Talk:Quetiapine/Archive 2

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Adverse effects

Let's keep all the side effect discussion together. 70.112.3.127 (talk) 05:22, 15 January 2011 (UTC)

About the last line under Adverse Effects: 195.197.175.22 added a book by Peter Breggin (an anti-psychiatry activist) to several antipsychotic articles. IMHO such a biased, secondary source has no place on Wikipedia - instead we need some primary sources (studies and case reports) about brain damage. However, the Antipsychotic article is already full of controversial references, so we might as well keep a single copy there. 70.112.3.127 (talk) 19:05, 15 January 2011 (UTC)

Long term use of Seroquel can cause permanent damage to dopamine receptors in brain which is almost irreversible. Because of the possible damages its use for insomnia should be restricted only to chronic cases. In long term the permanent damage to dopamine receptors makes the insomnia worse or permanent. Seroquel is also know to cause pinned pupils. This is not a permanent side effect, just while the drug is taking effect on your body. As Seroquel wears off the users eyes return to a normal state.

—Preceding unsigned comment added by 128.214.71.116 (talk) 13:03, 19 April 2010 (UTC) 

I think you mean acute cases of insomnia, not chronic. Chronic insomnia would require longer-term use. Kat (talk) 03:47, 7 January 2011 (UTC)Kitkatkelly

Also, this information should not appear in the dosage section:

"the use of quetiapine only for insomnia is not recommended and can be considered inappropriate, as it is antipsychotic medication designed to treat psychotic symptoms, and there is a danger of serious neurological and cognitive side effects[22], including damage to sleep-wake regulating brain areas and lowered life-expectancy"

It is misplaced and of questionable verifiability. The reference cited is an article from 1990 which appears quite biased and makes no mention of side effects for either short-term or long-term treatment of insomnia. No reference is present to support the claim that using quetiapine to treat insomnia is not recommended (by whom) or considered inappropriate (by whom). This weasel-worded section should be removed or supplemented with appropriate evidence for its claims.Kat (talk) 03:43, 7 January 2011 (UTC)kitkatkelly

Where is the evidence that Seroquel damages the dopamin receptors? —Preceding unsigned comment added by 62.167.68.217 (talk) 17:04, 17 January 2010 (UTC)

All antipsychotics block dopamine receptors and in long term cause tardive dyskinesia. Even seroquel can do this. Doesn't it sound like a clear symptom of damaged dopaminergic system? —Preceding unsigned comment added by 128.214.71.116 (talk) 12:56, 19 April 2010 (UTC)

This was added to the side effects section

An overdosage of the medication can cause severe deteriorating catatonia. One patient in the state of Michigan was given 400mg instead of the 25mg start up dosage and is still suffering severe side effects. It is unknown if he will recover and how, He is currently being studied at the Univesity of Michigan.

There is no citation provided and it is poorly-written to boot. Puck35 (talk) 01:52, 11 December 2009 (UTC)

"Study 15"

in the Washington Post, today:
It was a long-term trial of the antipsychotic drug Seroquel. The common wisdom in psychiatric circles was that newer drugs were far better than older drugs, but Study 15's results suggested otherwise.
As a result, newly unearthed documents show, Study 15 suffered the same fate as many industry-sponsored trials that yield data drugmakers don't like: It got buried. It took eight years before a taxpayer-funded study rediscovered what Study 15 had found -- and raised serious concerns about an entire new class of expensive drugs.
Details of Study 15 have emerged through lawsuits now playing out in courtrooms nationwide alleging that Seroquel caused weight gain, hyperglycemia and diabetes in thousands of patients. The Houston-based law firm Blizzard, McCarthy & Nabers, one of several that have filed about 9,210 lawsuits over Seroquel, publicized the documents, which show that the patients taking Seroquel in Study 15 gained an average of 11 pounds in a year -- alarming company scientists and marketing executives.
In approving Seroquel, the agency said 23 percent of patients taking the drug in all studies available up to that point experienced significant weight increases, compared with 6 percent of control-group patients taking sugar pills. In 2006, FDA warned AstraZeneca against minimizing metabolic problems in its sales pitches. In the years since, taxpayer-funded research has found that newer antipsychotic drugs such as Seroquel, which are 10 times as expensive, offer little advantage over older ones. The older drugs cause involuntary muscle movements known as tardive dyskinesia, and the newer ones have been linked to metabolic problems.
In disputing Study 15's weight-gain data, company officials said they were not reliable because only about 50 patients completed the year-long trial. But even without precise numbers, this suggests a high discontinuation rate among patients taking Seroquel. Even if every single patient taking Haldol dropped out, it appears that at a minimum about 220 patients -- or about 82 percent of patients on Seroquel -- dropped out. Far from dismissing Study 15, internal documents show that company officials were worried because 45 percent of the Seroquel patients had experienced what AstraZeneca physician Lisa Arvanitis termed "clinically significant" weight gain.
Eight years after Study 15 was buried, an expensive taxpayer-funded study pitted Seroquel and other new drugs against another older antipsychotic drug. The study found that most patients getting the new and supposedly safer drugs stopped taking them because of intolerable side effects. The study also found that the new drugs had few advantages. As with older drugs, the new medications had very high discontinuation rates. The results caused consternation among doctors, who had been kept in the dark about trials such as Study 15.

Could someone who has more feel for where to insert this integrate the relevant facts into this article? boombaard (talk) 12:36, 18 March 2009 (UTC)

Neitherday edits

I've made the following revisions to this article based on the following --

(1) Lithium Carbonate is not indicated for the treatment of bipolar depression. It is, however, indicated for the treatment of manic episodes and maintenance therapy associated with bipolar disorder. See http://www.pdrhealth.com/drug_info/rxdrugprofiles/drugs/esk1231.shtml for verification

(2) Seroquel is not being aggressively marketed towards children. While your citations are compelling, they do not mention that Seroquel was marketed towards children/adolescents. Rather, they state that a psychiatrist prescribed these children quetiapine (NY Times article). There simply was no mention of the manufacturer or marketing.

(3) The NEJOM data is completely relevant to the information that was provided here.

(4) NMS = Since the launch of quetiapine, there has never been a report of NMS is in randomized-controlled trial with quetiapine. While case reports do exist, these are always confounded by the interactions between other medications (for example, patients taking 2 antipsychotics or those taking paroxetine and quetiapine).

(5) While there are many law suits alleged against many pharmaceutical companies, there is no direct link between diabetes and quetiapine. Therefore this information isn't valid.

(6) The information regarding Alzheimer's patients is not relevant to this discussion because quetiapine, unlike Risperidone, does not have an indication for Alzheimer's related dementia — [unsigned comment from User:162.84.181.169.]

The above (unsigned) comments came from 162.84.181.169, a user who previously and uniquely edited only on another AstraZeneca product, the asthma medication budesonide/formoterol. (See changes here.)

While I certainly acknowledge AstraZeneca's current legal position that there is no link between diabetes and Seroquel, that does not alter the fact that substantial lawsuits have been filed. Why delete any mention of these lawsuits, filed by multiple firms? There are in fact media references to these lawsuits as well, so the edits will be restored.

AstraZeneca has included teenagers and teenage models in its ads, recently in Parade and TV Guide, calling the drug to the attention of parents and families with moody and irritable teenagers. (See 'Seroquel is an Antipsychotic' for one doctor's discussion of this; the company's efforts to promote this drug's use by children and teenagers is well-known to the doctors who take care of these children.) AstraZeneca has historically promoted the drug for uses unapproved by the FDA, which is why it is so widely mis-prescribed as a sedative and why it is used with the elderly despite no evidence that it improves their conditions in any way (in fact, it has been shown to accelerate dementia). As you indeed remind us, Seroquel was indeed implicated in the death of a toddler, as reported by The New York Times in February 2007.

Can you explain why you removed the modifying phrase "not approved by the FDA"? Or do you believe "off-label" is simply a benign way of misleading people into thinking the drug is safe for purposes, and for people, for whom it is expressly not approved?

AstraZeneca's executives and apologists would do better than to write unsigned comments. (The comparison to Risperdal could only come from an embed.) Please observe good Wikipedia practice, please sign comments with four tildes, and please stop marketing this drug to teenagers, children, and people whose lives are so easily wrecked by it. There's a reason why the FDA would never approve this drug for them. — Sandover 16:43, 16 July 2007 (UTC)

Sorry for stirring up, but could you specify, how the comparison to Risperdal could only come from an embed? I know edits in question were probably made by an AstraZeneca employee, yet, it could have been pointed by any psychiatrist, gerontopsychiatrist or pharmacologue familiar with atypicals.--84.163.96.19 04:42, 29 September 2007 (UTC)

To answer 162.84.181.169's points:

1) While it is true that Lithium Carbonate is not independently approved for mania and depression it is approved as a monotherapy (which means it can be prescribed as the sole treatment for bipolar, not that it has been separately approved for mania and depression).

2) They are not "my references", I did not put them there. I simply restored deleted referenced material.

3) How is the data from the NEJOM irrelevant if the text goes on to specifically refute it?

4) Then state that there has never been an occurrence within a controlled study, to simply state it has never happened is very misleading. NMS is rare and controlled studies have small enough sample sizes that you would not expect NMS to show up in them.

5) The link between diabetes and Seoquel is controversial, and the lawsuits are relevant to that controversy.

6) It is not indicated, but as the article discusses, Seroquel is used for a wide variety of off-label purposes. It is relevant. Neitherday 16:59, 16 July 2007 (UTC)

As a mother to two bipolar sons -- both on Seroquel -- I'm very aware of pharmaceutical marketing, and FWIW, I've never personally seen DTC ads pitching Seroquel use for children. On the other hand, I'm sure that AstraZeneca reps do whatever they can to encourage such uses; as I understand it, they're allowed to share studies which include indications of this kind. —Preceding unsigned comment added by 68.49.254.236 (talk) 22:56, 6 June 2010 (UTC)

"Abuse" biased

I propose we change the "Addiction and Abuse" section to "Recreational Use", because "abuse" seems to imply that something is wrong or immoral, and is certainly POV.--Metalhead94 (talk) 03:07, 8 February 2009 (UTC)

Renamed section myself, also, there are no conclusive reports of quetiapine actually being physically addicitve.--Metalhead94 (talk) 16:32, 22 February 2009 (UTC)

"In children"

Every single cite in the "in children" section was either non-reliable or a failed verification. (The NY Times story was about parents who overprescribed a 4-year-old with several different drugs.) I'm inclined to strike the whole section. THF (talk) 02:56, 12 February 2009 (UTC)

I agree. In addition, media reports like those from the NY Times or other newspapers, magazines, etc. are generally not reliable sources. It should instead site something from a reliable source such as a medical journal or the like.--Metalhead94 (talk) 16:36, 22 February 2009 (UTC)

Phenothiazine derivitive?

I was looking at the chemical structure of this new wonder drug, and noticed that its chemical structure has a great deal in common with a number of earlier drugs, in that it appears to be a Phenothiazine derivative?

dibenzothiazine in Prolixin looks a lot like the ...(4-dibenzo[b,f][1,4]thiazepine... component of Quetiapine.

Is this correct?

If so perhaps this new repackaging of a compound originally developed by DuPont in 1935 as an insecticide would be notable?

Quetiapine looks a lot like Fluphenazine also called Prolixin chemically?

Would a side by side, diagram of these compounds be a notable subject for the article?

Are the side effects of all these compounds like Tardive_dyskinesia related to the fact that they all could possibly break down into that same triple ring structure, with the middle ring containing one sulfur and one nitrogen atom?

TeamQuaternion (talk) 01:46, 12 August 2009 (UTC)

Quetiapine is a dibenzothiazepine (a seven-membered, nitrogen- and sulfur-containing central ring flanked by two benzene rings), and is therefore more structurally similar to e.g. clozapine and loxapine.

The conformation of tricyclic compounds with a seven-membered central ring is different from the conformation of tricyclics with a six-membered central ring, such as the phenothiazines and the thioxanthenes, which are isosteric with the phenothiazines. If quetiapine and fluphenazine have not been compared in the literature, or if their structural similarity has not been noted in a reliable source, then a side-by-side comparison would simply be original research

Long-term blockade of dopamine receptors, particularly D₂ receptors, in the nigrostriatal pathway by any drug—from benzamide antiemetics such as metoclopramide to the phenothiazines to "atypical" antipsychotics—can lead to tardive dyskinesia. It's more of a mechanism of action thing than a structural thing. Fvasconcellos (t·c) 02:01, 19 August 2009 (UTC)

By the way, if you want to learn more about the mechanisms behind extrapyramidal effects such as tardive dyskinesia and you're comfortable reading scientific texts, try to get your hands on Stahl's Essential Psychopharmacology or a good general pharmacology textbook (look for the chapter on antipsychotics or drugs that act on the dopaminergic system). Fvasconcellos (t·c) 02:14, 19 August 2009 (UTC)

So in other words, dibenzothiazine and dibenzothiazepine are two different chemicals. Thanks for explaining this to me, because when I began this discussion I did not understand this, and thought that it was possible that these two terms were different names for the exact same chemical. Hence the base molecule for these two compounds Is DIFFERENT, and not the same. Perhaps this information should be included in the article?TeamQuaternion (talk) 05:44, 28 August 2009 (UTC)

what if someone abused this drug and took 300 mg of it? —Preceding unsigned comment added by Wikigirl190909 (talk • contribs) 00:59, 15 November 2009 (UTC)

Can someone explain the recreational potential of...

...of what is assumingly the dopamine equivilant of what to opioid abusers would be naloxone or naltrexone? The pharmocological part of the page makes it out to be a dopamine receptor antagonist, though elsewhere it says it dissociates dopamine from certain pathways in the brain: does it only an antagonist in certain parts of the brain leaving more dopamine for others? 65.102.21.129 (talk) 07:18, 22 March 2010 (UTC)

It's highly sedative, with anxiolitic properties. It, along with other atypicals (particularly olanzapine), is used recreationally in much the same capacity that benzodiazapines are used recreationally - for relaxing and calmative effects. It is often used to ease the 'come-down' from stimulants such as the amphetamines and cocaine, and analogously to ease withdrawal from same. Their major advantage over benzodiazapenes is the fact that they don't cause physical dependence and are not (in the usual sense of the word) addictive. --Aseld ^talk 13:57, 15 May 2010 (UTC)

It's not recreational in the sense of providing euphoria, but it causes intoxication. Subjectively, it is somewhat similar to benzodiazepines if you had to liken it to a more well known recreational drug. Anything that causes intoxication can be considered recreational. Plenty of other substances that are not euphoric or even dysphoric are considered recreational, such as benzodiazepines of course (they technically aren't euphoric, but some subjective effects may be mistaken for euphoria), diphenhydramine, datura, etc. Charles35 (talk) 19:28, 16 December 2012 (UTC)

Request to remove unsourced information

The reason quetiapine is so popular in treating insomnia, is because the sedative effect is always the same, when taking it. I was on Seroquel for 4 years, because I suffered from insomnia and I never had to higher or lower my dosage to get the same effect each night. This is also what my doctor told me; because the chemicals leave your body within 7 hours, you can't get used to them nor can you get physically addicted to them --95.245.5.98 (talk) 05:03, 26 April 2010 (UTC)

I've been on them for a similar time-frame (nearly three years), at 600mg (it was, obviously, gradually increased over these three years). It depends on what you call "addiction." I had to quit taking them, "cold turkey" (had an allergic reaction), and got super-sensitivity psychosis. In particular I'd hallucinate every time I'd shut my eyes. Yeah, this is anecdotal, but it's also easily detectable without any sort of training. And stopping like that gave me insomnia big time (impossible for me to be tired, though this may be from something resembling mania). Then again, I said I was on 600mg. That's a very heavy dosage, and what you've described may not show up so easily on a lower dose. But this does at least prove there was a compensatory mechanism within my brain, and one would assume, within others. 75.181.4.105 (talk) 05:40, 11 September 2010 (UTC)

Your description of quetiapin "addiction" is very similar to what was experienced by someone I know. The "cold turkey" from 900mg resulted in symptoms matching those of schizophrenia (paronoia, sleep disturbances, anxiety, ...) and lasted for a year. Astra Zeneca has a very accurate description of the withdrawal symptoms - but they claim that those symtoms are symptoms of schizophrenia, and that the patient should resume the medication, if he or she experiences those symptoms. I'm tempted to edit the encyclopedia, but so far this is only anecdotal: Withdrawal from high doses of quetiapin can in some cases develop into "schizophrenia". — Preceding unsigned comment added by Knowww (talk • contribs) 22:03, 21 March 2011 (UTC)

It can't "develop into schizophrenia". It might resemble/mimic the disease, even for a long period of time, but it generally does not cause lasting brain damage of such a specific type. If it were to cause brain damage (which is possible), it would not be severe enough to be considered full-blown schizophrenia, it would fade over time, and there's no reason it would mimic the symptoms of schizophrenia. In other words, it would be an incredible coincidence if quetiapine-induced brain damage were to mimic schizophrenia. The brain damage of drugs typically has little to do with the clinical effects of the drug. For instance, the most obvious type of brain damage from quetiapine is dyskinesia, which certainly has nothing to do with schizophrenia / bipolar / depression / insomnia / other off label uses. Charles35 (talk) 19:33, 16 December 2012 (UTC)

Pharmacology changes

Howdy, I'm the editor that just changed the pharmacology. As best as I can figure, and I'm certainly not a doctor, some of the receptors I didn't change are actually wrong. One site I just found said it was utterly devoid of any action at the D₄ receptor, and is probably why I couldn't find any sort of value for it. Here's the link.

For D₃, I also couldn't find anything, though I also didn't find any outright contradiction (I didn't find a page that explicitly said it had no action).

5-HT2A and 2C is a little fishy-ier. I did find a IC50 of 148nM for 5-HT2, but not 2A and 2C in particular. It's highly likely it's a 5-HT2A antagonist, but might be the whole 5-HT2 family.

See Table one of this page, as well. It lists sigma (90nM), but not a few of the others. Either that page is wrong, or this one is.

I'm not qualified to contest the reference. I can just echo it, nothing more. 174.108.96.130 (talk) 11:36, 14 October 2010 (UTC)

Metabolite of Quetiapine, Norquetiapine is also active (when using high doses) this may explain differences of pharmacology in different sources (pharmacology of quetiapine alone vs. quetiapine+norquetiapine+other possible metabolites). —Preceding unsigned comment added by 85.77.119.5 (talk) 19:25, 11 January 2011 (UTC)

Adrenergic stimulation of cerebral vessels in piglets with traumatic brain injury?

"Quetiapine strongly affects the adrenergic system (vasoconstriction) and can therefore cause problems with cerebral blood flow[19] and circulatory system in general."

• The statement "strongly affects the adrenergic system (vasoconstriction)" is ambiguous to say the least. It suggests that quetiapine causes vasoconstriction, while I think the opposite is true.

The reference [19] is http://thejns.org/doi/abs/10.3171/jns.1993.79.5.0696 :

Cerebral blood flow decreased by adrenergic stimulation of cerebral vessels in anesthetized newborn pigs with traumatic brain injury

Changes in cerebral blood flow (CBF), pial arteriolar diameter, and arterial blood pressure, gases, and pH were examined before and for 3 hours after fluid-percussion brain injury in α-chloralose-anesthetized piglets. The brain injury was induced by a percussion of 2.28 ± 0.06 atm applied for 23.7 ± 0.5 msec to the right parietal cortex. ..

While CBF of uninjured control animals did not change over a 3-hour observation period, after brain injury blood flow decreased 30% ± 1% below the baseline level within 10 minutes and remained there for 2 to 3 hours posttrauma. After adrenergic blockade, CBF did not decrease at any time during the 3-hour period in either the uninjured control or the injured animals. .. The present results support the hypothesis that increased sympathetic outflow to the cephalic vasculature following the fluid-percussion brain injury causes cerebral vasoconstriction decreasing pial arteriolar diameter and regional CBF.

What the blood flow in traumatic brain injury in pigs has to do with quetiapine is beyond me. The only thing that could be seen as potentially referring to quetiapine effects would be "after adrenergic blockade, CBF did not decrease". Unless "problems with cerebral blood flow" are defined as "no decrease in blood flow after traumatic injury", this does not support the claim made imo.

That's just one thing I spotted, maybe someone with a medical background could review the article? DS Belgium ٩(͡๏̯͡๏)۶ 02:29, 14 October 2011 (UTC)

Date rape

Two cases where the drug was used hardly justify it being mentioned, let alone have a separate section about it. Murders are committed with knifes, hammers, crowbars almost daily; that's no reason to add a section "murder weapon" to all these articles. Also, the sources do not support the claim of "date rape drug":

• "According to the prosecution's case, the rapes happened at Pugh's home between November 2009 and January 2010, when the girl was 13. He put Seroquel in her drinks and then raped her when she was unconscious."

13 year old girl, in his home? Molesting a kid repeatedly is date rape??

• "Detectives arrested the man Wednesday night. The alleged victim says she invited the man to her apartment and was persuaded by him to take a pill, which he claimed would help her sleep. The last thing she remembers is waking up a few hours later in her bedroom with this man sexually assaulting her."

Not the typical spiked drink scenario...

Neither source mentions date rape drug, or date, the second one doesn't even contain the word drug . The rape drug section is not based on the sources, it's an interpretation thereof, in violation of WP:OR: you must be able to cite reliable, published sources that are directly related to the topic of the article, and directly support the material being presented. Ssscienccce (talk) 20:23, 8 July 2012 (UTC)

Synthesis Section is very Vague

Someone needs to explain the sythesis of this drug in detailed language from the very beginning so lay people can understand. 2602:306:C518:62C0:5C06:758E:E477:60D6 (talk) 20:58, 31 July 2012 (UTC)

Recreational use

Do letters to the editor qualify as WP:MEDRS?
Intranasal Quetiapine Abuse:

To the Editor: We would like to report on the widespread "abuse" of quetiapine among inmates in the Los Angeles County Jail—"the largest mental health institution in the world." Anecdotal reports from clinicians and staff estimate that as many as 30% of the inmates seen in psychiatric services report malingered psychotic symptoms (typically endorsing "hearing voices" or ill-defined "paranoia") in order to specifically obtain quetiapine. A history of substance dependence is common among those engaging in this practice. In addition to oral administration, the drug is also taken intranasally by snorting pulverized tablets. Such abusive self-administration seems to be driven by quetiapine’s sedative and anxiolytic effects (to help with sleep or to "calm down") rather than by its antipsychotic properties.

Intravenous Quetiapine-Cocaine Use ("Q-Ball"): Links to "Hyperglycemia in a 7-Year-Old Child Treated With Aripiprazole". Only the PMID link is valid (but no abstract available)

Quetiapine Addiction?:

To the Editor: Quetiapine is not a controlled substance and is not considered addictive. Yet there are several reports describing abuse among inmates in jails and prisons (1, 2).

The pharmaceutical formulary for the Ohio correctional system contains three second-generation antipsychotics, but quetiapine is not one of them. It may be prescribed with special authorization for patients with serious mental disorders who have not responded to formulary agents. However, inmates entering prison on quetiapine for other conditions, such as sleep and anxiety disorders, must have it tapered and discontinued.

The authors have treated a number of inmates who have engaged in drug-seeking and sometimes illegal behavior to obtain this medication. The following case is illustrative...

Anecdotal reports about the use of medication and observations on some individual cases in a high-stress environment where patients want to continue the treatment prescribed by the physician(s) of their choice. The authors provide some other "arguments", like an internet search yielding a number of self-reports by individuals and a popular rap song in which “seroquel” is included in a long list of addictive substances. Arguments you can find on almost every talk page, from astrology to colloidal silver. Ssscienccce (talk) 09:21, 12 September 2012 (UTC)

Dosage

The dosage section contains no information on dosages. It alludes to high and low doses but makes no attempt to explain what might constitute a high or low dose. Interestingly, the source cited to support the claim that "Use of low-dose quetiapine is not recommended except temporarily during drug titration period" ( http://pharmacy.oregonstate.edu/drug_policy/sites/default/files/pages/dur_board/evaluations/articles/seroquel_due.pdf ) contains FDA dosage guidelines for various indications which might have been useful to include. The source also never states low dose Quetiapine is not recommended, and looks at the use of low doses for periods exceeding 60 days rather than the 30 day titration period stated. If I was any more than someone who had just been prescribed this drug I might edit the article myself, but I won't deign to tell the world what dosages they should be expecting with nothing more than a layman's interest. Someone else can do that please. — Preceding unsigned comment added by Atmospheric-Injection (talk • contribs) 05:52, 4 October 2012 (UTC)

AstraZeneca's $520 million U. S. Department of Justice fine

It is not surprising that AstraZeneca, lacking any moral compass whatsoever in its well-documented efforts to market Seroquel to patients who never needed it, regularly removes references to the 2010 U. S. Department of Justice settlement. Given that AstraZeneca's aggressive and illegal off-label marketing techniques ontinue to have highly adverse consequences for patients even in the drug's generic phase, it is important that the references to this settlement remain in the entry. I appreciate the vigilance of Wikipedists (other than those working for AstraZeneca) in this matter. Sandover (talk) 10:00, 24 March 2013 (UTC)

Semiprotection

I am semi-protecting, not necessarily because of the removal as such (as if it is not a review article it probably should be removed, but the concerns raised mean that everyone who edits that page should be as identifiable and accountable as possible. Casliber (talk · contribs) 21:03, 29 March 2013 (UTC)

Conflicting pharmocology?

Under the section on pharmocology is states 5-HT1A (IC50 = 717nM), 5-HT2A (IC50 = 148nM), 5-HT2C, and 5-HT7 receptor antagonist Does that mean it is listing Seroquel as an antagonist of all those receptors? If so then my query is that when you follow the 5-HT1A link it has seroquel listed as a 5-HT1A agonist. So is it both and if so should the 5-HT1A page have seroquel under both the agonist and antagonist lists?

It's only regular quetiapine that is 5HT1A antagonist, not the XR. You will find information in pharmacology description of each product. — Preceding unsigned comment added by 206.167.216.8 (talk) 21:26, 2 April 2013 (UTC)

My apologies if i've missunderstood the actual line in question as stating seroquel is a antagonist of all those on the line seperated by commas and not just the last receptor (5-HT7) Viper1431 (talk) 22:14, 8 August 2012 (UTC)

Hmm, you're right, that's weird. I was pretty sure it's a serotonin antagonist, but I just did a bit of research through wikipedia (hardly research I know, but there's nothing wrong with looking at the other articles and trying to find info there). The 5ht-1a page lists it as an agonist, and also lists abilify, geodon, and clozapine as agonists as well. The wikipedia articles for those drugs say that they are (partial) agonists (and in some cases have SSRI action). So based on that, I would venture the guess that seroquel is an agonist / partial agonist. Charles35 (talk) 19:42, 16 December 2012 (UTC)

AstraZeneca's self-editing on Wikipedia, August 2007

Three years before its half-billion dollar fine, AstraZeneca was caught (in August 2007) editing its own Wikipedia page from an IP address originating within the company itself (specifically, AstraZeneca was caught removing warning information about the drug's link to suicidial ideation in minors). This was written up in the entry and on the Talk page, after the scandal received attention from the Times of London, Fox News, etc. Not wanting to be the poster boy for Big Pharma's most egregious trespasses, the company has since become smarter about how it disguises its Wikipedia activity. But I thought it worth mentioning again for the sake of newer editors. Sandover (talk) 10:25, 25 March 2013 (UTC)

Do you think the company is still editing Wikipedia but we have not been able to detect it? Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:38, 26 May 2013 (UTC)

One could, I suppose, ask editors whether they are in the pocket of Big Pharma, but the response would be quite predictable, and quite independent of its own veracity. Or, we could WP:AGF, unless conclusively shown otherwise... DavidLeighEllis (talk) 14:59, 28 July 2013 (UTC)

Treatment of insomnia

Since the beginning of last year,I've been suffering from severe insomnia,so I need to take a pill of this medicine every single night.This drug was prescripted by my psychiatrist.Lately,I've been really worried about my situation,as I fear that such a long usage period will cause serious side effects,and withdrawing it could possibly worsen my condition or even cause other issues.What do current studies and researchs reveal about that?What are the hazards of taking this medicine for too long or withdrawing it after a period of one or two years?--Ksio.amaral89 (talk) 05:16, 15 March 2012 (UTC)

I'm not sure if this is the right place to ask this question, maybe this section should be removed. Anyway: the possible side effects are by a long shot smaller than the side effects of insomnia. Also, the longer you take it, the easier it will be for you to stop using it. Ask your psychiatrist, he probably knows what he is doing. 189.103.31.150 (talk) 22:35, 14 May 2013 (UTC)

If I were you I would taper Seroquel asap. It is hard to withdraw and has numerous side effects. The use for insomnia is off-label. But the drug is very expensive and that's the reason it's being prescribed for insomnia. Take care.--Justana (talk) 01:55, 8 May 2012 (UTC)

Not that much is know as it has not been well studied. Look at review article on pubmed. Have added evidence to this page. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:46, 14 May 2013 (UTC)

giving out medical advice on a wikipedia discussion page about a medication without posting your MD credentials is inappropriate. Furthermore, taking said advice is dangerous at best. quetiapine is known to have a great deal of sedation(i've heard it called "sleepaquel" by psychiatrists). It's also NOT very expensive anymore due to generic availability. — Preceding unsigned comment added by 159.238.36.19 (talk) 16:52, 21 August 2013 (UTC)

Citation

The citation for this agent as an adjunct for depression treatment is inappropriate.

the citation for partial agonism at the 5ht1a receptor site is inappropriate. Primary citations should be used when possible: Jensen NH, Rodriguiz RM, Caron MG, Wetsel WC, Rothman RB, Roth BL. N-desalkylquetiapine, a potent norepinephrine reuptake inhibitor and partial 5-HT1A agonist, as a putative mediator of quetiapine’s antidepressant activity. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology 2008;33:2303-12. should replace citation #46 — Preceding unsigned comment added by 159.238.36.19 (talk) 16:45, 21 August 2013 (UTC)

Incorrect citation

The doi in this citation:

Leucht, S; Cipriani, A; Spineli, L; Mavridis, D; Örey, D; Richter, F; Samara, M; Barbui, C; Engel, RR; Geddes, JR; Kissling, W; Stapf, MP; Lässig, B; Salanti, G; Davis, JM (September 2013). "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis". The Lancet 382 (9896): 951-962. doi:10.1016/S0140-6736(13)60733-. PMID 23810019. is incorrect, the correct doi should be:

doi:10.1016/S0140-6736(13)60733-3

The article is protected, though, so I couldn't edit it. --Vibackup (talk) 16:20, 1 December 2013 (UTC)

Thanks for the heads up, I've corrected it. Fuse809 (talk) 21:35, 1 December 2013 (UTC)

Content

Unable to find the support for this in the ref in question "It appears to be the only atypical antipsychotic that is capable of preventing depressive relapse which can likely be attributed to the norepinephrine-reuptake inhibiting effects of its active metabolite, norquetiapine. It appears to rival lithium in its ability to prevent mood episode relapse." Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:28, 9 September 2013 (UTC)

The first doesn't sound right. The scond, well, all antipsychotics can act as mood stabilisers really. Cas Liber (talk · contribs) 02:35, 2 December 2013 (UTC)

Oh it can prevent depressive relapse. This source gives it a NNT of around 3 for both depression and mania prevention. Additional support may be found here. Fuse809 (talk) 02:54, 2 December 2013 (UTC)

The amusing thing was that the 2008 Weisler paper used to support quetiapine monotherapy in that polarity paper had not been published at that point. Anyway it is published in 2011 - fulltext here - I have problems with it, as breakdown in prerandomization phase (on quetiapine) is going to select out nonresponders to that (pretty big weeder-outer here!). At least they mention that in one line at the very end of the study. Also lithium and placebo are nonsedating, quetiapine is, hence not really blinded trial. Still, some interesting results. Cas Liber (talk · contribs) 04:03, 2 December 2013 (UTC)

The study was also finded by Astra-Zeneca. I was surpised that the weight gain was that small for quetiapine too, and that similar rates of sleeping tablets were used. Cas Liber (talk · contribs) 04:05, 2 December 2013 (UTC)

If you want to argue about the ability for trials to truly blind patients when they're taking drugs with obvious side effects well here's one for lithium -- polyuria and polydipsia. Pretty noticeable when you're urinated twice as frequently as normal and this side effect is about as common as somnolence is with quetiapine. For instance, I've been personally been on quetiapine myself for major depressive disorder and I barely even noticed I was on it at times. All mood stabilisers have some really noticeable AE in a significant number of patients. So, while you're argument has merit it can be just as easily applied to any mood stabiliser. As for the potential for bias well its difficult to find trials that aren't funded by some organisation or business with an axe to grind. But yeah at the very least there is evidence to support that quetiapine reduces depressive relapse rates too and while we may have our quarrels over whether it's a good source it is a review article published in a respected journal so I think at least it should be mentioned on this page. Fuse809 (talk) 04:11, 2 December 2013 (UTC)

I am not sure the polarity article is marked as a Review Article - I didn't see it come up. It is also using the data in a novel way. Didn't get to examine the NNT article in detail - got distracted. Look, I prescribe alot of quetiapine so am not averse to using it. I find patients talking of sedation very commonly, and more so than polyuria and polydipsia - realistically one could make it really blind with some promethazine. Anyway, will look at t'other article soon. Cas Liber (talk · contribs) 10:21, 2 December 2013 (UTC)

Funny, the NNT one doesn't appear to be listed as a Review article either.....Cas Liber (talk · contribs) 10:31, 2 December 2013 (UTC)

It is, scopus calls it a review article. Fuse809 (talk) 10:40, 2 December 2013 (UTC)

Is there a way to switch off the irritating mobiles attched to this article?

They look like they're GIFs e.g https://upload.wikimedia.org/wikipedia/commons/thumb/1/16/Quetiapine3DanBS.gif/250px-Quetiapine3DanBS.gif and I find them very irritating and distracting when studying an article. Is there any way in wiki or Windows to "freeze" them? LookingGlass (talk) 08:33, 19 March 2014 (UTC)

Semi-protected edit request on 2 May 2014

The product is called Neurofen+ NOT Neurofen Plus 213.106.56.145 (talk) 18:27, 2 May 2014 (UTC)

 Not done The box in my hand clearly says "Nurofen Plus", not "Neurofen" and not "+". In Wikipedia terms, reading the actual box is probably original research, so, to follow the correct procedure, please provide a reliable source to support your change. Arjayay (talk) 19:28, 2 May 2014 (UTC)

" pediatric exclusivity extension"

What is a "pediatric exclusivity extension"? Also the lead of the article is somewhat out-of-date, verb tense wise. Why is Canada there, and not other countries? Is this a drug that is used worldwide, or only in the major English-speaking countries? Was Canada the first country where the patent expired?

Thanks, Parabolooidal (talk) 16:12, 24 August 2014 (UTC)

mACh receptor activity

I signed up to wikipedia today to make this point and so please forgive me if this is not the proper format. The section "pharmacology," would be clearer if an explicit statement was added to make the following change:

"This means Quetiapine is a dopamine, serotonin, and adrenergic antagonist, and a potent antihistamine with clinically negligible anticholinergic properties. However, given the strong anticholinergic properties of this molecule's metabolite, norquetiapine, overall this medication does exert high levels of anticholinergic tone on the patient."

Sconri2 (talk) 14:36, 14 October 2014 (UTC)

Good point - anyone who prescribes the medicine knows this already from its side effect profile. I tagged the problem sentence in the article nad will look later. Cas Liber (talk · contribs) 22:59, 14 October 2014 (UTC)

Semi-protected edit request on 6 January 2015

Incorrect citation format Laemonicus (talk) 12:18, 6 January 2015 (UTC)

Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format.  ^B E _C K ^Y _S A ^{Y L} E _S  12:27, 6 January 2015 (UTC)

quetiapine

At low doses quetiapine is used as a sedative. Only in high doses does it become first a sedative, then an antipsychotic. References are freely available. thelastpsychiatrist surviving antidepressants and many other reputable sites. — Preceding unsigned comment added by 101.186.61.12 (talk) 12:44, 11 January 2015 (UTC)

Semi-protected edit request on 9 March 2015

In section "2.2. Overdosage" cardiac arrhythmia is spelled wrong (currently arrythmia). 188.193.242.22 (talk) 17:50, 9 March 2015 (UTC)

 Done Thanks for pointing that out - Arjayay (talk) 18:18, 9 March 2015 (UTC)

Dosage

It’s odd that the Dosage section says little or nothing about actual dosage. What is a low dose? What is a high dose? The Sustained-release sub-section is all about regulatory approval and marketing. ☸ Moilleadóir ☎ 04:04, 3 April 2015 (UTC)

Semi-protected edit request on 13 January 2016

This citation could be used for the claim "It is also sometimes used as a sleep aid because of its sedating effect but this use is not recommended." 92.37.27.181 (talk) 14:28, 13 January 2016 (UTC)

Done --allthefoxes ^(Talk) 17:30, 13 January 2016 (UTC)

References

Semi-protected edit request on 27 January 2016

All (3) instances of "Seroquel XL" should be replaced with "Seroquel XR", which is the true name of AstraZeneca's extended release (XR) formulation of quetiapine. Even though XL can be used to designate an extended-release formulation, XR should be used, because AstraZeneca markets it as "Seroquel XR" and because "Seroquel XL" has fewer (57.400) Google results than "Seroquel XR" (372.000).

Edit after response: this is the relevant pharmaceutical company's prescribing information: http://www1.astrazeneca-us.com/pi/seroquelxr.pdf 92.37.83.253 (talk) 17:24, 27 January 2016 (UTC)

Not done: as you have not cited reliable sources to back up your request, without which no information should be added to, or changed in, any article. The number of Google hits is entirely irrelevant, and contravenes WP:OR and WP:SYN - Arjayay (talk) 17:34, 27 January 2016 (UTC)

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Semi-protected edit request on 15 August 2016

I would like to add that Quetiapine may also be used in the treatment of PTSD.

Im1pramine (talk) 04:56, 15 August 2016 (UTC)

References

Not done, it appears you are autoconfirmed now and can edit yourself. — Andy W. (talk · ctb) 18:25, 17 August 2016 (UTC)

Sterochemistry (sulfur/nitrogen orientation)?

I don't know much about sterochemistry (I'm working my way through Harry Gray's 1994 Chemical Bonds - any suggestions of a more recent "update"?), so this probably has an obvious answer. Would there be the possibility of sterochemistry based on whether the sulfur and nitrogen atoms are on the same "side", or would one or both atoms be "allowed" to "wiggle" back and forth between the two benzene (?) rings? ("Yes, that's like very precise o-chem terminology!") Jimw338 (talk) 15:31, 24 March 2017 (UTC)

Semi-protected edit request on 19 May 2017

I would like to add in the article that quetiapine

Quetiapine is according to studies and may, according to clinical experience, have a good effect in severe anxiety disorders, particularly severe therapy-resistant cases, where nothing else has yielded results. It is important to inform about this, as treatment of anxiety can be problematic due to addictive properties of benzodiazepines and that antidepressants are often insufficient. This is not clearly apparent in the current article on quetiapine. I therefore ask you to include this in the end of the article, all references are given in summary form here mentalhealthdaily.com/2016/09/20/seroquel-quetiapine-for-anxiety-disorders-an-atypical-treatment/ Source references appear in linked article. Zodiacken (talk) 17:06, 19 May 2017 (UTC)

Which ref per WP:MEDRS do you propose we use? Doc James (talk · contribs · email) 04:02, 21 May 2017 (UTC)

Not done: please provide reliable sources that support the change you want to be made. —MRD2014 📞 contribs 01:16, 25 May 2017 (UTC)

Pharmacological receptor model: 5HT inconsistency

The wiki article Serotonin antagonist disagrees concerning the serotonergic pharmacodynamics of quetiapine, where it is identified as an antagonist of (only) the 5-HT_1A and 5-HT_2A receptors. Quetiapine does reference a source for the claimed partial agonistic effect on the 1A subtype, but does not cite sources for including 5-HT subtypes other than 1A and 1B as binding sites. I don't know which to believe. In an ideal world, these two articles would agree. The other article has no activity on the talk page, so I placed my comment here. thank you. ChuckBiggs2 (talk) —Preceding undated comment added 22:01, 12 June 2017 (UTC)

External links modified

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Dopamine receptor links broken

2014-10-19: The broken links are currently: D₁ They should be: D₁ for Dn where n in {1,2,3,4}  :)

I'd fix it, but can't due to protection. — Preceding unsigned comment added by Asciikewl (talk • contribs) 20:10, 19 October 2014 (UTC)

Semi-protected edit request on 30 November 2017

The line below appears twice in the "Discontinuation and Withdrawal" section, once towards the top, and once at the bottom. I believe the second occurrence should be removed:

The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotic treatment to avoid acute withdrawal syndrome or rapid relapse.[40] 80.229.12.5 (talk) 16:30, 30 November 2017 (UTC)

Done —KuyaBriBri^Talk 17:09, 30 November 2017 (UTC)

"Patent protection for the product ended in 2012; however, in a number of regions the long acting version remains under patent until 2017."

This should be updated for 2018. — Preceding unsigned comment added by ؛ (talk • contribs) 20:50, 27 March 2018 (UTC)

Semi-protected edit request on 16 April 2018

"however, in a number of regions the long acting version remains under patent until 2017."

It's now 2018, shouldn't "remains" be changed to "remained" now? Blysse (talk) 08:32, 16 April 2018 (UTC)

 Done DRAGON BOOSTER ★ 08:48, 16 April 2018 (UTC)

quetiapine and breastfeeding

The article states that women who are on quetiapine should not breastfeed, but I don't think that's accurate. Perhaps the manufactuer states that? however, the LactMed database (which is where clinicians and mothers should go for collected information on drugs and breastfeeding) states that breastfeeding on quetiapine isn't particularly dangerous (based on the studies/anecdotes they have collected there). I'm not quite sure where the article got the statement that women on quetiapine shouldn't breastfeed, maybe I'm missing something.

http://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+lactmed:@term+@DOCNO+233 Kajakitten (talk) 20:16, 16 October 2018 (UTC)

Semi-protected edit request on 10 November 2018

I want the external link https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2846118/ to be added to the article, because when I read it it made sense to me. I am a patient using quetiapine, I am not medically schooled nor trained. The article behind the link is "Role of extended release quetiapine in the management of bipolar disorders" from the site National Institute of Health, an American English language site on various medical topics like medications, primarily. 2001:14BB:420:D388:CDB7:87AF:E865:6555 (talk) 18:20, 10 November 2018 (UTC)

 Not done: That article is 8 years old, and the data on antipsychotic tranquilizers is not static, as it continues to be updated all the time. Do you have a more current article that could be used?  Spintendo  19:26, 24 November 2018 (UTC)

Semi-protected edit request on 2019-08-12

"Although not recommended, it is also used as a sleep aid due to its sedating effect."

I suggest a change to one of the following versions (maintaining the link to Sedation):

"Despite concerns of overprescription it is also widely used as a sleep aid due its sedating effect."

OR

"Despite concerns of overprescription and disproportionate risks it is widely used for its sedative effects."

OR

"It is also widely used for its sedating effect but there are concerns that it is often prescribed without acknowledging the potential side effects."

The cited article does not recommend cessation or a moratorium on the off-label prescription for sedation.

Citations 25 and 26 more aggressively repeat the notion that the prescription of Quetiapine for insomnia/off-label disorders should be more carefully considered by weighing the benefits over the potentially serious side-effects. There may be a better verbiage but I'm trying to convey that it's not that Quetiapine is not recommended for sedation but rather that it's way over-prescribed when you consider the potential for serious side effects and risks. Especially when the risks are not weighed against the clinical benefits.

From the Article (citation 8)

James J. Gugger; Manouchkathe Cassagnol (2008). "Low-dose quetiapine is not a benign sedative-hypnotic agent". The American Journal on Addictions. 17 (5): 454–455. doi:10.1080/10550490802266185. PMID 18770092.

(SGA's in this context mean second generation antiphychotics including Quetiapine)

"Although we are not advocating a moratorium on the prescription of low-doses of SGAs, we would like to point out that these are not benign agents."

"In fact, the utilization of SGAs for indications other than psychosis may exceed 70%."

"We are concerned about the widespread use of low-dose SGAs as sedative-hypnotic agents"

 Done Changed to "Despite concerns of overprescription it is also widely used as a sleep aid due its sedating effect." It's a bit hard for me to do the sourcing properly as I don't have access to most of the sources. I haven't changed anything about them, but the new description seem to be well sourced. --Trialpears (talk) 07:14, 27 August 2019 (UTC)

Have updated to this review "Robust studies evaluating the safety and efficacy of quetiapine for the treatment of insomnia are lacking. Given its limited efficacy data, its adverse-effect profile, and the availability of agents approved by the Food and Drug Administration for the treatment of insomnia, quetiapine's benefit in the treatment of insomnia has not been proven to outweigh potential risks, even in patients with a comorbid labeled indication for quetiapine."

https://www.ncbi.nlm.nih.gov/pubmed/24534594

Doc James (talk · contribs · email) 13:41, 27 August 2019 (UTC)

SMILES

OCCOCCN1CCN(CC1)C1=NC2=CC=CC=C2SC2=CC=CC=C12 is the correct one Juan Caturelli 14/10/2019 — Preceding unsigned comment added by 179.125.51.160 (talk) 17:27, 14 October 2019 (UTC)

Extra clarification for sedative use

The text in the introduction where quetiapine’s disadvantages are described to outweigh its benefits as a sleeping aid could change in formatting. A description like “for this particular use” or “for this use in particular” seems more visually friendly than “such use”, since the latter makes it visually seem as also ineffective for conditions like schizophrenia and bipolar disorder where it has a proven clinical use. Maybe it’s just me though, input would be appreciated regardless. 189.152.203.246 (talk) 00:06, 19 March 2022 (UTC)