Quetiapine

Background

• Should be prescribed in line with licensed indications

• Should not be used as a hypnotic

• Off-label prescribing only when other options exhausted

• Caution in patients with substance use history

Indications

• Immediate release

  • Bipolar Affective Disorder

  • Schizophrenia

• Extended Release

  • Bipolar Affective Disorder

  • MDD

  • GAD

Off label use

• Insomnia

• Anxiety disorders including OCD and PTSD

• BPD

• Psychosis and behavioural disturbances in dementia

• Psychosis in Parkinson’s Disease

• ADHD

• Eating disorders

Sleep

• Sedative effect from mechanism on histamine receptors

• NNH = 3 for sedation

• Lack of evidence to support efficacy or safety for use in insomnia

• Dose escalation is sometimes needed to maintain effect

• Australia guidelines for insomnia advise against Quetiapine

Anxiety

• XR is TGA approved for anxiety disorders but only modest evidence to support use as monotherapy

• Australian guidelines do not support use

• International guidelines suggest only by specialists

BPD

• Some evidence of low dose may be effective in BPD although evidence remains insufficient to be placed in guidelines

Dementia / LBD

• Mixed evidence

• Practice based evidence and some guidelines support low-dose short-term use over other antipsychotics

ADHD / Eating Disorders

• Limited evidence

Resources

• Antipsychotic Monitoring - NPS