Quetiapine: Difference between revisions

(One intermediate revision by one other user not shown)

Line 1:

'''Quetiapine''' (branded as '''Seroquel''', '''Xeroquel''', and '''~~Ketipinor~~''') is a short-acting atypical [[psychoactive class::antipsychotic]] approved for the treatment of schizophrenia, bipolar disorder, and along with an antidepressant to treat major depressive disorder.

'''Quetiapine''' (branded as '''Seroquel''', '''Xeroquel''', '''Ketipinor''', '''Ketilept''' and '''Derin''') is a short-acting atypical [[psychoactive class::antipsychotic]] approved for the treatment of schizophrenia, bipolar disorder, and along with an antidepressant to treat major depressive disorder.

Quetiapine was developed by AstraZeneca from 1992-1996 as an improvement from first-generation antipsychotics. It was first approved by the FDA in 1997.{{citation needed}}

Recreational usage is uncommon, but reports of quetiapine abuse have emerged within the medical literature. This seems to be driven by its [[sedative]] and [[anxiolytic]] effects (to help with sleep or to 'calm down') rather than by its antipsychotic properties.<ref name="Pierre2004">{{cite journal | vauthors=((Pierre, J. M.)), ((Shnayder, I.)), ((Wirshing, D. A.)), ((Wirshing, W. C.)) | journal=American Journal of Psychiatry | title=Intranasal Quetiapine Abuse | volume=161 | issue=9 | pages=1718–1718 | date= September 2004 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.161.9.1718 | issn=0002-953X | doi=10.1176/appi.ajp.161.9.1718}}</ref> In addition to oral administration, the drug is sometimes taken intranasally by insufflating pulverized tablets. Some estimate that up to 30% of inmates who were seen for psychiatric services in the Los Angeles County Jail were faking psychotic symptoms in an attempt to obtain quetiapine.<ref name="Pierre2004"/> It is thought that this drug is more commonly abused in prisons than on the street due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances.

Recreational usage is uncommon, but reports of quetiapine abuse have emerged within the medical literature. This seems to be driven by its [[sedative]] and [[anxiolytic]] effects (to help with sleep or to 'calm down') rather than by its antipsychotic properties.<ref name="Pierre2004">{{cite journal | vauthors=((Pierre, J. M.)), ((Shnayder, I.)), ((Wirshing, D. A.)), ((Wirshing, W. C.)) | journal=American Journal of Psychiatry | title=Intranasal Quetiapine Abuse | volume=161 | issue=9 | pages=1718–1718 | date= September 2004 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.161.9.1718 | issn=0002-953X | doi=10.1176/appi.ajp.161.9.1718}}</ref> In addition to oral administration, the drug is sometimes taken intranasally by insufflating pulverized tablets. Some estimate that up to 30% of inmates who were seen for psychiatric services in the Los Angeles County Jail were faking psychotic symptoms in an attempt to obtain quetiapine.<ref name="Pierre2004" /> It is thought that this drug is more commonly abused in prisons than on the street due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances.

==History and culture==

Quetiapine was developed by AstraZeneca from 1992-1996 as an improvement from first-generation antipsychotics. It was first approved by the FDA in 1997.{{citation needed}}

Annual sales of Seroquel are approximately $5.7 billion worldwide, with $2.9 billion in the United States.<ref>{{Citation | title=SEROQUEL Loss of Exclusivity (LOE). When will the SEROQUEL patents expire, and when will generic SEROQUEL be available? | url=//www.DrugPatentWatch.com/p/tradename/index.php?query=SEROQUEL}}</ref> The U.S. patent,<ref name="WarawaPatent">{{Citation | vauthors=((Warawa, E. J.)), ((Migler, B. M.)) | title=United States Patent: 4879288 - Novel dibenzothiazepine antipsychotic | url=https://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=4,879,288.PN.&OS=PN/4,879,288&RS=PN/4,879,288}}</ref> which was set to expire in 2011, received a pediatric exclusivity extension which pushed its expiration to March 26, 2012.<ref name="WarawaPatent"/><ref>Phillip Moeller (2011) Blockbuster Drugs That Will Go Generic Soon | http://money.usnews.com/money/blogs/the-best-life/2011/04/29/blockbuster-drugs-that-will-go-generic-soon</ref> The patent has already expired in Canada.

Annual sales of Seroquel are approximately $5.7 billion worldwide, with $2.9 billion in the United States.<ref>{{Citation | title=SEROQUEL Loss of Exclusivity (LOE). When will the SEROQUEL patents expire, and when will generic SEROQUEL be available? | url=//www.DrugPatentWatch.com/p/tradename/index.php?query=SEROQUEL}}</ref> The U.S. patent,<ref name="WarawaPatent">{{Citation | vauthors=((Warawa, E. J.)), ((Migler, B. M.)) | title=United States Patent: 4879288 - Novel dibenzothiazepine antipsychotic | url=https://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=4,879,288.PN.&OS=PN/4,879,288&RS=PN/4,879,288}}</ref> which was set to expire in 2011, received a pediatric exclusivity extension which pushed its expiration to March 26, 2012.<ref name="WarawaPatent" /><ref>Phillip Moeller (2011) Blockbuster Drugs That Will Go Generic Soon | http://money.usnews.com/money/blogs/the-best-life/2011/04/29/blockbuster-drugs-that-will-go-generic-soon</ref> The patent has already expired in Canada.

There are now several name brand versions of quetiapine, such as Quepin, Seroquel and Ketipinor.<ref>{{Citation | title=Quepin Tablets (Specifar), Drug Reference Encyclopedia | url=https://theodora.com/drugs/quepin_tablets_specifar.html}}</ref>

Line 26:

==Subjective effects==

{{effects/base

Line 43:

Line 44:

*'''[[Effect::Difficulty urinating]]'''

*'''[[Effect::Nausea suppression]]'''

*'''[[Effect::Restless Leg Syndrome]]'''

}}

Line 74:

Line 76:

===Combination effects===

*'''[[Cannabis]]''': Cannabis' effects synergise with quetiapine's effects thus increasing the physical effects of the "high" while decreasing the cognitive effects. <ref>https://www.drugs.com/interactions-check.php?drug_list=1979-0,2758-0</ref>

*'''[[Psychedelics]]''': Due to it being a [[serotonin|serotonergic]] [[antagonist]], quetiapine reduces the effects of psychedelics.

Line 89:

Line 92:

*'''Schizophrenia:''' There is tentative evidence of the benefit of quetiapine versus placebo in schizophrenia; however, definitive conclusions are not possible due to the high rate of attrition in trials (greater than 50%) and the lack of data on economic outcomes, social functioning, or quality of life.<ref>{{cite journal | vauthors=((Srisurapanont, M.)), ((Maneeton, B.)), ((Maneeton, N.)), ((Lankappa, S.)), ((Gandhi, R.)) | veditors=((Cochrane Schizophrenia Group)) | journal=Cochrane Database of Systematic Reviews | title=Quetiapine for schizophrenia | date=19 April 2004 | url=https://doi.wiley.com/10.1002/14651858.CD000967.pub2 | issn=14651858 | doi=10.1002/14651858.CD000967.pub2}}</ref>

*'''Bipolar disorder:''' In those with bipolar disorder, quetiapine is used to treat depressive episodes and acute manic episodes associated with bipolar I disorder.<ref>{{cite journal | vauthors=((Thase, M. E.)), ((Macfadden, W.)), ((Weisler, R. H.)), ((Chang, W.)), ((Paulsson, B.)), ((Khan, A.)), ((Calabrese, J. R.)) | journal=Journal of Clinical Psychopharmacology | title=Efficacy of Quetiapine Monotherapy in Bipolar I and II Depression: A Double-blind, Placebo-controlled Study (The BOLDER II Study) | volume=26 | issue=6 | pages=600–609 | date= December 2006 | url=https://journals.lww.com/00004714-200612000-00009 | issn=0271-0749 | doi=10.1097/01.jcp.0000248603.76231.b7}}</ref><ref>{{cite book | date= 2013 | title=British national formulary, no 65 (March - September 2013). | publisher=BMJ/Pharmaceutical Press | isbn=9780857110848}}</ref>

*'''Major depressive disorder:''' Quetiapine is effective when used by itself and when used along with other medications in major depressive disorder (MDD).<ref name="Komossa2010">{{cite journal | vauthors=((Komossa, K.)), ((Depping, A. M.)), ((Gaudchau, A.)), ((Kissling, W.)), ((Leucht, S.)) | veditors=((Cochrane Common Mental Disorders Group)) | journal=Cochrane Database of Systematic Reviews | title=Second-generation antipsychotics for major depressive disorder and dysthymia | date=8 December 2010 | url=https://doi.wiley.com/10.1002/14651858.CD008121.pub2 | issn=14651858 | doi=10.1002/14651858.CD008121.pub2}}</ref><ref>{{cite journal | vauthors=((Spielmans, G. I.)), ((Berman, M. I.)), ((Linardatos, E.)), ((Rosenlicht, N. Z.)), ((Perry, A.)), ((Tsai, A. C.)) | journal=PLOS Medicine | title=Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes | volume=10 | issue=3 | pages=e1001403 | date=12 March 2013 | url=https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001403 | issn=1549-1676 | doi=10.1371/journal.pmed.1001403}}</ref> However, sedation is often an undesirable side effect.<ref name="Komossa2010"/>

*'''Major depressive disorder:''' Quetiapine is effective when used by itself and when used along with other medications in major depressive disorder (MDD).<ref name="Komossa2010">{{cite journal | vauthors=((Komossa, K.)), ((Depping, A. M.)), ((Gaudchau, A.)), ((Kissling, W.)), ((Leucht, S.)) | veditors=((Cochrane Common Mental Disorders Group)) | journal=Cochrane Database of Systematic Reviews | title=Second-generation antipsychotics for major depressive disorder and dysthymia | date=8 December 2010 | url=https://doi.wiley.com/10.1002/14651858.CD008121.pub2 | issn=14651858 | doi=10.1002/14651858.CD008121.pub2}}</ref><ref>{{cite journal | vauthors=((Spielmans, G. I.)), ((Berman, M. I.)), ((Linardatos, E.)), ((Rosenlicht, N. Z.)), ((Perry, A.)), ((Tsai, A. C.)) | journal=PLOS Medicine | title=Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes | volume=10 | issue=3 | pages=e1001403 | date=12 March 2013 | url=https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001403 | issn=1549-1676 | doi=10.1371/journal.pmed.1001403}}</ref> However, sedation is often an undesirable side effect.<ref name="Komossa2010" />

*'''Parkinsons disease:''' Quetiapine and clozapine are the most widely used medications for the treatment of Parkinson's disease psychosis due to their very low extrapyramidal side effect liability. Owing to the risks associated with clozapine (e.g., agranulocytosis, diabetes mellitus, etc.), clinicians often attempt treatment with quetiapine first, although the evidence to support quetiapine's use for this indication is significantly weaker than that of clozapine.<ref>{{cite journal | vauthors=((Shotbolt, P.)), ((Samuel, M.)), ((David, A.)) | journal=Therapeutic Advances in Neurological Disorders | title=Quetiapine in the treatment of psychosis in Parkinson’s disease | volume=3 | issue=6 | pages=339–350 | date= November 2010 | url=http://journals.sagepub.com/doi/10.1177/1756285610389656 | issn=1756-2864 | doi=10.1177/1756285610389656}}</ref><ref>{{cite book | vauthors=((Taylor, D.)), ((Paton, C.)), ((Kapur, S.)), ((Taylor, D.)), ((South London and Maudsley NHS Trust)), ((Oxleas NHS Foundation Trust)) | date= 2012 | title=The Maudsley prescribing guidelines in psychiatry | url=http://public.eblib.com/choice/publicfullrecord.aspx?p=849912 | isbn=9780470979693}}</ref>

*'''Other:''' The use of low doses of quetiapine for insomnia, while common, is not recommended; there is little evidence of benefit and concerns regarding adverse effects.<ref>{{cite journal | vauthors=((Coe, H. V.)), ((Hong, I. S.)) | journal=Annals of Pharmacotherapy | title=Safety of Low Doses of Quetiapine When Used for Insomnia | volume=46 | issue=5 | pages=718–722 | date= May 2012 | url=http://journals.sagepub.com/doi/10.1345/aph.1Q697 | issn=1060-0280 | doi=10.1345/aph.1Q697}}</ref><ref>{{cite book | vauthors=((Maglione, M.)), ((Maher, A. R.)), ((Hu, J.)), ((Wang, Z.)), ((Shanman, R.)), ((Shekelle, P. G.)), ((Roth, B.)), ((Hilton, L.)), ((Suttorp, M. J.)), ((Ewing, B. A.)), ((Motala, A.)), ((Perry, T.)) | date= 2011 | title=Off-Label Use of Atypical Antipsychotics: An Update | publisher=Agency for Healthcare Research and Quality (US) | series=AHRQ Comparative Effectiveness Reviews | url=http://www.ncbi.nlm.nih.gov/books/NBK66081/}}</ref> It is sometimes used off-label, often as an augmentation agent, to treat conditions such as Tourette syndrome,<ref>{{cite journal | vauthors=((Mukaddes, N. M.)), ((Abali, O.)) | journal=Journal of Child and Adolescent Psychopharmacology | title=Quetiapine Treatment of Children and Adolescents with Tourette’s Disorder | volume=13 | issue=3 | pages=295–299 | date= September 2003 | url=https://www.liebertpub.com/doi/abs/10.1089/104454603322572624 | issn=1044-5463 | doi=10.1089/104454603322572624}}</ref> musical hallucinations<ref>{{cite book | vauthors=((Sacks, O.)) | date= 2008 | title=Musicophilia: tales of music and the brain | publisher=Vintage Books | isbn=9781400033539}}</ref> and anxiety disorders.<ref>{{cite journal | vauthors=((Becker, P. M.)) | journal=Current Treatment Options in Neurology | title=Treatment of sleep dysfunction and psychiatric disorders | volume=8 | issue=5 | pages=367–375 | date=1 October 2006 | url=https://doi.org/10.1007/s11940-006-0026-6 | issn=1534-3138 | doi=10.1007/s11940-006-0026-6}}</ref> It is particularly useful as a tool for forced sedation during bad trips or prolonged unwanted stimulation.

Line 96:

Line 99:

Quetiapine likely has a [[Toxicity::low toxicity]] relative to dose. Although simply trying this substance at a low to moderate dosage is considered as quite safe, there is an emerging controversy regarding quetiapine fatalities. Approximately 10,000<ref>Questions loom over drug for sleepless vets | http://www.marinecorpstimes.com/article/20100830/NEWS/8300315/Questions-loom-over-drug-for-sleepless-vets</ref> lawsuits<ref>{{Citation | vauthors=((Wilson, D.)) | year=2011 | title=Heart Warning Added to Label on Popular Antipsychotic Drug | url=https://www.nytimes.com/2011/07/19/health/19drug.html}}</ref><ref>Seroquel linked to Deadly Side Effects | http://www.defendingtheconsumer.com/drug-injury-lawyer/seroquel-linked-to-deadly-side-effects/</ref><ref>Seroquel | http://www.resource4thepeople.com/defectivedrugs/seroquel.html</ref> against AstraZeneca for problems ranging from slurred speech and chronic insomnia to death have been filed by individuals from civilian populations.

Both typical and atypical antipsychotics can cause tardive dyskinesia.<ref name="Correll2008">{{cite journal | vauthors=((Correll, C. U.)), ((Schenk, E. M.)) | journal=Current Opinion in Psychiatry | title=Tardive dyskinesia and new antipsychotics: | volume=21 | issue=2 | pages=151–156 | date= March 2008 | url=http://journals.lww.com/00001504-200803000-00012 | issn=0951-7367 | doi=10.1097/YCO.0b013e3282f53132}}</ref> According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.<ref name="Correll2008"/> Although quetiapine and clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.<ref>{{cite journal | vauthors=((Aia, P. G.)), ((Revuelta, G. J.)), ((Cloud, L. J.)), ((Factor, S. A.)) | journal=Current Treatment Options in Neurology | title=Tardive Dyskinesia | volume=13 | issue=3 | pages=231–241 | date=1 June 2011 | url=https://doi.org/10.1007/s11940-011-0117-x | issn=1534-3138 | doi=10.1007/s11940-011-0117-x}}</ref>

Both typical and atypical antipsychotics can cause tardive dyskinesia.<ref name="Correll2008">{{cite journal | vauthors=((Correll, C. U.)), ((Schenk, E. M.)) | journal=Current Opinion in Psychiatry | title=Tardive dyskinesia and new antipsychotics: | volume=21 | issue=2 | pages=151–156 | date= March 2008 | url=http://journals.lww.com/00001504-200803000-00012 | issn=0951-7367 | doi=10.1097/YCO.0b013e3282f53132}}</ref> According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.<ref name="Correll2008" /> Although quetiapine and clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.<ref>{{cite journal | vauthors=((Aia, P. G.)), ((Revuelta, G. J.)), ((Cloud, L. J.)), ((Factor, S. A.)) | journal=Current Treatment Options in Neurology | title=Tardive Dyskinesia | volume=13 | issue=3 | pages=231–241 | date=1 June 2011 | url=https://doi.org/10.1007/s11940-011-0117-x | issn=1534-3138 | doi=10.1007/s11940-011-0117-x}}</ref>

Weight gain can be a problem for some, with quetiapine causing more weight gain than other more commonly used [[Antipsychotic|antipsychotics]].<ref>{{cite journal | vauthors=((Allison, D. B.)), ((Mentore, J. L.)), ((Heo, M.)), ((Chandler, L. P.)), ((Cappelleri, J. C.)), ((Infante, M. C.)), ((Weiden, P. J.)) | journal=American Journal of Psychiatry | title=Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis | volume=156 | issue=11 | pages=1686–1696 | date=1 November 1999 | url=http://ajp.psychiatryonline.org/doi/10.1176/ajp.156.11.1686 | issn=0002-953X | doi=10.1176/ajp.156.11.1686}}</ref>

Line 112:

Line 115:

====Withdrawal symptoms====

Withdrawal symptoms reported to occur after discontinuation of quetiapine and other antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostatic hypotension, tachycardia, insomnia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.<ref>{{cite journal | vauthors=((Kim, D. R.)), ((Staab, J. P.)) | journal=American Journal of Psychiatry | title=Quetiapine Discontinuation Syndrome | volume=162 | issue=5 | pages=1020–1020 | date= May 2005 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.5.1020 | issn=0002-953X | doi=10.1176/appi.ajp.162.5.1020}}</ref><ref>Reversible withdrawal dyskinesia associated with quetiapine | http://onlinelibrary.wiley.com/{{cite journal | vauthors=((Michaelides, C.)), ((Thakore-James, M.)), ((Durso, R.)) | journal=Movement Disorders | title=Reversible withdrawal dyskinesia associated with quetiapine | volume=20 | issue=6 | pages=769–770 | date= June 2005 | url=https://onlinelibrary.wiley.com/doi/10.1002/mds.20427 | issn=0885-3185 | doi=10.1002/mds.20427}}</ref> According to Eli Lilly internal documents, discontinuation of atypical neuroleptics similar to seroquel can also cause psoriasis, gingivitis and other inflammatory conditions, dyspepsia, headache, high blood sugar and other health conditions unrelated to psychiatric condition.<ref>{{Citation | title=Seroquel, Seroquel XR (quetiapine) dosing, indications, interactions, adverse effects, and more | url=https://reference.medscape.com/drug/seroquel-xr-quetiapine-342984#10}}</ref><ref>http://www.medicines.org.uk/emc/medicine/26575/SPC/Quetiapine+25+mg+film-coated+tablets/</ref>

Withdrawal symptoms reported to occur after discontinuation of quetiapine and other antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostatic hypotension, tachycardia, insomnia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.<ref>{{cite journal | vauthors=((Kim, D. R.)), ((Staab, J. P.)) | journal=American Journal of Psychiatry | title=Quetiapine Discontinuation Syndrome | volume=162 | issue=5 | pages=1020–1020 | date= May 2005 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.5.1020 | issn=0002-953X | doi=10.1176/appi.ajp.162.5.1020}}</ref><ref>Reversible withdrawal dyskinesia associated with quetiapine | [http://onlinelibrary.wiley.com/{{cite journal | vauthors=((Michaelides, C.)), ((Thakore-James, M.)), ((Durso, R.)) | journal=Movement Disorders | title=Reversible withdrawal dyskinesia associated with quetiapine | volume=20 | issue=6 | pages=769–770 | date= June 2005 | url=https://onlinelibrary.wiley.com/doi/10.1002/mds.20427 | issn=0885-3185 | doi=10.1002/mds.20427}} http://onlinelibrary.wiley.com/Michaelides,+C.,+Thakore-James,+M.,+Durso,+R.+(June+2005).+%22Reversible+withdrawal+dyskinesia+associated+with+quetiapine%22.+Movement+Disorders.+20+(6):+769–770.+doi:10.1002/mds.20427.+ISSN 0885-3185.]</ref> According to Eli Lilly internal documents, discontinuation of atypical neuroleptics similar to seroquel can also cause psoriasis, gingivitis and other inflammatory conditions, dyspepsia, headache, high blood sugar and other health conditions unrelated to psychiatric condition.<ref>{{Citation | title=Seroquel, Seroquel XR (quetiapine) dosing, indications, interactions, adverse effects, and more | url=https://reference.medscape.com/drug/seroquel-xr-quetiapine-342984#10}}</ref><ref>http://www.medicines.org.uk/emc/medicine/26575/SPC/Quetiapine+25+mg+film-coated+tablets/</ref>

====Dangerous interactions====

@@ Line 1: / Line 1: @@
 {{SummarySheet}}
 {{SubstanceBox/Quetiapine}}
-'''Quetiapine''' (branded as '''Seroquel''', '''Xeroquel''',  and '''Ketipinor''') is a short-acting atypical [[psychoactive class::antipsychotic]] approved for the treatment of schizophrenia, bipolar disorder, and along with an antidepressant to treat major depressive disorder.
+'''Quetiapine''' (branded as '''Seroquel''', '''Xeroquel''', '''Ketipinor''', '''Ketilept''' and '''Derin''') is a short-acting atypical [[psychoactive class::antipsychotic]] approved for the treatment of schizophrenia, bipolar disorder, and along with an antidepressant to treat major depressive disorder.
 Quetiapine was developed by AstraZeneca from 1992-1996 as an improvement from first-generation antipsychotics. It was first approved by the FDA in 1997.{{citation needed}}
-Recreational usage is uncommon, but reports of quetiapine abuse have emerged within the medical literature. This seems to be driven by its [[sedative]] and [[anxiolytic]] effects (to help with sleep or to 'calm down') rather than by its antipsychotic properties.<ref name="Pierre2004">{{cite journal | vauthors=((Pierre, J. M.)), ((Shnayder, I.)), ((Wirshing, D. A.)), ((Wirshing, W. C.)) | journal=American Journal of Psychiatry | title=Intranasal Quetiapine Abuse | volume=161 | issue=9 | pages=1718–1718 | date= September 2004 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.161.9.1718 | issn=0002-953X | doi=10.1176/appi.ajp.161.9.1718}}</ref> In addition to oral administration, the drug is sometimes taken intranasally by insufflating pulverized tablets. Some estimate that up to 30% of inmates who were seen for psychiatric services in the Los Angeles County Jail were faking psychotic symptoms in an attempt to obtain quetiapine.<ref name="Pierre2004"/> It is thought that this drug is more commonly abused in prisons than on the street due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances.
+Recreational usage is uncommon, but reports of quetiapine abuse have emerged within the medical literature. This seems to be driven by its [[sedative]] and [[anxiolytic]] effects (to help with sleep or to 'calm down') rather than by its antipsychotic properties.<ref name="Pierre2004">{{cite journal | vauthors=((Pierre, J. M.)), ((Shnayder, I.)), ((Wirshing, D. A.)), ((Wirshing, W. C.)) | journal=American Journal of Psychiatry | title=Intranasal Quetiapine Abuse | volume=161 | issue=9 | pages=1718–1718 | date= September 2004 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.161.9.1718 | issn=0002-953X | doi=10.1176/appi.ajp.161.9.1718}}</ref> In addition to oral administration, the drug is sometimes taken intranasally by insufflating pulverized tablets. Some estimate that up to 30% of inmates who were seen for psychiatric services in the Los Angeles County Jail were faking psychotic symptoms in an attempt to obtain quetiapine.<ref name="Pierre2004" /> It is thought that this drug is more commonly abused in prisons than on the street due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances.
 ==History and culture==
 Quetiapine was developed by AstraZeneca from 1992-1996 as an improvement from first-generation antipsychotics. It was first approved by the FDA in 1997.{{citation needed}}
-Annual sales of Seroquel are approximately $5.7 billion worldwide, with $2.9 billion in the United States.<ref>{{Citation | title=SEROQUEL Loss of Exclusivity (LOE). When will the SEROQUEL patents expire, and when will generic SEROQUEL be available? | url=//www.DrugPatentWatch.com/p/tradename/index.php?query=SEROQUEL}}</ref> The U.S. patent,<ref name="WarawaPatent">{{Citation | vauthors=((Warawa, E. J.)), ((Migler, B. M.)) | title=United States Patent: 4879288 - Novel dibenzothiazepine antipsychotic | url=https://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=4,879,288.PN.&OS=PN/4,879,288&RS=PN/4,879,288}}</ref> which was set to expire in 2011, received a pediatric exclusivity extension which pushed its expiration to March 26, 2012.<ref name="WarawaPatent"/><ref>Phillip Moeller (2011) Blockbuster Drugs That Will Go Generic Soon | http://money.usnews.com/money/blogs/the-best-life/2011/04/29/blockbuster-drugs-that-will-go-generic-soon</ref> The patent has already expired in Canada.
+Annual sales of Seroquel are approximately $5.7 billion worldwide, with $2.9 billion in the United States.<ref>{{Citation | title=SEROQUEL Loss of Exclusivity (LOE). When will the SEROQUEL patents expire, and when will generic SEROQUEL be available? | url=//www.DrugPatentWatch.com/p/tradename/index.php?query=SEROQUEL}}</ref> The U.S. patent,<ref name="WarawaPatent">{{Citation | vauthors=((Warawa, E. J.)), ((Migler, B. M.)) | title=United States Patent: 4879288 - Novel dibenzothiazepine antipsychotic | url=https://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=1&f=G&l=50&co1=AND&d=PTXT&s1=4,879,288.PN.&OS=PN/4,879,288&RS=PN/4,879,288}}</ref> which was set to expire in 2011, received a pediatric exclusivity extension which pushed its expiration to March 26, 2012.<ref name="WarawaPatent" /><ref>Phillip Moeller (2011) Blockbuster Drugs That Will Go Generic Soon | http://money.usnews.com/money/blogs/the-best-life/2011/04/29/blockbuster-drugs-that-will-go-generic-soon</ref> The patent has already expired in Canada.
 There are now several name brand versions of quetiapine, such as Quepin, Seroquel and Ketipinor.<ref>{{Citation | title=Quepin Tablets (Specifar), Drug Reference Encyclopedia | url=https://theodora.com/drugs/quepin_tablets_specifar.html}}</ref>
@@ Line 26: / Line 26: @@
 ==Subjective effects==
 {{Preamble/SubjectiveEffects}}
 {{effects/base
@@ Line 43: / Line 44: @@
 *'''[[Effect::Difficulty urinating]]'''
 *'''[[Effect::Nausea suppression]]'''
+*'''[[Effect::Restless Leg Syndrome]]'''
 }}
@@ Line 74: / Line 76: @@
 ===Combination effects===
 *'''[[Cannabis]]''': Cannabis' effects synergise with quetiapine's effects thus increasing the physical effects of the "high" while decreasing the cognitive effects. <ref>https://www.drugs.com/interactions-check.php?drug_list=1979-0,2758-0</ref>
 *'''[[Psychedelics]]''': Due to it being a [[serotonin|serotonergic]] [[antagonist]], quetiapine reduces the effects of psychedelics.
@@ Line 89: / Line 92: @@
 *'''Schizophrenia:''' There is tentative evidence of the benefit of quetiapine versus placebo in schizophrenia; however, definitive conclusions are not possible due to the high rate of attrition in trials (greater than 50%) and the lack of data on economic outcomes, social functioning, or quality of life.<ref>{{cite journal | vauthors=((Srisurapanont, M.)), ((Maneeton, B.)), ((Maneeton, N.)), ((Lankappa, S.)), ((Gandhi, R.)) | veditors=((Cochrane Schizophrenia Group)) | journal=Cochrane Database of Systematic Reviews | title=Quetiapine for schizophrenia | date=19 April 2004 | url=https://doi.wiley.com/10.1002/14651858.CD000967.pub2 | issn=14651858 | doi=10.1002/14651858.CD000967.pub2}}</ref>
 *'''Bipolar disorder:''' In those with bipolar disorder, quetiapine is used to treat depressive episodes and acute manic episodes associated with bipolar I disorder.<ref>{{cite journal | vauthors=((Thase, M. E.)), ((Macfadden, W.)), ((Weisler, R. H.)), ((Chang, W.)), ((Paulsson, B.)), ((Khan, A.)), ((Calabrese, J. R.)) | journal=Journal of Clinical Psychopharmacology | title=Efficacy of Quetiapine Monotherapy in Bipolar I and II Depression: A Double-blind, Placebo-controlled Study (The BOLDER II Study) | volume=26 | issue=6 | pages=600–609 | date= December 2006 | url=https://journals.lww.com/00004714-200612000-00009 | issn=0271-0749 | doi=10.1097/01.jcp.0000248603.76231.b7}}</ref><ref>{{cite book | date= 2013 | title=British national formulary, no 65 (March - September 2013). | publisher=BMJ/Pharmaceutical Press | isbn=9780857110848}}</ref>
-*'''Major depressive disorder:''' Quetiapine is effective when used by itself and when used along with other medications in major depressive disorder (MDD).<ref name="Komossa2010">{{cite journal | vauthors=((Komossa, K.)), ((Depping, A. M.)), ((Gaudchau, A.)), ((Kissling, W.)), ((Leucht, S.)) | veditors=((Cochrane Common Mental Disorders Group)) | journal=Cochrane Database of Systematic Reviews | title=Second-generation antipsychotics for major depressive disorder and dysthymia | date=8 December 2010 | url=https://doi.wiley.com/10.1002/14651858.CD008121.pub2 | issn=14651858 | doi=10.1002/14651858.CD008121.pub2}}</ref><ref>{{cite journal | vauthors=((Spielmans, G. I.)), ((Berman, M. I.)), ((Linardatos, E.)), ((Rosenlicht, N. Z.)), ((Perry, A.)), ((Tsai, A. C.)) | journal=PLOS Medicine | title=Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes | volume=10 | issue=3 | pages=e1001403 | date=12 March 2013 | url=https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001403 | issn=1549-1676 | doi=10.1371/journal.pmed.1001403}}</ref> However, sedation is often an undesirable side effect.<ref name="Komossa2010"/>
+*'''Major depressive disorder:''' Quetiapine is effective when used by itself and when used along with other medications in major depressive disorder (MDD).<ref name="Komossa2010">{{cite journal | vauthors=((Komossa, K.)), ((Depping, A. M.)), ((Gaudchau, A.)), ((Kissling, W.)), ((Leucht, S.)) | veditors=((Cochrane Common Mental Disorders Group)) | journal=Cochrane Database of Systematic Reviews | title=Second-generation antipsychotics for major depressive disorder and dysthymia | date=8 December 2010 | url=https://doi.wiley.com/10.1002/14651858.CD008121.pub2 | issn=14651858 | doi=10.1002/14651858.CD008121.pub2}}</ref><ref>{{cite journal | vauthors=((Spielmans, G. I.)), ((Berman, M. I.)), ((Linardatos, E.)), ((Rosenlicht, N. Z.)), ((Perry, A.)), ((Tsai, A. C.)) | journal=PLOS Medicine | title=Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder: A Meta-Analysis of Depression, Quality of Life, and Safety Outcomes | volume=10 | issue=3 | pages=e1001403 | date=12 March 2013 | url=https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001403 | issn=1549-1676 | doi=10.1371/journal.pmed.1001403}}</ref> However, sedation is often an undesirable side effect.<ref name="Komossa2010" />
 *'''Parkinsons disease:''' Quetiapine and clozapine are the most widely used medications for the treatment of Parkinson's disease psychosis due to their very low extrapyramidal side effect liability. Owing to the risks associated with clozapine (e.g., agranulocytosis, diabetes mellitus, etc.), clinicians often attempt treatment with quetiapine first, although the evidence to support quetiapine's use for this indication is significantly weaker than that of clozapine.<ref>{{cite journal | vauthors=((Shotbolt, P.)), ((Samuel, M.)), ((David, A.)) | journal=Therapeutic Advances in Neurological Disorders | title=Quetiapine in the treatment of psychosis in Parkinson’s disease | volume=3 | issue=6 | pages=339–350 | date= November 2010 | url=http://journals.sagepub.com/doi/10.1177/1756285610389656 | issn=1756-2864 | doi=10.1177/1756285610389656}}</ref><ref>{{cite book | vauthors=((Taylor, D.)), ((Paton, C.)), ((Kapur, S.)), ((Taylor, D.)), ((South London and Maudsley NHS Trust)), ((Oxleas NHS Foundation Trust)) | date= 2012 | title=The Maudsley prescribing guidelines in psychiatry | url=http://public.eblib.com/choice/publicfullrecord.aspx?p=849912 | isbn=9780470979693}}</ref>
 *'''Other:''' The use of low doses of quetiapine for insomnia, while common, is not recommended; there is little evidence of benefit and concerns regarding adverse effects.<ref>{{cite journal | vauthors=((Coe, H. V.)), ((Hong, I. S.)) | journal=Annals of Pharmacotherapy | title=Safety of Low Doses of Quetiapine When Used for Insomnia | volume=46 | issue=5 | pages=718–722 | date= May 2012 | url=http://journals.sagepub.com/doi/10.1345/aph.1Q697 | issn=1060-0280 | doi=10.1345/aph.1Q697}}</ref><ref>{{cite book | vauthors=((Maglione, M.)), ((Maher, A. R.)), ((Hu, J.)), ((Wang, Z.)), ((Shanman, R.)), ((Shekelle, P. G.)), ((Roth, B.)), ((Hilton, L.)), ((Suttorp, M. J.)), ((Ewing, B. A.)), ((Motala, A.)), ((Perry, T.)) | date= 2011 | title=Off-Label Use of Atypical Antipsychotics: An Update | publisher=Agency for Healthcare Research and Quality (US) | series=AHRQ Comparative Effectiveness Reviews | url=http://www.ncbi.nlm.nih.gov/books/NBK66081/}}</ref> It is sometimes used off-label, often as an augmentation agent, to treat conditions such as Tourette syndrome,<ref>{{cite journal | vauthors=((Mukaddes, N. M.)), ((Abali, O.)) | journal=Journal of Child and Adolescent Psychopharmacology | title=Quetiapine Treatment of Children and Adolescents with Tourette’s Disorder | volume=13 | issue=3 | pages=295–299 | date= September 2003 | url=https://www.liebertpub.com/doi/abs/10.1089/104454603322572624 | issn=1044-5463 | doi=10.1089/104454603322572624}}</ref> musical hallucinations<ref>{{cite book | vauthors=((Sacks, O.)) | date= 2008 | title=Musicophilia: tales of music and the brain | publisher=Vintage Books | isbn=9781400033539}}</ref> and anxiety disorders.<ref>{{cite journal | vauthors=((Becker, P. M.)) | journal=Current Treatment Options in Neurology | title=Treatment of sleep dysfunction and psychiatric disorders | volume=8 | issue=5 | pages=367–375 | date=1 October 2006 | url=https://doi.org/10.1007/s11940-006-0026-6 | issn=1534-3138 | doi=10.1007/s11940-006-0026-6}}</ref> It is particularly useful as a tool for forced sedation during bad trips or prolonged unwanted stimulation.
@@ Line 96: / Line 99: @@
 Quetiapine likely has a [[Toxicity::low toxicity]] relative to dose. Although simply trying this substance at a low to moderate dosage is considered as quite safe, there is an emerging controversy regarding quetiapine fatalities. Approximately 10,000<ref>Questions loom over drug for sleepless vets | http://www.marinecorpstimes.com/article/20100830/NEWS/8300315/Questions-loom-over-drug-for-sleepless-vets</ref> lawsuits<ref>{{Citation | vauthors=((Wilson, D.)) | year=2011 | title=Heart Warning Added to Label on Popular Antipsychotic Drug | url=https://www.nytimes.com/2011/07/19/health/19drug.html}}</ref><ref>Seroquel linked to Deadly Side Effects | http://www.defendingtheconsumer.com/drug-injury-lawyer/seroquel-linked-to-deadly-side-effects/</ref><ref>Seroquel | http://www.resource4thepeople.com/defectivedrugs/seroquel.html</ref> against AstraZeneca for problems ranging from slurred speech and chronic insomnia to death have been filed by individuals from civilian populations.
-Both typical and atypical antipsychotics can cause tardive dyskinesia.<ref name="Correll2008">{{cite journal | vauthors=((Correll, C. U.)), ((Schenk, E. M.)) | journal=Current Opinion in Psychiatry | title=Tardive dyskinesia and new antipsychotics: | volume=21 | issue=2 | pages=151–156 | date= March 2008 | url=http://journals.lww.com/00001504-200803000-00012 | issn=0951-7367 | doi=10.1097/YCO.0b013e3282f53132}}</ref> According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.<ref name="Correll2008"/> Although quetiapine and clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.<ref>{{cite journal | vauthors=((Aia, P. G.)), ((Revuelta, G. J.)), ((Cloud, L. J.)), ((Factor, S. A.)) | journal=Current Treatment Options in Neurology | title=Tardive Dyskinesia | volume=13 | issue=3 | pages=231–241 | date=1 June 2011 | url=https://doi.org/10.1007/s11940-011-0117-x | issn=1534-3138 | doi=10.1007/s11940-011-0117-x}}</ref>
+Both typical and atypical antipsychotics can cause tardive dyskinesia.<ref name="Correll2008">{{cite journal | vauthors=((Correll, C. U.)), ((Schenk, E. M.)) | journal=Current Opinion in Psychiatry | title=Tardive dyskinesia and new antipsychotics: | volume=21 | issue=2 | pages=151–156 | date= March 2008 | url=http://journals.lww.com/00001504-200803000-00012 | issn=0951-7367 | doi=10.1097/YCO.0b013e3282f53132}}</ref> According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.<ref name="Correll2008" /> Although quetiapine and clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.<ref>{{cite journal | vauthors=((Aia, P. G.)), ((Revuelta, G. J.)), ((Cloud, L. J.)), ((Factor, S. A.)) | journal=Current Treatment Options in Neurology | title=Tardive Dyskinesia | volume=13 | issue=3 | pages=231–241 | date=1 June 2011 | url=https://doi.org/10.1007/s11940-011-0117-x | issn=1534-3138 | doi=10.1007/s11940-011-0117-x}}</ref>
 Weight gain can be a problem for some, with quetiapine causing more weight gain than other more commonly used [[Antipsychotic|antipsychotics]].<ref>{{cite journal | vauthors=((Allison, D. B.)), ((Mentore, J. L.)), ((Heo, M.)), ((Chandler, L. P.)), ((Cappelleri, J. C.)), ((Infante, M. C.)), ((Weiden, P. J.)) | journal=American Journal of Psychiatry | title=Antipsychotic-Induced Weight Gain: A Comprehensive Research Synthesis | volume=156 | issue=11 | pages=1686–1696 | date=1 November 1999 | url=http://ajp.psychiatryonline.org/doi/10.1176/ajp.156.11.1686 | issn=0002-953X | doi=10.1176/ajp.156.11.1686}}</ref>
@@ Line 112: / Line 115: @@
 ====Withdrawal symptoms====
-Withdrawal symptoms reported to occur after discontinuation of quetiapine and other antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostatic hypotension, tachycardia, insomnia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.<ref>{{cite journal | vauthors=((Kim, D. R.)), ((Staab, J. P.)) | journal=American Journal of Psychiatry | title=Quetiapine Discontinuation Syndrome | volume=162 | issue=5 | pages=1020–1020 | date= May 2005 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.5.1020 | issn=0002-953X | doi=10.1176/appi.ajp.162.5.1020}}</ref><ref>Reversible withdrawal dyskinesia associated with quetiapine | http://onlinelibrary.wiley.com/{{cite journal | vauthors=((Michaelides, C.)), ((Thakore-James, M.)), ((Durso, R.)) | journal=Movement Disorders | title=Reversible withdrawal dyskinesia associated with quetiapine | volume=20 | issue=6 | pages=769–770 | date= June 2005 | url=https://onlinelibrary.wiley.com/doi/10.1002/mds.20427 | issn=0885-3185 | doi=10.1002/mds.20427}}</ref> According to Eli Lilly internal documents, discontinuation of atypical neuroleptics similar to seroquel can also cause psoriasis, gingivitis and other inflammatory conditions, dyspepsia, headache, high blood sugar and other health conditions unrelated to psychiatric condition.<ref>{{Citation | title=Seroquel, Seroquel XR (quetiapine) dosing, indications, interactions, adverse effects, and more | url=https://reference.medscape.com/drug/seroquel-xr-quetiapine-342984#10}}</ref><ref>http://www.medicines.org.uk/emc/medicine/26575/SPC/Quetiapine+25+mg+film-coated+tablets/</ref>
+Withdrawal symptoms reported to occur after discontinuation of quetiapine and other antipsychotics include nausea, emesis, lightheadedness, diaphoresis, dyskinesia, orthostatic hypotension, tachycardia, insomnia, nervousness, dizziness, headache, excessive non-stop crying, and anxiety.<ref>{{cite journal | vauthors=((Kim, D. R.)), ((Staab, J. P.)) | journal=American Journal of Psychiatry | title=Quetiapine Discontinuation Syndrome | volume=162 | issue=5 | pages=1020–1020 | date= May 2005 | url=https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.162.5.1020 | issn=0002-953X | doi=10.1176/appi.ajp.162.5.1020}}</ref><ref>Reversible withdrawal dyskinesia associated with quetiapine | [http://onlinelibrary.wiley.com/{{cite journal | vauthors=((Michaelides, C.)), ((Thakore-James, M.)), ((Durso, R.)) | journal=Movement Disorders | title=Reversible withdrawal dyskinesia associated with quetiapine | volume=20 | issue=6 | pages=769–770 | date= June 2005 | url=https://onlinelibrary.wiley.com/doi/10.1002/mds.20427 | issn=0885-3185 | doi=10.1002/mds.20427}} http://onlinelibrary.wiley.com/Michaelides,+C.,+Thakore-James,+M.,+Durso,+R.+(June+2005).+%22Reversible+withdrawal+dyskinesia+associated+with+quetiapine%22.+Movement+Disorders.+20+(6):+769–770.+doi:10.1002/mds.20427.+ISSN 0885-3185.]</ref> According to Eli Lilly internal documents, discontinuation of atypical neuroleptics similar to seroquel can also cause psoriasis, gingivitis and other inflammatory conditions, dyspepsia, headache, high blood sugar and other health conditions unrelated to psychiatric condition.<ref>{{Citation | title=Seroquel, Seroquel XR (quetiapine) dosing, indications, interactions, adverse effects, and more | url=https://reference.medscape.com/drug/seroquel-xr-quetiapine-342984#10}}</ref><ref>http://www.medicines.org.uk/emc/medicine/26575/SPC/Quetiapine+25+mg+film-coated+tablets/</ref>
 ====Dangerous interactions====