Seroquel side effects, risk, danger and benefits

Seroquel is is an antipsychotic medication but may also be used in severe cases of bipolar disorder. Seroquel is indicated for the treatment of depressive episodes in bipolar disorder; acute manic episodes in bipolar I disorder, as either monotherapy or adjunct therapy to lithium or divalproex; and schizophrenia. Patients should be periodically reassessed to determine the need for treatment beyond the acute response. Elderly patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. Seroquel is not approved for the treatment of patients with dementia-related psychosis.

Uses of Seroquel
The uses and outcomes of quetiapine in depressive and bipolar mood disorders in clinical practice.
J Psychopharmacol. 2009. Shajahan P, Taylor M. NHS Lanarkshire, Scotland, UK; University of Glasgow, Scotland, UK.
We conducted an electronic chart review of a sample of all people attending secondary mental health care, in the county of Lanarkshire, Scotland, who were commenced on quetiapine for the following mood disorders: non-psychotic depression (n = 171), psychotic depression , bipolar mania, bipolar depression and bipolar mixed states, between 2002 and 2007. We retrospectively assigned severity and improvement Clinical Global Impression (CGI) scores to measure effectiveness. Seroquel was co-prescribed with antidepressants in 75-97% of depressive disorders. Commencing quetiapine was associated with clinical improvement in >64% of all patients, median doses (200-400 mg/day). For all depressive subtypes (non-psychotic, psychotic and bipolar) Seroquel was associated with improvement in 69% of patients. Across CGI measures, bipolar mania patients had the best outcome (89% improved). In bipolar mania, higher maximum doses were associated with greater improvement and 45% were continued on antidepressants. The results should be interpreted with caution due to the observational nature of the study and findings may not be attributed to the effects of quetiapine alone. Seroquel was used mainly as an adjunct to other antidepressant and mood stabilising agents. The pharmacological profile of Seroquel suggests its properties extend beyond antipsychotic action, to antidepressant, anxiolytic and mood stabilising effects.

Seroquel for bipolar disorder
AstraZeneca Pharmaceuticals LP has announced that quetiapine fumarate tablets are now indicated for the treatment of patients with depressive episodes associated with bipolar disorder. SEROQUEL tablets are also indicated for the treatment of acute manic episodes associated with bipolar I disorder as either monotherapy or adjunct therapy to lithium or divalproex and for the treatment of schizophrenia. SEROQUEL is available as 25-mg, 50-mg, 100-mg, 200-mg, 300-mg, and 400-mg tablets.

Seroquel dosage
The usual dosage of Seroquel for the treatment of patients with depressive episodes associated with bipolar disorder is 300 mg/day administered once daily at bedtime. The recommended initial dosing schedule is 50 mg, 100 mg, 200 mg, and 300 mg per day for Days 1-4, respectively. Antidepressant efficacy was demonstrated with SEROQUEL at both 300 mg and 600 mg; however, no additional benefit was seen with 600 mg.

Seroquel side effects and danger
Schizophrenia patients have a potential increased risk of metabolic dysregulation during antipsychotic treatments. The most commonly observed Seroquel side effects in clinical trials for schizophrenia and bipolar disorder were dry mouth, sedation, somnolence, dizziness, constipation, SGPT increase, dyspepsia, lethargy, and weight gain. The most commonly observed Seroquel side effect in clinical trials as adjunct therapy with lithium or divalproex in bipolar mania were somnolence, dry mouth, asthenia, constipation, abdominal pain, postural hypotension, pharyngitis, and weight gain. In the elderly and in patients with hepatic impairment, consideration should be given to a lower starting dose, a slower rate of dose titration, careful monitoring during the initial dosing period, and a lower target dose. It is not recommended to use yohimbe bark supplement in those who are taking this medication.

Modern antipsychotic drugs, especially AstraZeneca’s blockbuster Seroquel, may increase the risk of patients developing life-threatening blood clots. BMJ, 2010.

Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma, or death, has been reported in patients treated with atypical antipsychotics, including SEROQUEL. The relationship of atypical use and glucose abnormalities is complicated by the possibility of increased risk of diabetes in the schizophrenic population and the increasing incidence of diabetes in the general population. However, epidemiological studies suggest an increased risk of treatment-emergent, hyperglycemia-related adverse events in patients treated with atypical antipsychotics. Patients starting treatment with atypical antipsychotics who have or are at risk for diabetes should undergo fasting blood glucose testing at the beginning of and during treatment. Patients who develop symptoms of hyperglycemia should also undergo fasting blood glucose testing. Precautions include the risk of seizures, orthostatic hypotension, and cataracts. Examination of the lens by methods adequate to detect cataract formation, such as slit lamp exam or other appropriately sensitive methods, is recommended at initiation of treatment or shortly thereafter, and at 6-month intervals during chronic treatment

Seroquel and suicides
Suicidality in children and adolescents–antidepressants increased the risk of suicidal thinking and behavior in short-term studies of 9 antidepressant drugs in children and adolescents with major depressive disorder and other psychiatric disorders. Patients started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.

Neuroleptic Malignant Syndrome
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including Seroquel. Rare cases of Neuroleptic Malignant Syndrome have been reported with Seroquel. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis) and acute renal failure. The management of NMS should include immediate discontinuation of antipsychotic drugs

Tardive dyskinesia concern
Tardive dyskinesia, a potentially irreversible syndrome of involuntary dyskinetic movements, may develop in patients treated with antipsychotic drugs. The risk of developing TD and likelihood that it will become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic drugs administered to the patient increase. TD may remit, partially or completely, if antipsychotic treatment is withdrawn. Seroquel should be prescribed in a manner that is most likely to minimize the occurrence of TD.