quetiapine-fumarate and Substance-Withdrawal-Syndrome

Withdrawal from psychoactive medication such as quetiapine is a well-documented phenomenon. Despite the extensive use of quetiapine, there have been few studies into the presence of discontinuation symptoms. We therefore performed a systematic review of published literature for evidence of quetiapine withdrawal or symptoms associated with discontinuation.. We searched PubMed, Embase, CINAHL, Medline, Web of Science, PsycINFO for articles containing the terms 'Quetiapine' AND 'withdraw. We included 13 papers, all of which were individual case reports. The quality of the individual case reports was sub-optimal, as assessed by the CARE Case Report Guidelines. There was an association between rapid cessation of quetiapine and onset of somatic symptoms such as nausea, vomiting, agitation, restlessness, diaphoresis, irritability, anxiety, dysphoria, sleep disturbance, insomnia, tachycardia, hypertension and dizziness. Three studies also reported the onset of a withdrawal dyskinesia characterised by abnormal choreiform movements as well as confusion and speech disturbance in some cases. However, these findings were limited by the number and quality of case reports identified.. Discontinuation symptoms are an uncommon side effect of quetiapine cessation, which may have clinical implications. Clinicians should therefore be alert to the possibility of quetiapine withdrawal in individuals who present with somatic symptoms or choreiform movements. However, large prospective studies are required to clarify this association.

Topics: Anxiety Disorders; Humans; Psychomotor Agitation; Psychotic Disorders; Quetiapine Fumarate; Substance Withdrawal Syndrome

A recent years' increase in both prescribing and availability of second-generation antipsychotics (SGAs) has been observed. According to the literature, typically made up by case studies/series, quetiapine seems to be the most commonly misused SGA, with both intranasal and intravenous intake modalities having been described. Another SGA that has been anecdotally reported to be misused is olanzapine. For these molecules, both a previous history of drug misuse and being an inmate have been described as factors associated with misuse. Hence, while providing here an updated literature review of the topic, we aimed at assessing all cases of quetiapine misuse/abuse/dependence/withdrawal as reported to the European Medicines Agency's EudraVigilance (EV) database; this was carried out in comparison with the reference drug olanzapine.. All spontaneous, European Medicines Agency database reports relating to both quetiapine (2005-2016) and olanzapine (2004-2016) misuse/abuse/dependence/withdrawal issues were retrieved, and a descriptive analysis was performed.. From the EV database, 18,112 (8.64% of 209,571) and 4178 (7.58% of 55,100) adverse drug reaction reports of misuse/abuse/dependence/withdrawal were associated with quetiapine and olanzapine, respectively. The resulting proportional reporting ratio values suggested that the misuse/abuse-, dependence-, and withdrawal-related adverse drug reactions were more frequently reported for quetiapine (1.07, 1.01, and 5.25, respectively) in comparison with olanzapine.. Despite data collection limitations, present EV data may suggest that, at least in comparison with olanzapine, quetiapine misuse may be a cause for concern.

Topics: Adolescent; Adult; Adverse Drug Reaction Reporting Systems; Antipsychotic Agents; Benzodiazepines; Child; Databases, Factual; European Union; Female; Humans; Male; Middle Aged; Olanzapine; Prescription Drug Misuse; Quetiapine Fumarate; Substance Withdrawal Syndrome; Substance-Related Disorders; Young Adult

Corticosteroids generally result in short-lasting neuropsychiatric symptoms following cessation, but the following case highlights an unusually long-lasting course of symptoms in a patient following near immediate cessation of medication, despite medication management and electroconvulsive therapy. The case presentation will be followed by a discussion of the presentation, treatment, and management of steroid-induced neuropsychiatric symptoms.. The patient was followed from symptom onset to resolution.. The patient's symptom course was unusually long and required a long course of multimodal therapy.. Corticosteroids are commonly used medications both in a wide variety of medical settings, and despite this, their neuropsychiatric effects are poorly understood. The affective and behavioral symptoms, in particular mania and psychosis, can be unpredictable and challenging to treat as in our patient, who developed a long-lasting psychotic episode on high-dose steroids despite discontinuation and treatment of nearly six months. This was despite having tolerated steroids multiple times in the past.

Topics: Adrenal Cortex Hormones; Bipolar Disorder; Dexamethasone; Dose-Response Relationship, Drug; Drug Administration Schedule; Electroconvulsive Therapy; Hospitalization; Humans; Long-Term Care; Male; Middle Aged; Prednisone; Psychoses, Substance-Induced; Purpura, Thrombocytopenic; Quetiapine Fumarate; Retreatment; Substance Withdrawal Syndrome

The development of effective treatments for alcohol use disorders represents an important public health concern. Quetiapine, a multiple receptor antagonist at 5-HT(1A) and 5-HT(2A), dopamine D(1) and D(2), histamine H(1), and adrenergic α(1) and α(2) receptors, is an atypical antipsychotic medication that has recently shown promise for the treatment of alcoholism.. This manuscript reviews the rationale and empirical literature suggesting that quetiapine may be useful for the treatment of alcohol use disorders, including a discussion of its putative neurobiological and biobehavioural mechanisms of action.. The effects of quetiapine on drinking outcomes may be due to its effects on mood, anxiety and sleep, which may help alleviate protracted withdrawal symptoms and address psychiatric comorbidities often associated with alcohol use disorders.. These findings have implications to treatment development for alcoholism and suggest that the scientific study of quetiapine for alcoholism warrants further resources and attention.. Quetiapine has advanced as a potentially promising pharmacotherapy for alcoholism. Additional research is needed to more clearly ascertain its clinical utility as a stand-alone treatment for this indication, as well as to identify patients who are more likely to respond favourably to this medication.

Topics: Affect; Alcoholism; Antipsychotic Agents; Anxiety; Diagnosis, Dual (Psychiatry); Dibenzothiazepines; Humans; Mental Disorders; Quetiapine Fumarate; Sleep Wake Disorders; Substance Withdrawal Syndrome

The incidence of acute extrapyramidal symptoms (EPS)--akathisia, dystonia, and parkinsonism--associated with traditional antipsychotics varies, but most researchers agree that neuroleptic-induced EPS occur in 50% to 75% of patients who take conventional antipsychotics. Atypical antipsychotics were developed to widen the therapeutic index and to reduce EPS. Although the mechanisms are unclear, the risk of EPS is less with the novel antipsychotics than with conventional drugs, and agents that produce low levels of acute EPS are likely to produce less tardive dyskinesia. Nevertheless, clinicians should exercise caution when comparing data from investigations of the novel antipsychotics and, until long-term data become available, should administer the new drugs at doses below the EPS-producing level.

Topics: Akathisia, Drug-Induced; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Clinical Trials as Topic; Clozapine; Dibenzothiazepines; Drug Administration Schedule; Dyskinesia, Drug-Induced; Dystonia; Humans; Olanzapine; Parkinson Disease, Secondary; Pirenzepine; Psychotic Disorders; Quetiapine Fumarate; Risperidone; Schizophrenia; Substance Withdrawal Syndrome

Pharmacotherapy for cannabis use disorder (CUD) is an important unmet public health need.. In a 12-week randomized double-blind placebo-controlled trial, the efficacy of quetiapine (300 mg nightly) for the treatment of CUD was tested in 130 outpatients. Weekly cannabis use was categorized into three groups: heavy use (5-7 days), moderate use (2-4 days) and light use (0-1 days).. At baseline both groups were considered heavy users (using days per week: median = 7.0; interquartile range (IQR): 6.5-7.0; daily dollar value: median = $121.4; IQR: 73.8-206.3). The week-by-treatment interaction was marginally significant (χ. The use of quetiapine to treat CUD was associated with an increased likelihood of heavy frequency use transitioning to moderate use, but not light use. The clinical significance of reductions in cannabis use, short of abstinence warrants further study.

Topics: Adult; Antipsychotic Agents; Cannabis; Double-Blind Method; Female; Hallucinogens; Humans; Male; Marijuana Abuse; Marijuana Smoking; Middle Aged; Outpatients; Quetiapine Fumarate; Substance Withdrawal Syndrome; Treatment Outcome

Marijuana withdrawal contributes to the high relapse rates in individuals seeking treatment for marijuana-use disorders. Quetiapine, an atypical antipsychotic, reduces characteristic symptoms of marijuana withdrawal in a variety of psychiatric conditions, including mood lability, sleep disruption and anorexia. This human laboratory study investigated the effectiveness of quetiapine to decrease marijuana withdrawal and relapse to marijuana use in non-treatment-seeking marijuana smokers. Volunteers were maintained on placebo or quetiapine (200 mg/day) in this double-blind, counter-balanced, within-subject study consisting of two 15-day medication phases, the last 8 days of which were in-patient. On the first in-patient day, active marijuana [6.2% delta (9)-tetrahydrocannabinol (THC)] was repeatedly smoked under controlled conditions. For the next 3 days, inactive marijuana (0.0% THC) was available for self-administration (withdrawal). On the subsequent 4 days, active marijuana (6.2% THC) was available for self-administration (relapse). Volunteers (n = 14) who smoked an average of 10 marijuana cigarettes/day, 7 days/week, completed the study. Under placebo, withdrawal was marked by increased subjective ratings of negative mood, decreased sleep quality, and decreased caloric intake and weight loss. Compared with placebo, quetiapine improved sleep quality, increased caloric intake and decreased weight loss. However, quetiapine increased marijuana craving and marijuana self-administration during the relapse phase. These data do not suggest that quetiapine shows promise as a potential treatment for marijuana dependence.

Topics: Adult; Affect; Analysis of Variance; Anorexia; Antipsychotic Agents; Dibenzothiazepines; Dose-Response Relationship, Drug; Double-Blind Method; Dronabinol; Female; Humans; Male; Marijuana Abuse; Middle Aged; Neuropsychological Tests; Placebos; Psychomotor Performance; Quetiapine Fumarate; Secondary Prevention; Self Administration; Sleep Wake Disorders; Substance Withdrawal Syndrome; Weight Loss; Young Adult

The available treatments for alcoholism are only modestly effective, and patients vary widely in their treatment response. Quetiapine, an atypical antipsychotic medication with antagonist activity at D1 and D2, 5-HT(1A) and 5-HT(2A), H(1), and α1 and α2 receptors was shown to promote abstinence, reduce drinking days, and reduce heavy drinking days in a 12-week double-blind placebo-controlled trial.. Although quetiapine represents one of the promising pharmacotherapies for the treatment of alcoholism, its mechanisms of action are poorly understood. The objective of this study is to elucidate the biobehavioral mechanisms of action of quetiapine for alcoholism, by examining its effects on subjective intoxication and craving.. A total of 20 non-treatment-seeking alcohol-dependent individuals were randomized to one of the following conditions in a double-blind, placebo-controlled design: (1) quetiapine (400 mg/day); or (2) matched placebo. Participants were on the target medication dose (or matched placebo) for 4 weeks during which they completed weekly assessments of drinking, sleep, mood, and anxiety. Participants completed two counterbalanced intravenous placebo-alcohol administration sessions as well as cue-reactivity assessments.. Analyses revealed a significant effect of quetiapine in reducing craving during the alcohol administration, the alcohol cue-exposure, and the weekly reports of alcohol craving. Quetiapine was also found to reduce subjective intoxication and alcohol-induced sedation during the alcohol administration paradigm.. This study contributes critical new information about mechanisms of response to quetiapine for alcoholism, which, in turn, can inform larger-scale studies and ultimately, clinical practice.

Topics: Adult; Aged; Alcoholic Intoxication; Alcoholism; Antipsychotic Agents; Cues; Dibenzothiazepines; Double-Blind Method; Ethanol; Female; Humans; Male; Middle Aged; Pilot Projects; Quetiapine Fumarate; Substance Withdrawal Syndrome; Surveys and Questionnaires; Treatment Outcome; Young Adult

The objectives of this study were to evaluate the efficacy, safety, and tolerability of quetiapine for treating psychosis in patients with probable/possible Alzheimer disease and assess its impact on other psychopathology and social and daily functioning.. The authors conducted a multicenter, double-blind, placebo-controlled, randomized trial of flexibly dosed quetiapine and haloperidol. Primary outcomes were change in total Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impressions-Severity of Illness (CGI-S) scores at week 10. Secondary outcomes included BPRS factors, Neuropsychiatric Inventory (NPI), Multidimensional Observation Scale for Elderly Subjects (MOSES), and Physical Self-Maintenance Scale (PSMS).. Two hundred eighty-four participants (mean age: 83.2 years) were randomized; 63.4% completed; and mean Mini-Mental State Examination score was 12.8. Median of the mean daily dose was 96.9 mg for quetiapine and 1.9 mg for haloperidol. No differential benefit was seen on any psychosis measure. BPRS agitation factor scores improved with quetiapine versus placebo and not quetiapine versus haloperidol. BPRS anergia scores worsened with haloperidol versus quetiapine but not quetiapine versus placebo. No NPI factors showed change, including the agitation factor. MOSES Withdrawal Subscale and PSMS total scores worsened with haloperidol versus quetiapine. Somnolence occurred in 25.3%, 36.2%, and 4.1% of the quetiapine, haloperidol, and placebo groups, respectively; parkinsonism was most prevalent in the haloperidol group; other safety and tolerability measures differed little among groups.. All treatment groups showed improvement in measures of psychosis without significant differences between them when planned comparisons were performed. Participants treated with quetiapine or haloperidol showed inconsistent evidence of improvement in agitation. Tolerability was better with quetiapine compared with haloperidol.

Topics: Aged; Aged, 80 and over; Alzheimer Disease; Antipsychotic Agents; Basal Ganglia Diseases; Brain; Brief Psychiatric Rating Scale; Cholinesterase Inhibitors; Diagnostic and Statistical Manual of Mental Disorders; Dibenzothiazepines; Double-Blind Method; Drug Administration Schedule; Drug Tolerance; Female; Haloperidol; Humans; Male; Middle Aged; Neuropsychological Tests; Parkinson Disease, Secondary; Psychomotor Agitation; Psychotic Disorders; Quetiapine Fumarate; Severity of Illness Index; Substance Withdrawal Syndrome

To determine the utility of quetiapine in a population undergoing ambulatory detoxification from opioids.. Medications utilized in our outpatient clinic for opioid withdrawal were evaluated for quality-assurance purposes. The treatment regimen generally included clonidine, hydroxyzine, trazodone, diphenoxylate/atropine, and sometimes chlordiazepoxide. Patients were also initially given eight 25-mg tablets of quetiapine and instructed to take 1 or 2 tablets every 4 hours as needed for symptoms of withdrawal or craving (with a maximum daily dose of 200 mg). Data were based on patient evaluations from June 2003 to June 2004.. 41% of all patients (N = 213) successfully completed the detoxification phase of the program (i.e., completed at least 5 days of abstinence). A medication questionnaire was instituted for quality-assurance purposes after some apparent initial success with quetiapine. A retrospective analysis of these data revealed that, of the 107 patients evaluated for medication response, 79 reported that quetiapine helped reduce craving for opioids, 52 reported that quetiapine helped reduce their anxiety, 24 reported a reduction in somatic pain, 22 reported that quetiapine helped alleviate insomnia, and 14 reported an improved appetite. Four individuals did not feel quetiapine had any benefit, and another 7 were unable to tolerate quetiapine because of side effects. The quetiapine dose used ranged from 25 to 600 mg/day (mean +/- SD dose = 206 +/- 122 mg/day).. Quetiapine use during opioid cessation was found to help abate symptoms of opioid withdrawal in our patient population and was generally well tolerated.

Topics: Adult; Ambulatory Care; Antipsychotic Agents; Behavior, Addictive; Dibenzothiazepines; Drug Administration Schedule; Drug Therapy, Combination; Female; Health Status; Humans; Male; Opioid-Related Disorders; Quality Assurance, Health Care; Quetiapine Fumarate; Retrospective Studies; Substance Withdrawal Syndrome; Surveys and Questionnaires; Treatment Outcome

Topics: Benzodiazepines; Catatonia; Humans; Quetiapine Fumarate; Substance Withdrawal Syndrome

As an atypical antipsychotic drug, quetiapine had been approved for bipolar disorder and for adjunctive therapy in major depressive disorder and schizophrenia. Recently quetiapine has been suggested to be a promising pharmacotherapy for alcohol dependence. This study was performed to determine the effects of quetiapine in rats chronically exposed to ethanol.. Rats were exposed to ethanol solution (10 %; v/v) for 6 weeks. Saline or one of three doses of quetiapine (10, 20 or 40 mg/kg/day) was given by oral gavage while ethanol exposure for the next 14 weeks. Performance of learning and memory and withdrawal signs were evaluated. Then immunohistochemistry, western blot, quantitative real-time-PCR and transmission electron microscopy were performed to determine the effects of quetiapine on alterations of brain white matter markers (myelin basic protein, MBP; proteolipid protein, PLP) and morphology caused by chronic ethanol exposure.. Quetiapine treatment significantly alleviated withdrawal signs in the ethanol exposed rats. Chronic ethanol exposure reduced Y-type electric maze scores and the protein/mRNA expression levels of MBP and PLP in the prefrontal cortex and hippocampus, and these effects were reversed by quetiapine treatment. Similar ultrastructure morphological changes were observed.. Chronic quetiapine treatment alleviated the damage induced by chronic ethanol exposure with regard to learning and memory ability and to brain white matter. Thus, quetiapine appears to be a potentially promising pharmacotherapy for the treatment of alcohol use disorder.

Topics: Alcoholism; Animals; Antipsychotic Agents; Behavior, Animal; Brain; Central Nervous System Depressants; Ethanol; Learning; Memory; Microscopy, Electron, Transmission; Myelin Basic Protein; Myelin Proteolipid Protein; Quetiapine Fumarate; Rats; RNA, Messenger; Substance Withdrawal Syndrome

Topics: Adult; Baclofen; Hallucinations; Humans; Male; Quetiapine Fumarate; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Amines; Anticonvulsants; Antidiarrheals; Antipsychotic Agents; Antitussive Agents; Cyclohexanecarboxylic Acids; Dextromethorphan; Drug Misuse; Gabapentin; gamma-Aminobutyric Acid; Humans; Loperamide; Pregabalin; Quetiapine Fumarate; Substance Withdrawal Syndrome; Substance-Related Disorders

Carisoprodol, a centrally acting muscle relaxant with a high abuse potential, has barbiturate-like properties at the GABA-A receptor, leading to central nervous system depression and desired effects. Its tolerance and dependence has been previously demonstrated in an animal model, and withdrawal has been described in several recent case reports. Many cases can be effectively managed with a short course of benzodiazepines or antipsychotic agents. However, abrupt cessation in a patient with a history of long-term and high-dose carisoprodol abuse may result in symptoms that are more difficult for providers to treat.. We present a case of a 34-year-old man with a long history of carisoprodol abuse who was found unresponsive after having ingested 7.5 grams of carisoprodol. He was intubated and admitted to the intensive care unit. He was given propofol, dexmedetomidine, fentanyl, ketamine, lorazepam, midazolam, quetiapine, and haloperidol, some at high-dose infusions, before his agitation and ventilator asynchrony could be controlled. His improvement coincided with the addition of carisoprodol and phenobarbital to his treatment regimen. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Trends show increasing emergency department presentations for drug-related disorders and treatment. This case highlights an uncommon case of carisoprodol withdrawal that may be encountered by emergency physicians, and demonstrates that benzodiazepines may not be sufficient to suppress severe withdrawal symptoms. Treatment with carisoprodol and phenobarbital provided additional benefit and can be considered in cases of severe carisoprodol withdrawal.

Topics: Adult; Carisoprodol; Dexmedetomidine; Drug Overdose; Fentanyl; Haloperidol; Humans; Hypnotics and Sedatives; Intensive Care Units; Ketamine; Lorazepam; Male; Midazolam; Propofol; Quetiapine Fumarate; Respiration, Artificial; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Female; Humans; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Lamotrigine; Maternal-Fetal Exchange; Phenobarbital; Pregnancy; Pregnancy Complications; Quetiapine Fumarate; Substance Withdrawal Syndrome; Triazines

It has been suggested that amphetamine abuse and withdrawal mimics the diverse nature of bipolar disorder symptomatology in humans. Here, we determined if a single paradigm of amphetamine sensitization would be sufficient to produce both manic- and depressive-related behaviors in mice. CD-1 mice were subcutaneously dosed for 5 days with 1.8 mg/kg d-amphetamine or vehicle. On days 6-31 of withdrawal, amphetamine-sensitized (AS) mice were compared to vehicle-treated (VT) mice on a range of behavioral and biochemical endpoints. AS mice demonstrated reliable mania- and depression-related behaviors from day 7 to day 28 of withdrawal. Relative to VT mice, AS mice exhibited long-lasting mania-like hyperactivity following either an acute 30-min restraint stress or a low-dose 1 mg/kg d-amphetamine challenge, which was attenuated by the mood-stabilizers lithium and quetiapine. In absence of any challenge, AS mice showed anhedonia-like decreases in sucrose preference and depression-like impairments in the off-line consolidation of motor memory, as reflected by the lack of spontaneous improvement across days of training on the rotarod. AS mice also demonstrated a functional impairment in nest building, an ethologically-relevant activity of daily living. Western blot analyses revealed a significant increase in methylation of histone 3 at lysine 9 (H3K9), but not lysine 4 (H3K4), in hippocampus of AS mice relative to VT mice. In situ hybridization for the immediate-early gene activity-regulated cytoskeleton-associated protein (Arc) further revealed heightened activation of corticolimbic structures, decreased functional connectivity between frontal cortex and striatum, and increased functional connectivity between the amygdala and hippocampus of AS mice. The effects of amphetamine sensitization were blunted in C57BL/6J mice relative to CD-1 mice. These results show that a single amphetamine sensitization protocol is sufficient to produce behavioral, functional, and biochemical phenotypes in mice that are relevant to bipolar disorder.

Topics: Anhedonia; Animals; Bipolar Disorder; Cerebral Cortex; Dextroamphetamine; Disease Models, Animal; Limbic System; Lithium Compounds; Male; Memory Consolidation; Mice; Mice, Inbred C57BL; Motor Activity; Nesting Behavior; Neural Pathways; Psychotropic Drugs; Quetiapine Fumarate; Restraint, Physical; Species Specificity; Stress, Psychological; Substance Withdrawal Syndrome

Comorbid substance use in schizophrenic patients is common, and substance dependence is a predictive factor for psychosis. The present study was designed to investigate the effects of risperidone, quetiapine and ziprasidone, atypical antipsychotic drugs, on ethanol withdrawal syndrome (EWS) in rats. Adult male Wistar rats were used in the study. Ethanol (7.2%, v/v) was given to rats via a liquid diet for 21 days. An isocaloric liquid diet without ethanol was given to control rats. Risperidone (1 and 2 mg/kg), quetiapine (8 and 16 mg/kg), ziprasidone (0.5 and 1 mg/kg) and vehicle were injected into rats intraperitoneally at 1.5 and 5.5 h of ethanol withdrawal. At the 2nd, 4th and 6th hours of ethanol withdrawal, rats were observed for 5 min, and withdrawal signs that included locomotor hyperactivity, stereotyped behaviors, abnormal gait and posture, tail stiffness and agitation were recorded or rated. Following the observations at the 6th hour, the rats were tested for audiogenic seizures. All three drugs had some significant inhibitory effects on EWS-induced behavioral signs beginning at the 2nd hour of withdrawal. The drugs also significantly reduced the incidence of audiogenic seizures. Overall, risperidone and quetiapine seemed to be more effective than ziprasidone in ameliorating the withdrawal signs. Doses of the drugs used in the present study did not produce any significant changes in locomotor activities of naïve rats. Our results suggest that risperidone, quetiapine and ziprasidone had beneficial effects on EWS in rats. Thus, these drugs may be helpful for controlling withdrawal signs in ethanol-dependent patients.

Topics: Alcoholism; Animals; Antipsychotic Agents; Behavior, Animal; Body Weight; Central Nervous System Depressants; Comorbidity; Dibenzothiazepines; Ethanol; Humans; Hyperkinesis; Male; Motor Activity; Piperazines; Psychomotor Agitation; Quetiapine Fumarate; Rats; Rats, Wistar; Risperidone; Schizophrenia; Substance Withdrawal Syndrome; Thiazoles; Time Factors

Quetiapine is a new-generation antipsychotic medication approved in the treatment of schizophrenia, bipolar disorder, and related disorders. There are reports about the abuse and possible dependence of quetiapine. We present the first case of definite quetiapine dependence. This is a 37-year-old male who applied to the addiction unit because he could not control quetiapine use. He had a history of alcohol and benzodiazepine dependence as well as cannabis abuse. He reported to have a rush on quetiapine and suffered from its withdrawal when he tried to wean off the medication. This case and similar other suggest that while quetiapine may be beneficial in the treatment of some patients with addictive disorders, we should be cautious when using quetiapine to treat patients with drug or alcohol dependence.

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Humans; Male; Quetiapine Fumarate; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Adult; Antipsychotic Agents; Dibenzothiazepines; Humans; Hyperkinesis; Male; Quetiapine Fumarate; Substance Withdrawal Syndrome

Recent clinical studies show that the atypical antipsychotic medication, quetiapine, may be beneficial in the treatment of substance abuse by alleviating the withdrawal-negative affect stage of addiction. Since the effect of quetiapine on central reward function is largely unknown we studied its effects on brain stimulation reward in animals under withdrawal from escalating doses of d-amphetamine. Male Sprague-Dawley rats were trained to produce an operant response to receive a short train of electrical stimulation to the lateral hypothalamus. Measures of reward threshold were determined with the curve-shift method in different groups of rats before, and during four days after treatment with escalating doses (1 to 10mg/kg, i.p.) of d-amphetamine or its vehicle. At 24h of withdrawal, the effects of two doses of quetiapine (2 and 10mg/kg i.p.) were tested. Animals treated with d-amphetamine showed a 25% reward deficit at 24h of withdrawal, an effect that decreased progressively over the next three days. Quetiapine attenuated reward in the vehicle-control animals, and amplified the anhedonia at the moderate, but not the low, dose in the animals under withdrawal. These results show that acute treatment with clinically relevant doses of quetiapine for the treatment of schizophrenia may exacerbate anhedonia induced by amphetamine withdrawal. Further research should investigate whether repeated treatment with quetiapine has the ability to reverse amphetamine withdrawal-induced anhedonia.

Topics: Amphetamine-Related Disorders; Animals; Antipsychotic Agents; Behavior, Animal; Central Nervous System Stimulants; Dextroamphetamine; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Tolerance; Electric Stimulation; Hypothalamus; Male; Pleasure; Quetiapine Fumarate; Rats; Rats, Sprague-Dawley; Reward; Schizophrenia; Substance Withdrawal Syndrome

Topics: Aged; Antipsychotic Agents; Dibenzothiazepines; Female; Hospitalization; Humans; Quetiapine Fumarate; Schizophrenia, Paranoid; Substance Withdrawal Syndrome

Topics: Antipsychotic Agents; Dibenzothiazepines; Humans; Psychotic Disorders; Quetiapine Fumarate; Substance Withdrawal Syndrome

To compare discontinuation rates of atypical antipsychotic agents in patients with schizophrenia.. Adult Maryland Medicaid patients with schizophrenia were categorized based on initial atypical antipsychotic drug received: aripiprazole (n=446); olanzapine (n=1705); quetiapine (n=1467); risperidone (n=1580); and ziprasidone (n=700). Discontinuation was measured using refill patterns, allowing 14-day gaps between refill dates. Using olanzapine as the reference drug, the hazard of discontinuation within the first year of follow-up was compared across atypicals using Cox proportional hazard models adjusted for demographic and clinical covariates. Sensitivity analysis tested the robustness of results by using different definitions of the index date.. At one-year follow-up, most patients discontinued their antipsychotic medication (90.4% adjusted mean discontinuation). The hazard ratio (HR) for discontinuing therapy in patients starting treatment on aripiprazole, risperidone, or ziprasidone was not significantly different from olanzapine [HR 1.047, 0.973 and 0.990, respectively]. Quetiapine was associated with significantly higher hazard of discontinuation [HR 1.130] than olanzapine. Covariates associated with significantly lower discontinuation were being male [HR 0.899], older age [HR 0.997] and being on concurrent medication when initiating therapy [HR 0.225]; having a previous hospitalization was associated with significantly higher discontinuation hazard [HR 1.276]. Results were robust in the sensitivity analysis.. Discontinuation rates were high at one-year follow-up and did not differ significantly for patients on aripiprazole, olanzapine, risperidone, or ziprasidone. The higher hazard of discontinuation associated with quetiapine when compared to olanzapine is consistent with that observed in Phase I of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE).

Topics: Adolescent; Adult; Antipsychotic Agents; Aripiprazole; Dibenzothiazepines; Female; Follow-Up Studies; Humans; Male; Middle Aged; Patient Readmission; Piperazines; Proportional Hazards Models; Quetiapine Fumarate; Quinolones; Randomized Controlled Trials as Topic; Risk Factors; Risperidone; Schizophrenia; Schizophrenia, Paranoid; Schizophrenic Psychology; Sensitivity and Specificity; Substance Withdrawal Syndrome; Survival Rate; Thiazoles

After rapid discontinuation of clozapine treatment rebound psychosis have been reported. Preexposure of D (2) receptors to clozapine may alter their affinity to endogenous dopamine. Clozapine withdrawal may also lead dysfunctional NMDA-receptors to cause dopamine release in the striatum.. We report a case of a schizophrenic patient treated with clozapine 200 mg and aripiprazole 15 mg per day. After rapid clozapine discontinuation we added quetiapine up to 700 mg daily.. No rebound psychosis occurred. Even ten weeks after switching to quetiapine the patient's condition remained stable in the Brief Psychiatric Rating Scale.. The combination of aripiprazole and quetiapine seemed to control supersensitivity effects at the D (2) receptor after clozapin withdrawal in this case.

Topics: Adult; Antipsychotic Agents; Aripiprazole; Brain; Brief Psychiatric Rating Scale; Clozapine; Dibenzothiazepines; Drug Therapy, Combination; Humans; Male; Piperazines; Quetiapine Fumarate; Quinolones; Receptors, Dopamine D2; Schizophrenia; Secondary Prevention; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Aggression; Amphetamines; Attention Deficit Disorder with Hyperactivity; Child; Clonidine; Depression; Dibenzothiazepines; Domestic Violence; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Humans; Irritable Mood; Length of Stay; Male; Methylphenidate; Patient Admission; Psychiatric Department, Hospital; Psychomotor Agitation; Psychotropic Drugs; Quetiapine Fumarate; Recurrence; Sertraline; Sleep Initiation and Maintenance Disorders; Substance Withdrawal Syndrome; Valproic Acid

To report a case of quetiapine/venlafaxine intoxication associated with multiple complications and to review their possible relationship with these 2 drugs.. A 53-year-old white man was admitted to the hospital for loss of consciousness secondary to voluntary intoxication with venlafaxine and quetiapine. Several complications were attributable to this intoxication including seizures, prolonged coma, respiratory depression, neuroleptic malignant syndrome, prolonged QRS and QTc intervals, and a possible venlafaxine withdrawal syndrome.. Quetiapine could be responsible for the neuroleptic malignant syndrome presented in this case. Moreover, venlafaxine intoxication, fever, autonomic instability, and myoclonus presented serotonin syndrome as a differential diagnosis. Potential causes of seizures and prolongation of the QRS and QTc intervals are reviewed. Finally, prolonged coma and late venlafaxine withdrawal are discussed with regard to the pharmacodynamics and pharmacokinetics of drug elimination in the context of intoxication.. Clinicians should be aware of possible complications following intoxication with atypical antipsychotics and anti-depressants, including protracted altered mental status.

Topics: Coma; Cyclohexanols; Diagnosis, Differential; Dibenzothiazepines; Drug Overdose; Electrocardiography; Humans; Male; Middle Aged; Neuroleptic Malignant Syndrome; Quetiapine Fumarate; Respiratory Insufficiency; Seizures; Serotonin Agents; Serotonin Syndrome; Substance Withdrawal Syndrome; Venlafaxine Hydrochloride

Topics: Antipsychotic Agents; Depression; Dibenzothiazepines; Dyskinesia, Drug-Induced; Humans; Male; Middle Aged; Quetiapine Fumarate; Substance Withdrawal Syndrome

Topics: Adult; Antipsychotic Agents; Bipolar Disorder; Dibenzothiazepines; Female; Humans; Nausea; Prochlorperazine; Quetiapine Fumarate; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Adolescent; Antipsychotic Agents; Attention Deficit Disorder with Hyperactivity; Dibenzothiazepines; Dyskinesia, Drug-Induced; Humans; Male; Quetiapine Fumarate; Risperidone; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Adult; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Quetiapine Fumarate; Schizophrenia; Substance Withdrawal Syndrome

In an attempt to understand the basis of early relapse after antipsychotic withdrawal, the objective of this study was to determine whether the low occupancy of dopamine D2 receptors by clozapine and by quetiapine, as seen by brain imaging, could arise from a rapid release of some of the D2-bound clozapine or quetiapine by the brain imaging compounds and by the action of a physiological concentration of dopamine.. Human cloned D2 receptors were first pre-equilibrated with the [3H]antipsychotic drug, after which raclopride, iodobenzamide, or dopamine (at the physiological concentration in the synapse) was added, and the time course of release of the [3H]antipsychotic from the D2 receptor was measured.. Within 5 minutes, low concentrations of raclopride and iodobenzamide displaced appreciable amounts of [3H]clozapine and [3H]quetiapine from the D2 receptors but, during the course of 1 hour, did not displace any of the other antipsychotic [[3H]ligands. [3H]Clozapine and [3H]quetiapine, moreover, were displaced by dopamine (100 nM) at least 100 times faster than the other antipsychotic [3H]ligands.. Clozapine and quetiapine are loosely bound to the D2 receptor, and the injected radioactive ligand at its peak concentration may displace some of the D2-bound antipsychotic drug, resulting in apparently low D2 occupancies. Therefore, under clinical brain imaging conditions with [11C]raclopride, D2 occupancies by clozapine and by quetiapine may be higher than currently estimated. These considerations may result in high levels of the D2 receptors being occupied by therapeutic doses of clozapine or quetiapine. The rapid release of clozapine and quetiapine from D2 receptors by endogenous dopamine may contribute to low D2 receptor occupancy and to early clinical relapse upon withdrawal of these medications.

Topics: Animals; Antipsychotic Agents; Benzamides; Brain; Carbon Radioisotopes; Cloning, Molecular; Clozapine; Dibenzothiazepines; Dopamine; Dose-Response Relationship, Drug; Humans; Iodine Radioisotopes; Mice; Pyrrolidines; Quetiapine Fumarate; Raclopride; Radionuclide Imaging; Receptors, Dopamine D2; Salicylamides; Spodoptera; Substance Withdrawal Syndrome; Tritium

Topics: Adult; Antipsychotic Agents; Contraindications; Diabetes Mellitus, Type 1; Dibenzothiazepines; Glucose Intolerance; Humans; Male; Quetiapine Fumarate; Substance Withdrawal Syndrome