Found something of interest for anyone as sleep-deprived as I've been. I just know how wonderful I feel if I can get eight sleeps consistently. It effects everything I do and think! Always watching out for Big Pharma influence anytime my shrink nurse wants to discuss "how I'm doing." She's very good and listens intently to what I say. I trust her pretty much. I brought in the formulary from my insurance coverage to see what could be done about this lack of sleep. Just can't get tired enough to make it to bed and after about four hours sleep, I wake up and am bored with being asleep. So, I get up and do things that are interesting and damn near nod out doing them. Having a touch of narcolepsy, she put me on Provigil a few months ago. She raised the dosage to 400mgs a day but I was still too drowsy. She suggested Seraquill. Uh huh, but "stay on the Provigil" I'm already suspecting Big Pharma looking over her shoulder. Hey, I may be wrong but since they really are using us as guinea pigs, ya just never know.
Found something on the Oprah site. Are you believing the crap being thrown at her about being non-religious, ferchrissakes? Guess we're going to have to get out the torches and pitchforks. The religious right needs to look to home with their criticism. So, she had a link to something called
www.iguard.org. I like the idea of something out there looking over my meds, just gotta keep watching out for Big Pharma, the bastards. So, the following is something that might make a difference if you have a sleep disorder. Seems like if you take care of a sleep disorder, it might help with an eating disorders well as other problems . Got the book-tape of "You: On a Diet," By Dr. Oz and Dr. Roizen, Ophrah's "boyz." Why, I'm a changed Beepath today. Seems will-power can be prgrammed into your thinking. Imagine that. So, when my doc (actually an ARNP who should've gone on to be a doc, just like my cousin, Jaime.) suggested that with an A1C of 8.8, we need to think about insulin. I felt like dramatically falling on my knees and wrapping my arms around her, begging for three more months to bring the A1C down. But I didn't want to frighten her, she being such a skinny little thing. I can see it now, sitting in jail being asked what I'm in for. "Oh," I'd say,hysterically, "objecting to taking insulin." Then, some big, black, buffed gangster chica who doesn't have diabetes would suggest just doing some situps. Then, I'd have to jump her....yeah, that could happen.....
Quetiapine is indicated for the treatment of schizophrenia as well as for the treatment of acute manic episodes associated with
bipolar I disorder, as either mono-therapy or adjunct therapy to
lithium or
divalproex. Quetiapine received its initial indication from the
FDA for treatment of
schizophrenia in 1997. In 2004, it received its second indication for the treatment of mania-associated
bipolar disorder.
[1] It is sometimes used
off-label, often as an augmentation agent, to treat such conditions as
obsessive-compulsive disorder,
post-traumatic stress disorder,
restless legs syndrome,
autism,
alcoholism,
[2] Tourette syndrome,
[3] and has been used by physicians as a
sedative for those with
sleep disorders or
anxiety disorders.
[4]In 2005, quetiapine and other anti-psychotics were shown by the
New England Journal of Medicine to be no more effective than
perphenazine (Trilafon), a
typical anti-psychotic, for the treatment of schizophrenia. However, the subsequent CATIE trial, funded by AstraZeneca and other major pharmaceutical manufacturers,
[5] contradicted the 2005 study in certain instances.
A 2005
British Medical Journal report showed that quetiapine was ineffective in reducing agitation among Alzheimer's patients, whose consumption of the drug then constituted 29% of sales; in fact, quetiapine was found to make cognitive functioning worse in elderly patients with dementia.
[6]Use of quetiapine to minimize the symptoms of
opioid withdrawal has been studied.
[7]Phase III trials are being conducted to prove quetiapine's efficacy in treating
generalized anxiety disorder and
major depressive disorder as of January 2007. The company expects to file a New Drug Application for treating generalized anxiety disorder in the second half of 2007 and for major depressive disorder in 2008.
[8]AstraZeneca's patent for Seroquel expires in September 2011, which will allow other companies to manufacture and market quetiapine.
[
edit] In children
Quetiapine is controversially marketed to parents of moody and irritable teenagers in magazines such as
PARADE and
TV Guide.
[9][10] The
National Institutes of Health recommends against the use of quetiapine and almost all other psychotropic medications (including all atypicals, most antidepressants, and all benzodiazepines) by children or those under 18,
[11] observing that teenagers taking quetiapine "may be more likely to think about harming or killing themselves or to plan or try to do so".
[12][
edit] Pharmacology
The antipsychotic effect of quetiapine is thought by some to be mediated through
antagonist activity at
dopamine and
serotonin receptors. Specifically the
D1 and
D2 dopamine receptor, the
alpha-1 and
alpha-2 adrenergic receptor, and
5-HT1A and
5-HT2 serotonin receptor subtypes are antagonized.
[13] Serial PET scans evaluating the D2 receptor occupancy of quetiapine have demonstrated that quetiapine very rapidly disassociates from the D2 receptor.
[14] Theoretically, this allows for normal physiological surges of dopamine to elicit their normal effects in areas such as the
nigrostriatal and
tuberoinfundibular pathways, thus minimizing the risk of side effects such as pseudo-parkinsonism as well as elevations in
prolactin.[
citation needed]
Quetiapine also has an antagonistic effect on the histamine H1 receptor. This is thought to be responsible for the sedative effect of the drug.
[15][
edit] Forms
Quetiapine is available under the brand name Seroquel. It was originally available in 25 mg, 50 mg, 100 mg, 200 mg, and 300 mg tablets. 400 mg tablets have since been introduced to increase dosing flexibility.
[
edit] Sustained-release quetiapine (Seroquel XR)
AstraZeneca has submitted a
New Drug Application for a
sustained-release version of quetiapine in the
United States,
Canada, and the
European Union in the second half of 2006 for treatment of schizophrenia.
[16][17] AstraZeneca will retain the exclusive right to market sustained release quetiapine until 2017.
On
May 18,
2007, AstraZeneca announced that the U.S.
Food and Drug Administration has approved Seroquel XR for acute treatment of schizophrenia.
[18] During its 2007 Q2 earnings conference, AstraZeneca announced plans to launch Seroquel XR in the U.S. during August 2007.
[19] However, Seroquel XR has only become available in U.S. pharmacies after the FDA approved Seroquel XR for use as maintenance treatment for schizophrenia, in addition to acute treatment of the illness, on
November 16,
2007.
[20] The company has not provided a reason for the delay of Seroquel XR's launch.
Health Canada approved sale of Seroquel XR on
September 27,
2007.
[21][
edit] Side effects
Quetiapine has multiple side effects, some of them common, a few of them serious and life-threatening.
The most common
side effect of quetiapine is
sedation.
[22] It is prescribed specifically (off-label) for this effect in patients with sleep disorders. It is one of the most sedating of all antipsychotics, rivaling even the most sedating older drugs. Beginning users may feel extremely tired and 'out of it' for the first few days, sometimes longer. Quetiapine's newest indication, for
bipolar depression, usually specifically calls for the entire dose to be taken before bedtime due to its sedative effects. Although quetiapine is approved by the FDA for the treatment of
schizophrenia and bipolar disorder, it is frequently prescribed for off-label purposes, including insomnia and the treatment of anxiety disorders. The sedative effects may disappear after some time on the drug, or with a change of dosage, and with possibly different, non-sedative side effects emerging.
Common side effects include
constipation,
headache,
dry mouth, weight gain (or loss). Six to seven percent of patients may experience Tachycardia. Less common side effects (less than 1% of patients) include abnormal liver tests,
dizziness,
upset stomach, substantial
weight gain or
weight loss, a stuffy nose,
akathisia and increased
paranoia.
There is a risk of development of
tardive dyskinesia, an incurable
neurological disorder, with any prolonged use of quetiapine and some other neuroleptic drugs. However, quetiapine is believed to cause tardive dyskinesia somewhat less often than
typical antipsychotics based on the data sources which point to placebo-level incidence of extrapyramidal side effects.
[23][24]The rare, but life-threatening,
narcoleptic malignant syndrome may also result from quetiapine use.
Weight gain can be a problem for some patients using quetiapine, by causing the patient's appetite to persist even after meals. However, this effect may occur to a lesser degree compared to some other atypical antipsychotics such as
olanzapine or
clozapine. As with other atypical antipsychotics, there is evidence suggesting a link to the development of
diabetes and
blood sugar disorders, however this remains controversial due to disparities between the results of studies.
In the United States, two separate lawsuits—over claims that quetiapine use has led to diabetes—have been filed in federal court.
[25]Studies conducted on
beagles have resulted in the formation of
cataracts—while there are reports of cataracts occurring in humans, controlled studies including thousands of patients have not demonstrated a clear causal association between quetiapine therapy and this side effect. (Reference needed to April 2006 results of CATIE study.) However, the Seroquel website
[26] still recommends users have eye examinations every six months.
As with some other antipsychotics, quetiapine may lower the seizure threshold, and should be taken with care in combination with drugs such as
bupropion.
[
edit] Addiction and abuse
Quetiapine is not currently classified as a controlled substance. Reports of quetiapine abuse have emerged in the medical literature, however. While the drug is usually abused through the crushing and snorting of tablets (
insufflation), there have also been reports of intravenous abuse and intravenous co-administration with cocaine.
[27] A 2004 report recorded a 30% rate of inmate use in the Los Angeles County Jail, where the drug was obtained by inmates faking schizophrenic symptoms and resold under the street name "quell".
[28] Also known as "Susie-Q", the drug may be more commonly abused in prisons due to its capacity to be regularly prescribed as a sedative and the unavailability in prison of more commonly abused substances. A letter to the editor which appeared in the January 2007 American Journal of Psychiatry has proposed a “need for additional studies to explore the addiction-potential of quetiapine”. The letter reports that its authors are physicians who work in the Ohio correctional system. They report that “prisoners ... have threatened legal action and even suicide when presented with discontinuation of quetiapine” and that they have “not seen similar drug-seeking behavior with other second-generation antipsychotics of comparable efficacy”.
[29]Along with
benzodiazepines, atypical antipsychotics have sometimes been used to "come down" off
cocaine or
amphetamines. When used in this manner the slang term "
downer" is often applied.
[
edit] References
^ AstraZeneca Receives FDA Approval for SEROQUEL in Bipolar Mania,
http://www.prnewswire.co.uk/cgi/news/release?id=115109.
^ Croissant B, Klein O, Gehrlein L, Kniest A, Hermann D, Diehl A, Mann K.. "Quetiapine in relapse prevention in alcoholics suffering from craving and affective symptoms: a case series". Eur Psychiatry 2006 Dec;21(8):570-3.
PMID 17161284.
^ Quetiapine treatment of children and adolescents with Tourette's disorder. Fall 2003, retrieved January 27, 2007.
^ Becker PM. "Treatment of sleep dysfunction and psychiatric disorders". Curr Treat Options Neurol 2006 Sep;8(5):367-75.
PMID 16901376.
^ New Schizophrenia Drugs No Better Than Cheaper Generics^ Clive Ballard, Marisa Margallo-Lana, Edmund Juszczak, Simon Douglas, Alan Swann, Alan Thomas, John O'Brien, Anna Everratt, Stuart Sadler, Clare Maddison, Lesley Lee, Carol Bannister, Ruth Elvish, Robin Jacoby (2005). "
Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial". BMJ 2005;330:874: 874.
doi:
10.1136/bmj.38369.459988.8F.
PMID 15722369,
http://www.bmj.com/cgi/content/full/330/7496/874.
^ Pinkofsky HB, Hahn AM, Campbell FA, Rueda J, Daley DC, Douaihy AB (2005). "Reduction of opioid-withdrawal symptoms with quetiapine". J Clin Psychiatry 66 (10): 1285–8.
PMID 16259542.
^ AstraZeneca—Pipeline Summary—New chemical entities and line extensions. Retrieved
January 5,
2007^ http://www.nytimes.com/2007/02/15/us/15bipolar.html "Debate Over Children and Psychiatric Drugs", New York Times, February 15, 2007.
^ Seroquel is an Antipsychotic.^ Seroquel stories: understanding Seroquel, important safety information^ National Institutes of Health, Medline guidelines for Quetiapine^ Seroquel.pdf,
http://www1.astrazeneca-us.com/pi/Seroquel.pdf.
^ Kapur, S. (2001). "
Does fast dissociation from the dopamine d(2) receptor explain the action of atypical antipsychotics?:a new hypothesis.". American Journal of Psychiatry (Am J Psychiatry 2001; 158: 360-9) 158: 360.
doi:
10.1176/appi.ajp.158.3.360.
PMID 11229973,
http://ajp.psychiatryonline.org/cgi/content/abstract/158/3/360.
^ "
Schizophrenia: From Circuits to Symptoms". Medscape Today. Retrieved on 2007-06-05.
^ http://www.astrazeneca.com/pressrelease/5256.aspx AstraZeneca Submits an NDA For Sustained Release Formulation Seroquel XR™. For the treatment of
schizophrenia.
July 18,
2006, retrieved
January 1,
2007^ AstraZeneca Submits EU and Canadian Regulatory Filings for Sustained Release Formulation SEROQUEL XR™ for the Treatment of Schizophrenia.
October 19,
2006, retrieved
January 1,
2007^ FDA Approves AstraZeneca’s Once-Daily SEROQUEL XR™ Extended-Release Tablets For The Treatment Of Schizophrenia.
May 18,
2007, retrieved
August 2,
2007^ Second Quarter and Half Year Results 2007.
July 26,
2007, retrieved
August 2,
2007^ Seroquel XR™ Receives Approval from FDA for Maintenance Treatment of Schizophrenia November 16, 2007. Retrieved December 3, 2007.
^ Notice of Compliance Information - Seroquel XR September 27, 2007, retrieved December 3, 2007
^ Jon A. Shaw, John E. Lewis, Shlomo Pascal, Rakesh K. Sharma, Rosemarie A. Rodriguez, Ramiro Guillen, Marilyn Pupo-Guillen. "
A Study of Quetiapine: Efficacy and Tolerability in Psychotic Adolescents". Journal of Child and Adolescent Psychopharmacology December 1, 2001, 11(4): 415-424.
doi:
10.1089/104454601317261591 A Study of Quetiapine: Efficacy and Tolerability in Psychotic Adolescents].
^ Ghaemi, S. Nassir, M.D.; Ko, James Y., A.B (October 2001). "
Quetiapine-related tardive dyskinesia.".
^ "
Tardive dyskinesia with quetiapine.".
^ "
Seroquel suit claims 'so much' is poured into marketing and away from research". The Madison St. Clair Record.
^ Seroquel website^ Intravenous Quetiapine-Cocaine Use ("Q-Ball")^ Intranasal Quetiapine Abuse^ Emil R. Pinta, and Robert E. Taylor (2007). "
Quetiapine addiction?". Am J Psychiatry 164:174, January 2007: 174.
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10.1176/appi.ajp.164.1.174.
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