Rapid dose initiation of quetiapine for the treatment of acute schizophrenia and schizoaffective disorder: a randomised, multicentre, parallel‐group, open study

Boidi, G.; Ferro, Maurizio

doi:10.1002/hup.844

Cited by 17 publications

(14 citation statements)

References 26 publications

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“…These results are supported by another, larger, multicentre study in 269 hospitalised patients with schizophrenia or schizoaffective disorder which used the same dosing regimens as above for rapid and standard initiation [43]. In this study, rapid initiation of quetiapine was well tolerated, with no serious AEs, and there was no significant difference in the numbers of patient discontinuations due to AEs at Day 7 in the rapid and standard initiation groups (n 0/ 3 and n 0/ 2, respectively).…”

Section: Appropriate Dosing In the Acute Settingsupporting

confidence: 68%

“…One small study reported a higher incidence of orthostatic hypotension, but this was comparable between rapid (2/13 patients; 15.4%) and standard (1/7 patients; 14.3%) initiation groups [46]. In summary, although outside current prescribing information guidance, clinical experience and results from rapid initiation studies indicate that, in hospitalised patients with acute schizophrenia or bipolar mania, quetiapine can be initiated at 200 mg and the dose increased in increments of 200 mg/day to reach 800 mg by Day 4 (Figure 3) [42,43,46,47]. An alternative dosing regimen based on clinical experience has also been suggested for investigation in future clinical trials (N. Keks, personal communication).…”

Section: Appropriate Dosing In the Acute Settingmentioning

confidence: 99%

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Management of acutely ill patients in the hospital setting: focus on quetiapine

Kasper

Arango

Bandinelli

et al. 2007

International Journal of Psychiatry in Clinical Practice

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We have considered published work and clinical experience focusing on the atypical antipsychotic quetiapine in order to form a consensus on the most appropriate treatment strategies for hospitalised patients with acute schizophrenia or bipolar disorder. It is important to consider the specific treatment needs of these patients and these are discussed in the context of current treatment guidelines. We will review the efficacy and tolerability of atypical antipsychotics versus conventional antipsychotics and/or benzodiazepines as a first-line treatment, and examine the suitability of oral versus intramuscular formulations in the acute setting. The potentially beneficial properties of specific atypical agents are also considered. Appropriate dosing is particularly important in acutely ill patients as it can help achieve rapid improvement. We will discuss emerging data which show that rapid initiation of quetiapine in patients with acute psychosis or mania is not only as effective as standard initiation, but is also well tolerated. This may be important for treatment in the long term as a positive initial treatment experience can determine patient compliance and treatment adherence. In conclusion, this review recommends that oral atypical antipsychotics should be a first-choice medication for acutely ill cooperative patients in the hospital setting.

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Section: Appropriate Dosing In the Acute Settingsupporting

confidence: 68%

Section: Appropriate Dosing In the Acute Settingmentioning

confidence: 99%

Management of acutely ill patients in the hospital setting: focus on quetiapine

Kasper

Arango

Bandinelli

et al. 2007

International Journal of Psychiatry in Clinical Practice

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“…Quetiapine can be initiated at a dosage of 100 mg twice daily with subsequent dosage increases of 200 mg/day. [92][93][94] Olanzapine [95,96] and risperidone [97] may also be safely initiated with as much as 40 mg/day and 6 mg/day, respectively, in divided doses.…”

Section: Antipsychotic Reinitiationmentioning

confidence: 99%

“…Support for this strategy comes from the evaluation of protocols for rapid initial dose escalation of atypical antipsychotics. In these studies, rapid titration of quetiapine (up to 800 mg/day in 4 days [92][93][94] ), olanzapine (up to 40 mg in the first 24 hours [95,96] ) and risperidone (up to 6 mg in the first 24 hours [97] ) was possible with the use of multiple daily dosing regimens.…”

Section: Antipsychotic Dosing Frequencymentioning

confidence: 99%

Antipsychotic Pharmacotherapy and Orthostatic Hypotension

Gugger

2011

CNS Drugs

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Orthostatic hypotension is a common adverse effect of antipsychotics that may delay or prevent titration to a dose necessary to control psychotic symptoms. Complications of orthostatic hypotension include syncope, transient ischaemic attack, stroke, myocardial infarction and death. The risk of orthostatic hypotension associated with antipsychotic therapy is increased in patients with disorders of the autonomic nervous system, fluid imbalance and those taking concomitant drug therapy that affects haemodynamic tone. Prospective monitoring for changes in postural blood pressure is important because patients with psychotic disorders often do not articulate symptoms of orthostasis and the subjective report of dizziness does not correlate well with orthostatic blood pressure changes. Nonpharmacological strategies and patient education, most notably, slowly rising from the supine position, are crucial first steps in the prevention and treatment of both symptomatic and asymptomatic orthostatic hypotension. Pharmacological treatment is only recommended when symptomatic orthostatic hypotension persists despite proper nonpharmacological therapy and there is a compelling indication for antipsychotic treatment. Fludrocortisone is a reasonable first choice for symptomatic orthostatic hypotension. Other agents including desmopressin and midodrine may be considered in patients who do not respond favourably to a trial of fludrocortisone, but safety concerns and lack of evidence limit the utility of these agents.

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“…Orthostatic hypotension, dizziness, and syncope are of specific concern during rapid titration of quetiapine 74. In the post-hoc analysis, the incidence of these events was low during the first week of treatment, supporting rapid initiation 73…”

Section: Safety and Tolerabilitymentioning

confidence: 87%

The management of schizophrenia: focus on extended-release quetiapine fumarate

Peuskens

2011

NDT

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Effective management of schizophrenia remains a significant clinical challenge. While antipsychotic medications have proven efficacy in this disease, there remains an opportunity to further improve symptom control and long-term relapse prevention. Also, a number of factors, including tolerability and complex dosing regimens, can result in nonadherence to medication. Quetiapine is an atypical antipsychotic with proven efficacy and an established tolerability profile in schizophrenia. The once-daily extended-release formulation (quetiapine XR) offers a simplified dosing regimen and titration schedule. Short-term clinical studies have shown that quetiapine XR (400–800 mg/d) is efficacious in the acute treatment of schizophrenia, while a long-term study has shown that quetiapine XR was significantly more effective than placebo at preventing relapse. Furthermore, an investigation in which stable patients switched from the immediate-release formulation (quetiapine IR) to quetiapine XR showed that quetiapine XR is generally well tolerated and has no loss of efficacy compared with quetiapine IR. In patients who experienced insufficient efficacy or poor tolerability on their previous antipsychotic, switching to quetiapine XR significantly improved efficacy compared with the previous treatment. In conclusion, quetiapine XR is an effective and generally well tolerated treatment for schizophrenia. Furthermore, once-daily dosing may improve patient adherence, which may impact positively on patient outcomes.

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Rapid dose initiation of quetiapine for the treatment of acute schizophrenia and schizoaffective disorder: a randomised, multicentre, parallel‐group, open study

Abstract: A higher proportion of patients experienced AEs with rapid initiation of quetiapine (800 mg/day by Day 4), although withdrawals due to AEs were comparable. Rapid initiation of quetiapine was generally well tolerated and effective in this setting.

Cited by 17 publications

References 26 publications

Management of acutely ill patients in the hospital setting: focus on quetiapine

Management of acutely ill patients in the hospital setting: focus on quetiapine

Antipsychotic Pharmacotherapy and Orthostatic Hypotension

The management of schizophrenia: focus on extended-release quetiapine fumarate

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