment resulted in initial decreases, but tolerance developed to these effects. Acute doses of quetiapine did not improve sleep efficiency the following night, nor did chronic quetiapine. The first night after discontinuing quetiapine treatment resulted in significant decreases in sleep efficiency and increases in nighttime activity. Conclusions These findings do not offer support for the use of quetiapine as a monotherapy for treatment of cocaine abuse nor as an adjunct therapy to treat sleep disturbances associated with stimulant abuse.

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Section: Discussionmentioning

confidence: 99%

Effects of quetiapine treatment on cocaine self-administration and behavioral indices of sleep in adult rhesus monkeys

Brutcher

Nader

2014

Psychopharmacology

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“…It is nevertheless interesting to note that quetiapine is the only atypical AP which was not addressed in a specific safety warning. Furthermore, quetiapine is also prescribed for the management of sleep disturbances, which may explain an increase in its use [20]. This hypothesis could not be investigated in the current study owing to absence of data on indication in the RAMQ drug claims database.…”

Section: Discussionmentioning

confidence: 94%

“…19) and no association was found with the 2005 warning through multiple linear regression analysis (p=0. 20).…”

Section: Resultsmentioning

confidence: 99%

Patterns of Antipsychotic use Among Community-Dwelling Elderly Patients with Dementia: Impact of Regulatory Warnings

Craig¹,

Tannenbaum²,

Ducruet³

et al. 2016

Med Safe Glo Heal

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Purpose: In Canada, regulatory warnings on cerebrovascular effects of risperidone and olanzapine in the elderly population with dementia were issued, respectively, in 2002 and 2004, and those on mortality associated with all atypical antipsychotics (APs) in 2005. These warnings led to a decrease in the prescription of APs, but effects on patterns of usage remain poorly examined. We conducted a study to assess the association between warnings and patterns of AP use in a population of community-dwelling elderly with dementia. Methods: A retrospective cohort of 10,969 community-dwelling elderly (age 66+) with dementia who were new users of APs between 1st January 2000 and 31st December 2009 was assembled through the Quebec drug claims database (RAMQ). Association between regulatory warnings and rate of initiation of AP treatment was evaluated through interrupted time series analysis. Effects of the 2005 warning on cerebrovascular history in treated patients, and AP usage patterns (dosage, duration) were assessed, respectively through multivariate logistic regression and multiple linear regression analysis. Results: The proportion of AP treatments initiated with risperidone decreased over time while that of quetiapine increased and of olanzapine remained stable. Controlling for covariates, the cerebrovascular risk profile of treated patients did not change after the 2005 warning (OR=1.05, 95%CI: 0.90-1.22). A small decrease in mean prescribed daily dose for risperidone was observed after the 2005 warning (-0.05 mg, p<0.001) while an increase was observed for olanzapine (+0.34 mg, p=0.009) and quetiapine (+1.27 mg, p=0.40). No change in treatment duration was observed (p=0.19). Conclusion: Although regulatory warnings led to a decrease in the use of atypical APs, these products are still widely prescribed off-label in the elderly population with dementia. Channelling of APs toward patients with lower cerebrovascular risks and changes in prescription practices were not apparent after the warnings.

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“…In fact, efficacy of quetiapine for improving behavioral and psychological symptoms of dementia is not well established and findings from randomized clinical trials are inconclusive 24,25 . Nevertheless, off‐label use of quetiapine and other antipsychotics for dementia has been reported in multiple Scandinavian countries 26 and one study found that 46% of quetiapine‐treated patients with dementia received quetiapine for sleep disorders 27 …”

Section: Discussionmentioning

confidence: 99%

Predictors of quetiapine extended‐release formulation add‐on in older patients exposed to antidepressant drugs: A Danish register‐based cohort study

Hashimi

Andersen

Sessa

2020

Int J Geriat Psychiatry

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Objective This study investigated which comorbidities or comedications increased the probability of receiving quetiapine extended‐release formulation (quetiapine XR) as an add‐on treatment. Methods Danish administrative registers were used as data sources. The study period was from 01 January 2011 to 01 July 2017. New users of selective serotonin reuptake inhibitors (SSRI), serotonin and norepinephrine reuptake inhibitors (SNRI), atypical antidepressants (AAD), and tricyclic antidepressants (TCA) aged ≥65 years were included in the study population. A multivariable Cox regression model was used to find predictors for receiving quetiapine XR add‐on within the first year of antidepressant therapy. Results A total of 123 655 new users of SSRI, SNRI, TCA, and AAD were eligible. The study population was composed of 57.7% females and the mean age was 77.2 years (SD 7.9 years). SSRI users comprised 49.6% of the study population. Among users of antidepressants, 171 (0.14%) patients received quetiapine XR as add‐on treatment. In the adjusted analyses, female patients (HR 0.70; 95%CI 0.52‐0.95) and glucocorticoid users (HR 0.41; 95%CI 0.21‐0.80) had a significantly lower hazard of receiving quetiapine XR. Patients with dementia (HR 2.43; 95%CI 1.52‐3.87) had a significantly higher hazard of receiving quetiapine XR than patients without this condition. When compared with SSRI users, AAD (HR 1.80; 95%CI 1.31‐2.46) and TCA users (HR 0.18; 95%CI 0.06‐0.49) had an increased/reduced hazard of receiving quetiapine XR, respectively. Conclusions This study suggests that the choice of prescribing quetiapine add‐on is driven by patient's differences in comorbidities, comedications and the type of antidepressant drug.

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Quetiapine for Sleep in Patients with Dementia

Abstract: quetiapine prescribed as a sedative-hypnotic in patients with dementia, while common, is understudied and not without risk.

Cited by 17 publications

References 15 publications

Effects of quetiapine treatment on cocaine self-administration and behavioral indices of sleep in adult rhesus monkeys

Effects of quetiapine treatment on cocaine self-administration and behavioral indices of sleep in adult rhesus monkeys

Patterns of Antipsychotic use Among Community-Dwelling Elderly Patients with Dementia: Impact of Regulatory Warnings

Predictors of quetiapine extended‐release formulation add‐on in older patients exposed to antidepressant drugs: A Danish register‐based cohort study

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