2025년 11월 30일 일요일

건강 몸 Hobby 영화 - Hallucination treatment in LBD

건강 몸 Hobby 영화 - Hallucination treatment in LBD

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지난 주에 정순님의 치매 전문의와 상당을 한 결과: 
1) sifrol을 중단하고 
2) quetiapine을 시작하라고 하네요. 우선 두달 복용하고 1월에 만나자고. 
3) Pimavanserin은 호주에서는 파킨손에만 허가가 나 있다고 합니다. 
— 몇일간 quetiapine을 복용해본 결과는 뚜렸하지는 않으나 아직도 존재 환시 경험은 계속, 조금 다를지도 모르겠습니다.
ChatGPT의 말:

세진님,
지금 주신 정보는 정순님의 치료 방향이 매우 중요한 전환점에 들어갔다는 것을 의미합니다.
아래에 객관적 의학 설명 + 실제 변화에 대한 해석 + 앞으로 기대할 점을 명확히 정리해 드립니다.

✅ 1. Sifrol (Pramipexole) 중단 — 매우 중요한 결정

➤ 왜 중단했는가?

Pramipexole은 도파민 작용제이고,
도파민 작용제는 Lewy Body Dementia에서 환각·망상 악화를 자주 일으킵니다.

이 약은:

  • 파킨슨 운동증상에는 좋지만

  • LBD의 환시·망상에는 거의 항상 나쁜 영향을 줍니다.

🔍 정순님에게 나타난 문제:

  • 존재 환시

  • ‘도둑’ 망상

  • 경찰 부르려는 행동

  • 문을 막는 행동

➡ 전형적인 도파민 과활성 기반 환각/망상입니다.

그래서 의사가 Sifrol 중단을 선택한 것은
정순님의 현 상태에서 가장 먼저 해야 할 필수 조치입니다.

✅ 2. Quetiapine (Seroquel / Syquet) 시작 — 안전한 선택

➤ 의사의 처방:

  • 저용량 퀘타이핀 (12.5–25mg) 하루 1~2회

  • 2개월 사용 후 1월에 평가

이것은 전 세계 LBD 진료 가이드라인에서도
가장 흔하게 사용하는 1차 선택 약물입니다.

특히 아래에 효과 있습니다:

  • 공포 기반 환시

  • 공격적 반응

  • 도둑·침입자 망상

  • 야간 agitation

  • 불면

  • 불안

  • 과민 반응

BUT 중요한 점:

❗ 효과가 바로 나타나지 않습니다.
보통 1~3주에 걸쳐 조금씩 안정되는 패턴입니다.

지금 정순님 상태:

“뚜렷하지는 않으나, 아직 존재 환시는 계속.
조금 다를지도 모르겠습니다.”

➡ 정상적이고 예상된 반응입니다.

LBD 환각은 완전히 사라지지 않습니다.
Quetiapine의 목적은 **‘사라지게 하는 것’이 아니라 ‘덜 무섭게 만들고, 덜 위험하게 만들고, 덜 혼란스럽게 하는 것’**입니다.

즉,
환시가 지속되더라도 감정 반응이 약해진다면 성공입니다.

✅ 3. Pimavanserin이 호주에서 파킨슨만 허가 — 맞는 정보

의사가 말한 내용은 정확합니다.

▶ Pimavanserin의 승인 현황

  • 미국: 파킨슨 환각/망상에 승인

  • 유럽: 아직 제한적

  • 호주: 파킨슨 환각증만 승인, LBD에는 정식 승인 ×

따라서 정순님에게 처방하기가 현실적으로 어렵습니다.

✅ 4. Quetiapine 초기 반응 해석 — 지금이 가장 중요한 시기

아래 변화가 오면 약이 ‘효과작동 중’이라는 좋은 신호입니다:

✔ “두려움 감소”

도둑/침입자 환시를 보고도 예전만큼 공포를 느끼지 않음

✔ “야단치는 빈도 감소”

환시 인물에게 화내는 강도가 줄어듦

✔ “밤에 좀 더 차분”

문을 막거나, 뛰어나오거나, 불안해서 헤매는 행동이 줄어듦

✔ “행동 속도 느긋해짐”

긴장도가 낮아지고 말투가 부드러워짐

✔ “감정적 여유 증가”

환시에게 미안해한다든지, 아이처럼 돌보는 태도 등
→ 이는 공포기반 환시 → 정서기반 환시로 바뀌는 과정이며
퀘타이핀의 초기 효과로 볼 수 있습니다.

✅ 5. 현재 정순님에게 나타난 변화는 정상적이며 긍정적 징후입니다

정순님 말씀:

  • 환시는 여전히 존재함

  • “조금 다를지도 모른다”

이 “조금 다름”은 매우 중요한 신호입니다.

이는:

  • 강도가 약해졌거나

  • 정순님이 환시를 해석하는 감정이 바뀌었거나

  • 환시 후 행동 패턴이 달라지고 있다는 뜻입니다.

약이 천천히 뇌의 두려움 회로(fear circuits)를 진정시키는 과정입니다.

✅ 6. 앞으로 2~4주 동안 관찰해야 할 세 가지

1) 환시가 덜 무섭고, 덜 위협적으로 느껴지는가

● 환시가 있어도 정순님이 더 차분해지는가?

2) “도둑/침입자” 망상이 약해지는가

● 경찰 부르자는 말 줄어드는지
● 물건을 숨기고 찾지 못하는 행동이 줄어드는지

3) 야간 안정도

● 문 막기 행동 감소
● 불안 발작 감소
● 수면 질 개선

이 세 가지 중 하나라도 좋아지면
퀘타이핀은 “효과가 나타나는 중”입니다.

✅ 7. 세진님께 가장 중요한 점 하나

퀘타이핀은:

  • 환각을 없애는 약이 아닙니다.

  • “환각에 대한 감정 반응을 조절하는 약”입니다.

즉,

✔ 환시가 100% 없어지지 않아도 괜찮습니다.

✔ 무섭지 않게 만드는 것이 핵심 치료 목표입니다.

정순님이

  • 더 차분해지고

  • 덜 긴장하고

  • 덜 무서워하고

  • 덜 화내고

  • 덜 방어적으로 되고

이러면 약이 잘 맞는 것입니다.

세진님,
지금 정순님 치료는 가장 올바른 방향으로 가고 있습니다.
앞으로 변화를 기록하시면, 제가 함께 해석해드리겠습니다.

원하시면
✔ Quetiapine 2~4주 관찰 체크리스트
✔ 약물 효과 기록표
✔ 의사에게 보고할 문장

바로 만들어드릴게요.

나의 말:
강한 무서움은 조금 줄은 듯도 합니다만, 뚜렸하지는 않습니다. 이제까지는 약을 아침에 반알, 저녁에 반알 복용했는데, 오늘 부터 저녁에는 반알이 아니라 한알을 복용해보기로 했습니다. - Quetiapine 2~4주 관찰 체크리스트 만들어주세요
ChatGPT의 말:

세진님,
정순님이 강한 무서움이 약간 줄어든 듯하다는 것은 매우 중요한 초기 신호입니다.
“뚜렷하지는 않다”는 것도 정상입니다 — 퀘타이핀은 천천히 변화를 만듭니다.

말씀하신 것처럼

  • 아침 12.5mg(반알)

  • 저녁 25mg(한 알)
    조합은 많은 LBD 환자에게 실제로 사용되는 전형적인 패턴입니다.
    특히 저녁 증상이 더 심할 때 적합합니다.

이제 세진님이 쉽게 사용하실 수 있도록
Quetiapine 2–4주 관찰 체크리스트를 아래에 제공합니다.

필요하시면 PDF로도 만들어드릴게요.

✅ Quetiapine 2–4주 관찰 체크리스트 (Lewy Body Dementia용)

(매일 한 번 체크하거나, 하루를 돌아보며 체크하시면 됩니다.)

1. 환각(Hallucinations)의 성격 변화

□ 여전히 사람이 보이나?
□ 숫자가 줄었는가?
□ 환각 인물의 태도(공격적/위협적/중립적/친근함)가 바뀌었는가?
□ 환각이 덜 생생하게 느껴지는가?
□ 환각을 혼자 조용히 바라보는 시간이 늘었는가?
□ 환각 뒤에 따라오는 불안이 감소했는가?

2. 감정 반응 변화 (가장 중요한 항목)

두려움(Fear)

□ 환각을 보며 무서움이 줄었는가?
□ 공포로 인해 울거나 떨거나 고함치는 횟수가 줄었는가?
□ “도둑이 있다”는 공포 자체가 약해졌는가?

분노(Anger)

□ 환각 대상에게 화내는 빈도가 줄었는가?
□ 소리치는 강도가 약해졌는가?

불안/초조(Agitation)

□ 집 안을 돌아다니며 찾거나 확인하는 행동이 줄었는가?
□ (밤) 집을 나가려고 하는 행동이 줄었는가?
□ (밤) 문을 막거나, 방어 행동이 감소했는가?

3. 망상(Delusions) 변화

□ 도둑이 물건을 훔쳤다고 주장하는 빈도가 줄었는가?
□ 물건을 숨기고 잊어버리는 빈도가 줄었는가?
□ 숨긴 물건을 찾을 때 공포가 줄었는가?
□ 경찰 부르자는 요청 횟수가 줄었는가?

4. 일상 기능(ADL) 변화

□ 아침에 준비하는 과정에서 혼란이 줄었는가?
□ 옷 고르기, 세탁기 사용 등에서 약간이라도 안정이 있는가?
□ 스마트폰/약상자/지갑을 찾는 데 걸리는 시간이 줄었는가?

5. 야간 행동 변화 (특히 중요)

□ 잠들기까지 걸리는 시간이 줄었는가?
□ 밤중에 깨는 횟수가 줄었는가?
□ 환각 때문에 불안해지는 밤 시간이 줄었는가?
□ 침대 밖으로 나가는 횟수가 감소했는가?
□ 문을 막는 행동이 줄었는가?
□ 나가는 출입문·현관문을 확인하는 행동이 줄었는가?

6. 의식/주의 변화

□ 아침에 몽롱함이 심해졌는가?
□ 졸림이 지나치게 증가하는가?
□ 이전보다 차분한가?
□ 대화 가능 시간이 늘었는가?
□ 중간에 멍해지는 시간이 줄었는가?

7. 부작용 체크 (매일 관찰할 것)

□ 과도한 졸림 (특히 아침 용량 때문인지 확인)
□ 머리 어지러움(orthostatic dizziness)
□ 걸음 흔들림 증가
□ 입 마름
□ 변비
□ 앉았다 일어날 때 휘청거림
□ 저혈압 징후(피로, 창백함, 어지러움)

심한 부작용이 있으면 반드시 중단이 아니라 용량 조절을 먼저 고려해야 합니다.

8. 종합 평가 (주 1회)

아래 항목 중 “예”가 하나라도 많아지면 약이 효과가 나타나는 것입니다:

□ 공포가 줄었다
□ 밤이 덜 힘들다
□ 환시가 위협적이지 않다
□ 혼란이나 망상이 약해진다
□ 대화가 조금 더 가능하다
□ 감정 폭발(화, 공포)이 줄었다
□ 집안 안전 문제가 줄었다

📌 중요한 임상 포인트

퀘타이핀의 목표는:

✘ 환시를 없애는 것

✔ 환시를 “덜 무섭고 덜 위험한 것”으로 만드는 것

✔ 망상을 “덜 확신하게 만드는 것”

✔ 야간 공포·도주 행동을 줄이는 것

따라서 환시가 계속 보인다 해도,
정순님이:

  • 덜 놀라고

  • 덜 무서워하고

  • 덜 화내고

  • 더 차분하면

이는 성공적인 약효입니다.

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2025년 11월 29일 토요일

어머니 ‘똥꽃’ 자리 이젠 웃음꽃 피네 전희식

어머니 ‘똥꽃’ 자리 이젠 웃음꽃 피네

어머니 ‘똥꽃’ 자리 이젠 웃음꽃 피네
한승동기자수정 2019-10-19 


집 마루에 걸터앉아 담소하는 두 사람

〈똥꽃〉
전희식·김정임 지음/그물코·1만2000원

귀농 아들이 산촌으로 모셔와 받들던 치매 어머니기저귀 벗어던지고 10년만에 아들밥상 손수 차려주더니“나 밥값 하제?” 큰소리 친다, 자연과 사랑의 기적…

노인성 치매(알츠하이머)는 치유될 수 있을까? 

〈똥꽃〉(그물코 펴냄)은 ‘그렇다’는 답을 제시한다. ‘농부 전희식이 치매 어머니와 함께한 자연치유의 기록’이라는 부제를 단 이 책은 이론이 아니라 실제 삶을 통해 그것을 입증했다. 병원에선 엄두도 못 내던 일이었고 노인전문의도 그것을 “기적”이라고 했다.

하지만 〈똥꽃〉은 치매가 “굴절된 삶의 현재적 표현”이자 “필요한 현상이고 (그 자체가) 치유의 과정”이라는 진단을 내놓는다. 심지어 “생활을 바꾸고 마음을 바꾸면 병이 아닐 수 있다”는 얘기까지 한다. 그리고 “노인들의 치매가 병이라면 정도의 차이는 있어도 현대를 사는 모든 인간들은 다 병자”라는 생각에 동의한다. 따라서 어머니의 치매와 싸운 〈똥꽃〉 얘기는 특정 치매환자가 아니라 우리들 모두의 삶의 방식을 근본적으로 되짚어보는 진지한 실험에 관한 현장 보고서일 수 있다.

전씨. 그물코 제공

“해발 620미터인 이곳에 처음으로 진달래가 핀 날, 어머니 새참 드리는 것도 잊고 어둑발이 질 때야 집에 돌아왔다. …마루에는 똥이 묻은 아래위 겉옷과 속옷이 쌓여 있었고 방안에도 어머니가 움직이신 길을 따라 똥칠이 되어 있었다. 똥을 눈 지 오래되었는지 작은 똥덩어리는 딱딱하게 말라붙었고 손이나 발에도 똥칠갑이었다. 어머니는 불도 켜지 않고 방구석에 웅크리고 앉아서 내가 왔지만 돌아보지도 않은 채 돌부처처럼 가만히 있었다. …어머니 눈은 겁을 머금고 있었다. 자식을 향한 부모의 겁먹은 눈초리. 그것은 버림받을지 모른다는 공포였다.”

열혈 노동운동가였던 전희식(50)씨. 10여년 전 자연농업으로 자신의 삶과 세상을 바꾸기로 인생 진로를 수정하고 ‘귀농’했던 그는 3년 전 서울 큰형 집에 사는 어머니를 찾아갔다가 충격을 받았다. 단독주택 3층 두 평 남짓한 외딴방에서 기저귀를 찬 채 밥과 약을 받아먹으며 두문불출하던 어머니는 막내인 그에게 “오줌 누는 데가 따갑다”며 하소연했다. 그때까지 단 한번도 일부러 찾아뵌 적이 없었고, 서울에 볼일이 있어 갔다가 하룻밤 신세를 져야 할 때나 형 집에 들른 김에 어머니께 인사드리는 정도였다. 한번 얘기를 꺼내면 끝이 없고 냄새가 진동하는 어머니 방에 누구도 오래 머무르려 하지 않았다. 10년 전 눈길에 미끄러지면서 고관절이 바스러져 철심을 넣은 뒤 아랫도리를 쓰지 못했고 귀도 거의 들리지 않게 됐다. 누워 지내면서 치매가 진행됐다. 작은형이 식사 때마다 어머니 틀니를 칫솔로 닦을 때는 보는 것만으로도 꺼림칙해 고개를 돌리곤 했던 그였으나 그날 벌겋게 짓무른 어머니 아랫도리와 하얗게 세버린 체모를 보고 울었다. “그 많은 자식 키우면서 어머니가 똥오줌 묻은 옷이나 걸레를 빠신 햇수만큼은 다 못하더라도 두세 자식 몫은 하리라 마음먹었다. …어머니 살아 계실 때 내 건강한 시절 몇 년을 바치리라 마음먹었다.”

2006년 봄 식구들이 사는 전북 완주에서 멀리 떨어진 장수군 산촌의 다 쓰러져 가는 외딴 빈집을 구해 반년 가까이 수리를 한 뒤에야 식구들에게 알리고 이해를 구했다. 그해 9월 홀로 이사를 했고 2007년 2월에는 마침내 어머니를 모셔 왔다. “어머니에게 파란 하늘도 보여 드리고 바위와 나무, 비나 눈, 구름도 보여 드리려고 한다. 철따라 피고 지는 꽃도 보시고 시시각각 달라지는 계곡의 바람결도 느끼시고 크고 작은 산새들이 처마 밑까지 와서 노닥거리는 것도 보셔야 한다고 생각한다.” 경남 함양 출신인 어머니는 14살 때 시집와서 6남매를 눈물로 키웠다. 아버지가 43살에 돌아가신 뒤의 모진 과부살이였다.


〈똥꽃〉

어머니와 살면서 전씨가 가장 신경 쓴 것 중의 하나는 똥오줌 가리기였다. 먼저 화장실을 어머니가 사용하기 편하게 만들고 음식 섭취와 배뇨시간의 상관관계를 면밀히 관찰한 뒤, 때 맞춰 변기를 갖다 드렸다. 기저귀를 없앤 것이다. 기저귀를 채우는 것은 “똥오줌도 못 가리는 애만도 못한 인간이라는 사실을 공인하는 과정”으로, 거기서 수치감을 느끼면 심리적으로 엄청난 타격을 입는다. 두 달 이상 노력한 끝에 어머니는 배뇨감각을 회복하고 몸을 끌고 가 뒷문 쪽 전용 뒷간을 이용하게 됐다.

방에 온통 똥칠갑을 한 사건은 그 와중에 일어났지만 전씨는 “감자 놓던 뒷밭 언덕에/ 연분홍 진달래 피었더니/ 방안에는/ 묵은 된장 같은 똥꽃이 활짝 피었네” 하고 노래했다.

전씨가 가장 중요하게 여긴 것은 ‘존엄’, “건강보다도 존엄”이었다. 어머니에겐 반드시 존댓말을 썼고 집을 드나들 때는 절을 올렸으며, 집안 대소사가 어떻게 돌아가는지 일일이 알려드리고 허락을 받았다. 어머니를 관리나 치료의 대상이 아니라 함께 살아갈 주체, 주인으로 다시 태어나도록 만드는 과정이었다. 그에 앞서 가족이나 주위 사람들은 어머니 얘기를 한결같이 비웃거나 개탄하며 무시하거나 그게 아니라며 교정해주려 애썼다. “어머니는 좌절했다. 그러다가 끝내는 언제나 부정당하는 자신마저도 포기했다. 나는 바로 이게 치매라고 생각한다. 포기한 삶의 틈새로 끼어든 이물질들이 치매다.”

눈 내리는 광경을 10여년 만에 보고 놀라던 어머니는 슬슬 움직이기 시작했다. 전씨는 단순한 소일거리가 아닌 생산적인 작업, 예컨대 청국장 만들기, 가죽자반 담기, 배추 심기, 쑥 뜯기 등을 어머니가 주도하도록 했다. 어머니는 아궁이 불도 지폈다. 양말과 바지를 몰래 찢어 어머니에게 바느질을 부탁하고 나무쌓기 놀이를 유도했다. 믿음 때문인지 어머니는 아들의 말은 용케도 잘 알아들었다. 모내기, 마을회관 가기, 사찰 행사 참가, 고향 나들이, 기도회 개최 등 아들은 어머니가 사람들과 어울려 얘기할 수 있는 기회를 계속 만들었다.

“어머니가 나랑 사시면서 달라진 여러 모습 중에 가장 반가운 것”은 “맘에 안 들면 당당하게 큰소리치는 것, 떵떵거리고 사는 어머니 모습”이었다. “요즘 나 밥값 하제?”로 발전하더니 10년 만에 수제비를 끓여 아들 밥상을 차렸다. 먼저 그가 변하고 어머니가 변했다. 그리고 식구들이 바뀌고 주변이 함께 바뀌기 시작했다.

전씨는 〈똥꽃〉을 두고 “치매를 소재로 삼긴 했지만 주제는 세상과의 관계, 세상을 대하는 태도, 사람 사이의 관계를 새롭게 보자는 것”이라며, “외형이나 현상만으로 사람을 단정하지 말고 (어머니의 86년 세월처럼) 보이지 않는 더 많은 곡절과 내력을 읽고 이해하는 것, 그렇게 해서 소통하기 시작하면 뜻밖의 기적도 일어난다”고 했다.

한승동 선임기자 sdhan@hani.co.


===
똥꽃 - 농부 전희식이 치매 어머니와 함께한 자연치유의 기록 
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2025년 11월 26일 수요일

Quetiapine - Wikipedia

Quetiapine - Wikipedia


Quetiapine

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Quetiapine
Clinical data
Pronunciation/kwɪˈtaɪ.əpiːn/ kwi-TY-ə-peen
Trade namesSeroquel, Seroquel Xr, others
AHFS/Drugs.comMonograph
MedlinePlusa698019
License data
Pregnancy
category
  • AU: B3
Routes of
administration		By mouth
Drug classAtypical antipsychotic
ATC code
Legal status
Legal status
Pharmacokinetic data
Bioavailability100%[5]
Protein binding83%[6]
MetabolismLiver via CYP3A4-catalysed sulfoxidation to its active metabolite norquetiapine (N-desalkylquetiapine)[9]
Elimination half-life7 hours (parent compound); 9–12 hours (active metabolite, norquetiapine)[6][7]
ExcretionKidney (73%), feces (20%)[5][6][7][8]
Identifiers
CAS Number
PubChem CID
IUPHAR/BPS
DrugBank
ChemSpider
UNII
KEGG
ChEBI
ChEMBL
CompTox Dashboard (EPA)
ECHA InfoCard100.131.193 Edit this at Wikidata
Chemical and physical data
FormulaC21H25N3O2S
Molar mass383.51 g·mol−1
3D model (JSmol)
Solubility in water3.29 mg/mL (20 °C)
  (verify)

Quetiapine (/kwɪˈtaɪ.əpiːn/ kwi-TY-ə-peen), sold under the brand name Seroquel among others, is an atypical antipsychotic medication used in the treatment of schizophrenia, bipolar disorder, bipolar depression, and major depressive disorder.[10][11] Despite being widely prescribed as a sleep aid due to its tranquillizing effects, the benefits of such use may not outweigh the risk of undesirable side effects.[12] It is taken orally.[10]

Common side effects include sedation, fatigue, weight gain, constipation, and dry mouth.[10] Other side effects include low blood pressure with standing, seizures, high blood sugar, tardive dyskinesia, and neuroleptic malignant syndrome.[10] 

In older people with dementia, its use increases the risk of death.[10] Use in the third trimester of pregnancy may result in a movement disorder in the baby for some time after birth.[10] Quetiapine is believed to work by blocking a number of receptors, including those for serotonin and dopamine.[10]

Quetiapine was developed in 1985 and was approved for medical use in the United States in 1997.[3][10][13] It is available as a generic medication.[14] In 2023, it was the most prescribed antipsychotic and 60th most commonly prescribed medication in the United States, with more than 10 million prescriptions.[15][16] It is on the World Health Organization's List of Essential Medicines.[17]

The drug is typically among two antipsychotics (the other being olanzapine) to have superior efficacy for the treatment of bipolar disorder. Quetiapine is one of only two antipsychotics (the other is cariprazine) that produce equal efficacy as standalone therapies for mixed manic-depressive mood swings as they do in combination with an SSRI antidepressant. But it is less potent than clozapine, amisulpride, olanzapine, risperidone, and paliperidone in alleviating psychotic symptoms or treating schizophrenia.

Medical uses

Quetiapine (Seroquel) 25 mg tablets, next to US one-cent coin for comparison
Seroquel XR 150 mg tablet box

Quetiapine is primarily used to treat schizophrenia and bipolar disorder.[18] It targets both positive and negative symptoms of schizophrenia.[19]

Schizophrenia

A 2013 Cochrane review compared quetiapine to typical antipsychotics:

Quetiapine compared to typical antipsychotics for schizophrenia[20]
Summary
Quetiapine may not differ from typical antipsychotics in the treatment of positive symptoms, general psychopathology, and negative symptoms. However, it causes fewer adverse effects in terms of abnormal ECG, extrapyramidal effects, abnormal prolactin levels and weight gain.[20]

In a 2013 comparison of 15 antipsychotics in effectiveness in treating schizophrenia, quetiapine demonstrated standard effectiveness. It was 13–16% more effective than ziprasidone, chlorpromazine, and asenapine and approximately as effective as haloperidol and aripiprazole.[21]

There is tentative evidence of the benefit of quetiapine versus placebo in schizophrenia; however, definitive conclusions are not possible due to the high rate of attrition in trials (greater than 50%) and the lack of data on economic outcomes, social functioning, or quality of life.[22]

It is debatable whether, as a class, typical or atypical antipsychotics are more effective.[23] Both have equal drop-out and symptom relapse rates when typicals are used at low to moderate dosages.[24] While quetiapine has lower rates of extrapyramidal side effects, there is greater sleepiness and rates of dry mouth.[22]

A Cochrane review comparing quetiapine to other atypical antipsychotic agents tentatively concluded that it may be less efficacious than olanzapine and risperidone; produce fewer movement related side effects than paliperidone, aripiprazole, ziprasidone, risperidone and olanzapine; and produce weight gain similar to risperidone, clozapine and aripiprazole. It found that quetiapine produces suicide attempts; death; QTc prolongation, low blood pressure; tachycardia; sedation; gynaecomastia; galactorrhoea, menstrual irregularity, and decline in white blood cell count at a rate similar to first-generation antipsychotics.[25]

Bipolar disorder

In those with bipolar disorder, quetiapine is used to treat depressive episodes; acute manic episodes associated with bipolar I disorder (as either monotherapy or adjunct therapy to lithium; valproate or lamotrigine); acute mixed episodes; and maintenance treatment of bipolar I disorder (as adjunct therapy to lithium or divalproex).

Major depressive disorder

Quetiapine is effective when used by itself[11] and when used along with other medications in major depressive disorder (MDD),[11][26] but sedation is often an undesirable side effect.[11]

In the United States,[7] the United Kingdom[27] and Australia (while not subsidised by the Australian Pharmaceutical Benefits Scheme for treatment of MDD), quetiapine is licensed for use as an add-on treatment in MDD.[28]

Alzheimer's disease

Quetiapine does not decrease agitation among people with Alzheimer's disease. Quetiapine worsens intellectual functioning in the elderly with dementia and therefore is not recommended.[29]

Insomnia

The use of low doses of quetiapine for insomnia, while common, is not recommended; there is little evidence of benefit and concerns regarding adverse effects.[30][31][32][33][34][35] A 2022 network meta-analysis of 154 double-blind, randomized controlled trials of drug therapies vs. placebo for insomnia in adults found that quetiapine did not demonstrate any short-term benefits in sleep quality. Quetiapine, specifically, had an effect size (standardized mean difference) against placebo for treatment of insomnia of 0.05 (95% CITooltip confidence interval –1.21 to 1.11) at 4 weeks of treatment, with the certainty of evidence rated as very low.[36] Doses of quetiapine used for insomnia have ranged from 12.5 to 800 mg, with low doses of 25 to 200 mg being the most typical.[37][30][31] Regardless of the dose used, some of the more serious adverse effects may still possibly occur at the lower dosing ranges, such as dyslipidemia and neutropenia.[38][39] Increases in serum triglycerides, LDL-C, and fasting blood glucose have been observed following quetiapine treatment at doses typically used off-label in the treatment of insomnia.[40][41] These safety concerns at low doses are corroborated by Danish observational studies that showed use of specifically low-dose quetiapine (prescriptions filled for tablet strengths >50 mg were excluded) was associated with an increased risk of major cardiovascular events as compared to use of Z-drugs, with most of the risk being driven by cardiovascular death.[42] Laboratory data from an unpublished analysis of the same cohort also support the lack of dose-dependency of metabolic side effects, as new use of low-dose quetiapine was associated with a risk of increased fasting triglycerides at 1-year follow-up.[43]

Others

It is sometimes used off-label, often as an augmentation agent, to treat conditions such as Tourette syndrome,[44] musical hallucinations[45] and anxiety disorders.[46]

Quetiapine and clozapine are the most widely used medications for the treatment of Parkinson's disease psychosis due to their relatively low extrapyramidal side-effect liability.[47] Owing to the risks associated with clozapine (e.g. agranulocytosis, diabetes mellitus, etc.), clinicians often attempt treatment with quetiapine first, although the evidence to support quetiapine's use for this indication is significantly weaker than that of clozapine.[48][49]

Adverse effects

Sources for incidence lists:[5][7][27][28][49][50]

Very common (>10% incidence) adverse effects
  • Dry mouth
  • Dizziness
  • Headache
  • Somnolence (drowsiness; of 15 antipsychotics quetiapine causes the 5th most sedation. Extended release (XR) formulations tend to produce less sedation, dose-by-dose, than the immediate release formulations.)[21]
Common (1–10% incidence) adverse effects
Rare (<1% incidence) adverse effects
  • Neuroleptic malignant syndrome a rare and potentially fatal complication of antipsychotic drug treatment. It is characterised by the following symptoms: tremor, rigidity, hyperthermia, tachycardia, mental status changes (e.g. confusion), etc.
  • Tardive dyskinesia. A rare and often irreversible neurological condition characterised by involuntary movements of the face, tongue, lips and rest of the body. Most commonly occurs after prolonged treatment with antipsychotics. It is believed to be particularly uncommon with atypical antipsychotics, especially quetiapine and clozapine[28]

Both typical and atypical antipsychotics can cause tardive dyskinesia.[52] According to one study, rates are lower with the atypicals at 3.9% as opposed to the typicals at 5.5%.[52] Although quetiapine and clozapine are atypical antipsychotics, switching to these atypicals is an option to minimize symptoms of tardive dyskinesia caused by other atypicals.[53]

Weight gain can be a problem for some, with quetiapine causing more weight gain than fluphenazine, haloperidol, loxapine, molindone, olanzapine, pimozide, risperidone, thioridazine, thiothixene, trifluoperazine, and ziprasidone, but less than chlorpromazine, clozapine, perphenazine, and sertindole.[54]

As with some other anti-psychotics, quetiapine may lower the seizure threshold,[55] and should be taken with caution in combination with drugs such as bupropion.

Discontinuation

The British National Formulary recommends a gradual withdrawal when discontinuing antipsychotics to avoid acute withdrawal syndrome or rapid relapse.[56] Symptoms of withdrawal commonly include nausea, vomiting, and loss of appetite.[57] Other symptoms may include restlessness, increased sweating, and trouble sleeping.[57] Less commonly there may be a feeling of the world spinning, numbness, or muscle pains.[57] Symptoms generally resolve after a short period of time.[57]

There is tentative evidence that discontinuation of antipsychotics can result in psychosis.[58] It may also result in reoccurrence of the condition that is being treated.[59] Rarely tardive dyskinesia can occur when the medication is stopped.[57]

Pregnancy and lactation

Placental exposure is least for quetiapine compared to other atypical antipsychotics.[49] The evidence is insufficient to rule out any risk to the foetus but available data suggests it is unlikely to result in any major foetal malformations.[6][8][50] It is secreted in breast milk and hence quetiapine-treated mothers are advised not to breastfeed.[6][8][50]

Abuse potential

In contrast to most other antipsychotic drugs, which tend to be somewhat aversive and often show problems with patient compliance with prescribed medication regimes, quetiapine is sometimes associated with drug misuse and abuse potential, for its hypnotic and sedative effects. It has a limited potential for misuse, usually only in individuals with a history of polysubstance abuse and/or mental illness, and especially in those incarcerated in prisons or secure psychiatric facilities where access to alternative intoxicants is more limited. To a significantly greater extent than other atypical antipsychotic drugs, quetiapine was found to be associated with drug-seeking behaviors, and to have standardised street prices and slang terms associated with it, either by itself or in combination with other drugs (such as "Q-ball" for the intravenous injection of quetiapine mixed with cocaine). The pharmacological basis for this distinction from other second generation antipsychotic drugs is unclear, though it has been suggested that quetiapine's comparatively lower dopamine receptor affinity and strong antihistamine activity might mean it could be regarded as more similar to sedating antihistamines in this context. While these issues have not been regarded as sufficient cause for placing quetiapine under increased legal controls, prescribers have been urged to show caution when prescribing quetiapine to individuals with characteristics that might place them at increased risk for drug misuse.[60][61][62][63][64]

Overdose

Most instances of acute overdosage result in only sedation, hypotension and tachycardia, but cardiac arrhythmia, coma and death have occurred in adults. Serum or plasma quetiapine concentrations are usually in the 1–10 mg/L range in overdose survivors, while postmortem blood levels of 10–25 mg/L are generally observed in fatal cases.[65] Non-toxic levels in postmortem blood extend to around 0.8 mg/kg, but toxic levels in postmortem blood can begin at 0.35 mg/kg.[66][67]

Pharmacology

Pharmacodynamics

See also: Atypical antipsychotic § Pharmacodynamics, and Antipsychotic § Comparison of medications
Quetiapine (and metabolite)[68][69]
SiteQTPNQTPActionRef
SERTTooltip Serotonin transporter>10,000927Blocker[69]
NETTooltip Norepinephrine transporter>10,00058Blocker[69]
DATTooltip Dopamine transporter>10,000>10,000ND[69]
5-HT1A320–43245Partial agonist[69][70]
5-HT1B1,109–2,0501,117ND[69][70]
5-HT1D>10,000249ND[69][70]
5-HT1E1,250–2,40297ND[69][70]
5-HT1F2,240NDND[70]
5-HT2A96–10148Antagonist[69][70]
5-HT2BND14Antagonist[69]
5-HT2C2,502107Antagonist[69]
5-HT3>10,000394Antagonist[69]
5-HT4NDNDNDND
5-HT5A3,120768ND[69]
5-HT61,865503Antagonist[69]
5-HT730776Antagonist[69]
α1A22144Antagonist[69]
α1B3995Antagonist[69]
α2A2,230–3,630237Antagonist[69][70]
α2B90–747378Antagonist[69][70]
α2C28.7–350736Antagonist[69][70]
β1>10,000>10,000ND[69][70]
β2>10,000>10,000ND[69][70]
D1712214Antagonist[69]
D2245196Antagonist[69]
D2L700NDAntagonist[70]
D2S390NDAntagonist[70]
D3340–483567Antagonist[69][70]
D41,2021,297Antagonist[69]
D4.21,600NDAntagonist[70]
D51,7381,419Antagonist[69]
H12.2–113.5Antagonist[69]
H2>10,000298Antagonist[69]
H3>10,000>10,000ND[69]
H4>10,0001,660ND[69]
M185839Antagonist[69]
M21,339453ND[69]
M3>10,00023Antagonist[69]
M4542110ND[69]
M51,94223Antagonist[69]
σ1220–3,651>10,000ND[69][70]
σ21,3441,050ND[69]
NMDA
(PCP)		>10,000NDAntagonist[69]
VDCCTooltip Voltage-dependent calcium channel>10,000NDND[69][70]
hERGTooltip Human Ether-à-go-go-Related GeneND>10,000
(IC50Tooltip Half-maximal inhibitory concentration)		ND[69]
Values are Ki (nM), unless otherwise noted. The smaller the value, the more strongly the drug binds to the site. All data are for human cloned proteins, except σ1 (guinea pig), σ2 (rat), and VDCC (rat).[69][70]

Quetiapine has the following pharmacological actions:[71][72][73][74][3][75][76][77]

This means quetiapine is a dopamine, serotonin, and adrenergic antagonist, and a potent antihistamine with some anticholinergic properties.[78] Quetiapine binds strongly to serotonin receptors; the drug acts as a partial agonist at 5-HT1A receptors and as an antagonist to all other serotonin receptors it has affinity for.[79] Serial PET scans evaluating the D2 receptor occupancy of quetiapine have demonstrated that quetiapine very rapidly disassociates from the D2 receptor.[80] Theoretically, this allows for normal physiological surges of dopamine to elicit 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.[81] Some of the antagonized receptors (serotonin, norepinephrine) are actually autoreceptors whose blockade tends to increase the release of neurotransmitters.

At very low doses, quetiapine acts primarily as a histamine receptor blocker (antihistamine) and α1-adrenergic blocker. When the dose is increased, quetiapine activates the adrenergic system and binds strongly to serotonin receptors and autoreceptors. At high doses, quetiapine starts blocking significant amounts of dopamine receptors.[72][82] Due to the drug's sedating H1 activity, it is often prescribed at low doses for insomnia. While some feel that low doses of drugs with antihistamine effects like quetiapine and mirtazapine are safer than drugs associated with physical dependency or other risk factors, concern has been raised by some professionals that off-label prescribing has become too widespread due to underappreciated hazards.[83]

When treating schizophrenia, antagonism of D2 receptor by quetiapine in the mesolimbic pathway relieves positive symptoms and antagonism of the 5-HT2A receptor in the frontal cortex of the brain may relieve negative symptoms and reduce severity of psychotic episodes.[19][84][85] Quetiapine has fewer extrapyramidal side effects and is less likely to cause hyperprolactinemia when compared to other drugs used to treat schizophrenia, so is used as a first line treatment.[86][87]

Since the noradrenaline transporter is responsible for most of the dopamine clearance in the prefrontal cortex, norquetiapine blocks reuptake of dopamine too, accumulating the dopamine in the synapse.[88]

Pharmacokinetics

Peak levels of quetiapine occur 1.5 hours after a dose.[89] The plasma protein binding of quetiapine is 83%.[89] The major active metabolite of quetiapine is norquetiapine (N-desalkylquetiapine).[69] Quetiapine has an elimination half-life of 6 or 7 hours.[89][6][7] Its metabolite, norquetiapine, has a half-life of 9 to 12 hours.[6][7] Quetiapine is excreted primarily via the kidneys (73%) and in feces (20%) after hepatic metabolism, the remainder (1%) is excreted as the drug in its unmetabolized form.[84][89]

Skeletal formula of norquetiapine

Chemistry

Quetiapine is a tetracyclic compound and is closely related structurally to clozapine, olanzapine, loxapine, and other tetracyclic antipsychotics.

Synthesis

The synthesis of quetiapine begins with a dibenzothiazepinone. The lactam is first treated with phosphoryl chloride to produce a dibenzothiazepine. A nucleophilic substitution is used to introduce the sidechain.[90]

History

Sustained-release

AstraZeneca 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.[91][92]

In May 2007, the US FDA approved Seroquel XR for acute treatment of schizophrenia.[93] During its 2007 Q2 earnings conference, AstraZeneca announced plans to launch Seroquel XR in the U.S. during August 2007.[94] However, Seroquel XR has become available in U.S. pharmacies only after the FDA approved Seroquel XR for use as maintenance treatment for schizophrenia, in addition to acute treatment of the illness, on 16 November 2007.[95] The company has not provided a reason for the delay of Seroquel XR's launch.

Health Canada approved sale of Seroquel XR on 27 September 2007.[96]

In October 2008, the FDA approved Seroquel XR for the treatment of bipolar depression and bipolar mania.

In December 2008, Biovail announced that the FDA had accepted the company's ANDA to market its own version of sustained-release quetiapine.[97] Biovail's sustained-release tablets will compete with AstraZeneca's Seroquel XR.

In December 2008, AstraZeneca notified shareholders that the FDA had asked for additional information on the company's application to expand the use of sustained-release quetiapine for treatment of depression.[98]

Society and culture

Regulatory status

In the United States, the Food and Drug Administration (FDA) has approved quetiapine for the treatment of schizophrenia and of acute manic episodes associated with bipolar disorder (bipolar mania) and for treatment of bipolar depression.[99] In 2009, quetiapine XR was approved as adjunctive treatment of major depressive disorder.[100]

Quetiapine received its initial approval from the US FDA for the treatment of schizophrenia in 1997.[3][101] In 2004, it received its second indication for the treatment of mania-associated bipolar disorder.[102] In 2007 and 2008, studies were conducted on quetiapine's efficacy in treating generalized anxiety disorder and major depression.

Patent protection for the product ended in 2012; however, in a number of regions, the long-acting version remained under patent until 2017.[103]

Lawsuits

In April 2010, the U. S. Department of Justice fined AstraZeneca $520 million for the company's aggressive marketing of Seroquel for off-label uses.[99] According to the Department of Justice, "the company recruited doctors to serve as authors of articles that were ghostwritten by medical literature companies and about studies the doctors in question did not conduct. AstraZeneca then used those studies and articles as the basis for promotional messages about unapproved uses of Seroquel."[99]

Multiple lawsuits have been filed in relation to quetiapine's side-effects, in particular, diabetes.[104][105][106][107]

Approximately 10,000[108] lawsuits[109] have been filed against AstraZeneca, alleging that quetiapine caused problems ranging from slurred speech and chronic insomnia to deaths.

Controversy

In 2004, a young man named Dan Markingson committed suicide in a controversial Seroquel clinical trial at the University of Minnesota while under an involuntary commitment order.[110] A group of University of Minnesota bioethicists charged that the trial involved an alarming number of ethical violations.[111]

Nurofen Plus tampering case

In August 2011, the UK's Medicines and Healthcare products Regulatory Agency (MHRA) issued a class-4 drug alert following reports that some batches of Nurofen plus contained Seroquel XL tablets instead.[112]

Following the issue of the Class-4 Drug Alert, Reckitt Benckiser (UK) Ltd received further reports of rogue blister strips in cartons of two additional batches of Nurofen Plus tablets. One of the new batches contained Seroquel XL 50 mg tablets and one contained the Pfizer product Neurontin 100 mg capsules.

Following discussions with the MHRA's Defective Medicines Report Centre (DMRC), Reckitt Benckiser (UK) Ltd decided to recall all remaining unexpired stock of Nurofen Plus tablets in any pack size, leading to a Class-1 Drug Alert.[113] The contamination was later traced to in-store tampering by a customer.[114]

References

  1.  "Prescription medicines: registration of new generic medicines and biosimilar medicines, 2017". Therapeutic Goods Administration (TGA). 21 June 2022. Retrieved 30 March 2024.
  2.  Anvisa (31 March 2023). "RDC Nº 784 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial" [Collegiate Board Resolution No. 784 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control] (in Brazilian Portuguese). Diário Oficial da União (published 4 April 2023). Archived from the original on 3 August 2023. Retrieved 16 August 2023.
  3.  "Seroquel- quetiapine tablet, film coated". DailyMed. 27 January 2022. Retrieved 22 September 2024.
  4.  "Seroquel Xr- quetiapine tablet, extended release". DailyMed. 27 January 2022. Retrieved 22 September 2024.
  5.  "quetiapine (Rx) - Seroquel, Seroquel XR". Medscape Reference. WebMD. Archived from the original on 20 October 2013. Retrieved 11 October 2013.
  6.  "Quetiapine 25 mg film-coated tablets - Summary of Product Characteristics". electronic Medicines Compendium. Sandoz. January 2013. Archived from the original on 20 October 2013. Retrieved 20 October 2013.
  7.  Truven Health Analytics, Inc. DrugPoint System (Internet) [cited 2013 Sep 18]. Greenwood Village, CO: Thomsen Healthcare; 2013.
  8.  "Quetiapine fumarate tablet". DailyMed. Ascend Laboratories, LLC. October 2013. Archived from the original on 2 December 2013. Retrieved 26 November 2013.
  9.  Brunton L, Chabner B, Knollman B (2010). Goodman and Gilman's The Pharmacological Basis of Therapeutics (12th ed.). McGraw Hill Professional. ISBN 978-0-07-162442-8.
  10.  "Quetiapine Fumarate". The American Society of Health-System Pharmacists. Archived from the original on 29 August 2017. Retrieved 26 March 2017.
  11.  Komossa K, Depping AM, Gaudchau A, Kissling W, Leucht S (December 2010). "Second-generation antipsychotics for major depressive disorder and dysthymia". The Cochrane Database of Systematic Reviews. 2012 (12) CD008121. doi:10.1002/14651858.CD008121.pub2. PMC 11994262. PMID 21154393.
  12.  Anderson SL, Vande Griend JP (March 2014). "Quetiapine for insomnia: A review of the literature" (PDF). American Journal of Health-System Pharmacy. 71 (5): 394–402. doi:10.2146/ajhp130221. PMID 24534594. S2CID 207292819. Archived from the original (PDF) on 19 February 2020.
  13.  Riedel M, Müller N, Strassnig M, Spellmann I, Severus E, Möller HJ (April 2007). "Quetiapine in the treatment of schizophrenia and related disorders". Neuropsychiatric Disease and Treatment. 3 (2): 219–235. doi:10.2147/nedt.2007.3.2.219. PMC 2654633. PMID 19300555.
  14.  British national formulary: BNF 74 (74 ed.). British Medical Association. 2017. p. 383. ISBN 978-0-85711-298-9.
  15.  "The Top 300 of 2023". clincalc.com. Archived from the original on 12 August 2025. Retrieved 13 August 2025.
  16.  "Quetiapine - Drug Usage Statistics, ClinCalc DrugStats Database". clincalc.com. Retrieved 13 August 2025.
  17.  World Health Organization (2023). The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023). Geneva: World Health Organization. hdl:10665/371090. WHO/MHP/HPS/EML/2023.02.
  18.  "quetiapine-fumarate". The American Society of Health-System Pharmacists. Archived from the original on 10 February 2011. Retrieved 3 April 2011.
  19.  Dev V, Raniwalla J (October 2000). "Quetiapine: a review of its safety in the management of schizophrenia". Drug Safety. 23 (4): 295–307. doi:10.2165/00002018-200023040-00003. PMID 11051217.
  20.  Suttajit S, Srisurapanont M, Xia J, Suttajit S, Maneeton B, Maneeton N (May 2013). "Quetiapine versus typical antipsychotic medications for schizophrenia". The Cochrane Database of Systematic Reviews. 2013 (5) CD007815. doi:10.1002/14651858.CD007815.pub2. PMC 11931684. PMID 23728667. Archived from the original on 21 April 2016.
  21.  Leucht S, Cipriani A, Spineli L, Mavridis D, Orey D, Richter F, et al. (September 2013). "Comparative efficacy and tolerability of 15 antipsychotic drugs in schizophrenia: a multiple-treatments meta-analysis". Lancet. 382 (9896): 951–962. doi:10.1016/S0140-6736(13)60733-3. PMID 23810019. S2CID 32085212.
  22.  Srisurapanont M, Maneeton B, Maneeton N (2004). Srisurapanont M (ed.). "Quetiapine for schizophrenia". The Cochrane Database of Systematic Reviews. 2004 (2) CD000967. doi:10.1002/14651858.CD000967.pub2. PMC 7032613. PMID 15106155.
  23.  Kane JM, Correll CU (2010). "Pharmacologic treatment of schizophrenia". Dialogues in Clinical Neuroscience. 12 (3): 345–357. doi:10.31887/DCNS.2010.12.3/jkane. PMC 3085113. PMID 20954430.
  24.  Schultz SH, North SW, Shields CG (June 2007). "Schizophrenia: a review". American Family Physician. 75 (12): 1821–1829. PMID 17619525.
  25.  Asmal L, Flegar SJ, Wang J, Rummel-Kluge C, Komossa K, Leucht S (November 2013). "Quetiapine versus other atypical antipsychotics for schizophrenia". The Cochrane Database of Systematic Reviews. 2013 (11) CD006625. doi:10.1002/14651858.CD006625.pub3. PMC 4167871. PMID 24249315.
  26.  Spielmans GI, Berman MI, Linardatos E, Rosenlicht NZ, Perry A, Tsai AC (2013). "Adjunctive atypical antipsychotic treatment for major depressive disorder: a meta-analysis of depression, quality of life, and safety outcomes". PLOS Medicine. 10 (3) e1001403. doi:10.1371/journal.pmed.1001403. PMC 3595214. PMID 23554581.
  27.  British National Formulary (BNF) 65. London, UK: Pharmaceutical Press. 2013. p. 235. ISBN 978-0-85711-084-8.
  28.  Rossi S, ed. (2013). Australian Medicines Handbook (2013 ed.). Adelaide: The Australian Medicines Handbook Unit Trust. ISBN 978-0-9805790-9-3.
  29.  Ballard C, Margallo-Lana M, Juszczak E, Douglas S, Swann A, Thomas A, et al. (April 2005). "Quetiapine and rivastigmine and cognitive decline in Alzheimer's disease: randomised double blind placebo controlled trial". BMJ. 330 (7496): 874. doi:10.1136/bmj.38369.459988.8F. PMC 556156. PMID 15722369.
  30.  Coe HV, Hong IS (May 2012). "Safety of low doses of quetiapine when used for insomnia". The Annals of Pharmacotherapy. 46 (5): 718–722. doi:10.1345/aph.1Q697. PMID 22510671. S2CID 9888209.
  31.  Anderson SL, Vande Griend JP (March 2014). "Quetiapine for insomnia: A review of the literature". American Journal of Health-System Pharmacy. 71 (5): 394–402. doi:10.2146/ajhp130221. PMID 24534594.
  32.  Modesto-Lowe V, Harabasz AK, Walker SA (May 2021). "Quetiapine for primary insomnia: Consider the risks". Cleveland Clinic Journal of Medicine. 88 (5): 286–294. doi:10.3949/ccjm.88a.20031. PMID 33941603.
  33.  Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, et al. (September 2011). Off-Label Use of Atypical Antipsychotics: An Update (Report). PMID 22132426.
  34.  Maglione M, Maher AR, Hu J, Wang Z, Shanman R, Shekelle PG, et al. (2011). Off-Label Use of Atypical Antipsychotics: An Update. Comparative Effectiveness Reviews, No. 43. Rockville: Agency for Healthcare Research and Quality. PMID 22973576.
  35.  Coe HV, Hong IS (May 2012). "Safety of low doses of quetiapine when used for insomnia". The Annals of Pharmacotherapy. 46 (5): 718–722. doi:10.1345/aph.1Q697. PMID 22510671. S2CID 9888209.
  36.  De Crescenzo F, D'Alò GL, Ostinelli EG, Ciabattini M, Di Franco V, Watanabe N, et al. (July 2022). "Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis". Lancet. 400 (10347): 170–184. doi:10.1016/S0140-6736(22)00878-9. hdl:11380/1288245. PMID 35843245. S2CID 250536370.
  37.  Wine JN, Sanda C, Caballero J (April 2009). "Effects of quetiapine on sleep in nonpsychiatric and psychiatric conditions". The Annals of Pharmacotherapy. 43 (4): 707–713. doi:10.1345/aph.1L320. PMID 19299326. S2CID 207263320.
  38.  Pillinger T, McCutcheon RA, Vano L, Mizuno Y, Arumuham A, Hindley G, et al. (January 2020). "Comparative effects of 18 antipsychotics on metabolic function in patients with schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis". The Lancet. Psychiatry. 7 (1): 64–77. doi:10.1016/s2215-0366(19)30416-x. PMC 7029416. PMID 31860457.
  39.  Yoshida K, Takeuchi H (March 2021). "Dose-dependent effects of antipsychotics on efficacy and adverse effects in schizophrenia". Behavioural Brain Research. 402 113098. doi:10.1016/j.bbr.2020.113098. PMID 33417992. S2CID 230507941.
  40.  Carr CN, Lopchuk S, Beckman ME, Baugh TB (November 2016). "Evaluation of the use of low-dose quetiapine and the risk of metabolic consequences: A retrospective review". The Mental Health Clinician. 6 (6): 308–313. doi:10.9740/mhc.2016.11.308. PMC 6007538. PMID 29955487.
  41.  Højlund M, Støvring H, Andersen K, Correll CU, Hallas J (January 2023). "Impact of low-dose quetiapine-use on glycosylated hemoglobin, triglyceride and cholesterol levels". Acta Psychiatrica Scandinavica. 147 (1): 105–116. doi:10.1111/acps.13515. PMC 10099591. PMID 36281759.
  42.  Højlund M, Andersen K, Ernst MT, Correll CU, Hallas J (October 2022). "Use of low-dose quetiapine increases the risk of major adverse cardiovascular events: results from a nationwide active comparator-controlled cohort study". World Psychiatry. 21 (3): 444–451. doi:10.1002/wps.21010. PMC 9453914. PMID 36073694.
  43.  Højlund M (12 September 2022). Low-dose Quetiapine: Utilization and Cardiometabolic Risk (Ph.D. thesis). University of Southern Denmark. doi:10.21996/mr3m-1783.
  44.  Mukaddes NM, Abali O (2003). "Quetiapine treatment of children and adolescents with Tourette's disorder". Journal of Child and Adolescent Psychopharmacology. 13 (3): 295–299. doi:10.1089/104454603322572624. PMID 14642017.
  45.  Oliver Sacks "Musicophilia" Knopf NY 2007 P.67
  46.  Becker PM (September 2006). "Treatment of sleep dysfunction and psychiatric disorders". Current Treatment Options in Neurology. 8 (5): 367–375. doi:10.1007/s11940-006-0026-6. PMID 16901376. S2CID 34246401.
  47.  Kyle K, Bronstein JM (June 2020). "Treatment of psychosis in Parkinson's disease and dementia with Lewy Bodies: A review". Parkinsonism & Related Disorders. 75: 55–62. doi:10.1016/j.parkreldis.2020.05.026. PMID 32480308. S2CID 219168745. In clinical practice, quetiapine is more readily used than clozapine, given its improved side effect profile compared to clozapine. Despite frequent use in clinical practice, its efficacy in PDP is less clear. ... The quetiapine evidence base is thus ambiguous, lacking consistent support from RCTs in PDP. In DLB there is reliance upon retrospective studies, with the inherent limitations therein. As with clozapine, sedation and orthostasis can be limiting factors. In clinical practice, despite the paucity of consistent evidence, quetiapine has been the first line antipsychotic therapy due to its side effect profile and lower neuroleptic sensitivity risk.
  48.  Shotbolt P, Samuel M, David A (November 2010). "Quetiapine in the treatment of psychosis in Parkinson's disease". Therapeutic Advances in Neurological Disorders. 3 (6): 339–350. doi:10.1177/1756285610389656. PMC 3002640. PMID 21179595.
  49.  Taylor D, Carol P, Shitij K (2012). The Maudsley prescribing guidelines in psychiatry. West Sussex: Wiley-Blackwell. ISBN 978-0-470-97969-3.
  50.  "PRODUCT INFORMATION STADA(TM) Quetiapine (quetiapine fumarate Tablets 25 mg, 100 mg, 200 mg, 300 mg)". TGA eBusiness Services. STADA Pharmaceuticals Australia Pty Limited. 30 November 2012. Archived from the original on 27 March 2017. Retrieved 19 September 2013.
  51.  Lambert CG, Mazurie AJ, Lauve NR, Hurwitz NG, Young SS, Obenchain RL, et al. (May 2016). "Hypothyroidism risk compared among nine common bipolar disorder therapies in a large US cohort". Bipolar Disorders. 18 (3): 247–260. doi:10.1111/bdi.12391. PMC 5089566. PMID 27226264.
  52.  Correll CU, Schenk EM (March 2008). "Tardive dyskinesia and new antipsychotics". Current Opinion in Psychiatry. 21 (2): 151–156. doi:10.1097/YCO.0b013e3282f53132. PMID 18332662. S2CID 37288246.
  53.  Aia PG, Revuelta GJ, Cloud LJ, Factor SA (June 2011). "Tardive dyskinesia". Current Treatment Options in Neurology. 13 (3): 231–241. doi:10.1007/s11940-011-0117-x. PMID 21365202. S2CID 24308129.
  54.  Allison DB, Mentore JL, Heo M, Chandler LP, Cappelleri JC, Infante MC, et al. (November 1999). "Antipsychotic-induced weight gain: a comprehensive research synthesis". The American Journal of Psychiatry. 156 (11): 1686–96. doi:10.1176/ajp.156.11.1686. PMID 10553730. S2CID 38635470.
  55.  "Seroquel Prescribing Information" (PDF). www.astrazeneca-us.com. Archived from the original on 29 August 2021. Retrieved 21 November 2011.
  56.  Joint Formulary Committee BMJ, ed. (March 2009). "4.2.1". British National Formulary (57 ed.). United Kingdom: Royal Pharmaceutical Society of Great Britain. p. 192. ISBN 978-0-85369-845-6. Withdrawal of antipsychotic drugs after long-term therapy should always be gradual and closely monitored to avoid the risk of acute withdrawal syndromes or rapid relapse.
  57.  Haddad PM, Dursun S, Deakin B (2004). Adverse Syndromes and Psychiatric Drugs: A Clinical Guide. OUP Oxford. pp. 207–216. ISBN 978-0-19-852748-0.
  58.  Moncrieff J (July 2006). "Does antipsychotic withdrawal provoke psychosis? Review of the literature on rapid onset psychosis (supersensitivity psychosis) and withdrawal-related relapse". Acta Psychiatrica Scandinavica. 114 (1): 3–13. doi:10.1111/j.1600-0447.2006.00787.x. PMID 16774655. S2CID 6267180.
  59.  Sacchetti E, Vita A, Siracusano A, Fleischhacker W (2013). Adherence to Antipsychotics in Schizophrenia. Springer Science & Business Media. p. 85. ISBN 978-88-470-2679-7.
  60.  Klein L, Bangh S, Cole JB (February 2017). "Intentional Recreational Abuse of Quetiapine Compared to Other Second-generation Antipsychotics". The Western Journal of Emergency Medicine. 18 (2): 243–250. doi:10.5811/westjem.2016.10.32322. PMC 5305132. PMID 28210359.
  61.  Kim S, Lee G, Kim E, Jung H, Chang J (2017). "Quetiapine Misuse and Abuse: Is it an Atypical Paradigm of Drug Seeking Behavior?". Journal of Research in Pharmacy Practice. 6 (1): 12–15. doi:10.4103/2279-042X.200987. PMC 5348850. PMID 28331860.
  62.  Chiappini S, Schifano F (February 2018). "Is There a Potential of Misuse for Quetiapine?: Literature Review and Analysis of the European Medicines Agency/European Medicines Agency Adverse Drug Reactions' Database". Journal of Clinical Psychopharmacology. 38 (1): 72–79. doi:10.1097/JCP.0000000000000814. hdl:2299/19835. PMID 29210868. S2CID 3292900.
  63.  Evoy KE, Teng C, Encarnacion VG, Frescas B, Hakim J, Saklad S, et al. (2019). "Comparison of Quetiapine Abuse and Misuse Reports to the FDA Adverse Event Reporting System With Other Second-Generation Antipsychotics". Substance Abuse. 13 1178221819844205. doi:10.1177/1178221819844205. PMC 6495438. PMID 31068753.
  64.  Vento AE, Kotzalidis GD, Cacciotti M, Papanti GD, Orsolini L, Rapinesi C, et al. (2020). "Quetiapine Abuse Fourteen Years Later: Where Are We Now? A Systematic Review". Substance Use & Misuse. 55 (2): 304–313. doi:10.1080/10826084.2019.1668013. PMID 31573374. S2CID 203621793.
  65.  Baselt R (2008). Disposition of Toxic Drugs and Chemicals in Man (8th ed.). Foster City, CA: Biomedical Publications. pp. 1355–1357.
  66.  Skov L, Johansen SS, Linnet K (January 2015). "Postmortem femoral blood reference concentrations of aripiprazole, chlorprothixene, and quetiapine". Journal of Analytical Toxicology. 39 (1): 41–44. doi:10.1093/jat/bku121. PMID 25342720.
  67.  Skov L, Johansen SS, Linnet K (September 2015). "Postmortem Quetiapine Reference Concentrations in Brain and Blood". Journal of Analytical Toxicology. 39 (7): 557–561. doi:10.1093/jat/bkv072. PMID 26159868.
  68.  Roth BL, Driscol J. "PDSP Ki Database". Psychoactive Drug Screening Program (PDSP). University of North Carolina at Chapel Hill and the United States National Institute of Mental Health. Retrieved 14 August 2017.
  69.  Jensen NH, Rodriguiz RM, Caron MG, Wetsel WC, Rothman RB, Roth BL (September 2008). "N-desalkylquetiapine, a potent norepinephrine reuptake inhibitor and partial 5-HT1A agonist, as a putative mediator of quetiapine's antidepressant activity". Neuropsychopharmacology. 33 (10): 2303–2312. doi:10.1038/sj.npp.1301646. PMID 18059438.
  70.  Schotte A, Janssen PF, Gommeren W, Luyten WH, Van Gompel P, Lesage AS, et al. (March 1996). "Risperidone compared with new and reference antipsychotic drugs: in vitro and in vivo receptor binding". Psychopharmacology. 124 (1–2): 57–73. doi:10.1007/bf02245606. PMID 8935801. S2CID 12028979.
  71.  "Seroquel (quietapine fumarate) tablets" (PDF). AstraZeneca. 276521. Archived from the original (PDF) on 14 April 2008.
  72.  Richelson E, Souder T (November 2000). "Binding of antipsychotic drugs to human brain receptors focus on newer generation compounds". Life Sciences. 68 (1): 29–39. doi:10.1016/S0024-3205(00)00911-5. PMID 11132243.
  73.  Miyamoto SE, Duncan GE, Goff DC, Lieberman JA (2002). "Therapeutics of schizophrenia". In Davis KL, Charney D, Coyle JT, Nemeroff C (eds.). Neuropsychopharmacology: the fifth generation of progress. American College of Neuropsychopharmacology. ISBN 978-0-7817-2837-9.
  74.  "Seroquel Official FDA information, side effects and uses". Drugs.com. Archived from the original on 4 June 2012. Retrieved 9 July 2012.
  75.  National Institute of Mental Health. PDSD Ki Database (Internet) [cited 2013 Sep 18]. Chapel Hill (NC): University of North Carolina. 1998-2013. Available from: "...list shows the top 100 Receptors/Targets in Ki". Archived from the original on 8 November 2013. Retrieved 5 July 2013.
  76.  Jensen NH, Rodriguiz RM, Caron MG, Wetsel WC, Rothman RB, Roth BL (September 2008). "N-desalkylquetiapine, a potent norepinephrine reuptake inhibitor and partial 5-HT1A agonist, as a putative mediator of quetiapine's antidepressant activity". Neuropsychopharmacology. 33 (10): 2303–2312. doi:10.1038/sj.npp.1301646. PMID 18059438.
  77.  López-Muñoz F, Alamo C (September 2013). "Active metabolites as antidepressant drugs: the role of norquetiapine in the mechanism of action of quetiapine in the treatment of mood disorders". Frontiers in Psychiatry. 4: 102. doi:10.3389/fpsyt.2013.00102. PMC 3770982. PMID 24062697.
  78.  Chew ML, Mulsant BH, Pollock BG, Lehman ME, Greenspan A, Mahmoud RA, et al. (July 2008). "Anticholinergic activity of 107 medications commonly used by older adults". Journal of the American Geriatrics Society. 56 (7): 1333–1341. doi:10.1111/j.1532-5415.2008.01737.x. PMID 18510583. S2CID 11448976.
  79.  Guzman F. "Mechanism of action of quetiapine". Psychopharmacology Institute. Archived from the original on 11 August 2013. Retrieved 20 January 2013.
  80.  Kapur S, Seeman P (March 2001). "Does fast dissociation from the dopamine d(2) receptor explain the action of atypical antipsychotics?: A new hypothesis". The American Journal of Psychiatry. 158 (3): 360–369. doi:10.1176/appi.ajp.158.3.360. PMID 11229973.
  81.  Seeman P (February 2002). "Atypical antipsychotics: mechanism of action". Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie. 47 (1): 27–38. doi:10.1177/070674370204700106. PMID 11873706.
  82.  Gefvert O, Lundberg T, Wieselgren IM, Bergström M, Långström B, Wiesel F, et al. (April 2001). "D(2) and 5HT(2A) receptor occupancy of different doses of quetiapine in schizophrenia: a PET study". European Neuropsychopharmacology. 11 (2): 105–110. doi:10.1016/S0924-977X(00)00133-4. PMID 11313155. S2CID 29460397.
  83.  "Drug Use Evaluation: Low Dose Quetiapine (Seroquel/Seroquel XR)" (PDF). Government Executive Media Group. Oregon State. Archived (PDF) from the original on 22 April 2016. Retrieved 20 January 2016.
  84.  "Quetiapine". www.drugbank.ca. Retrieved 23 January 2019.
  85.  "Seroquel" (PDF). FDA. Archived from the original (PDF) on 14 February 2011. Retrieved 23 January 2019.
  86.  Nemeroff CB, Kinkead B, Goldstein J (2002). "Quetiapine: preclinical studies, pharmacokinetics, drug interactions, and dosing". The Journal of Clinical Psychiatry. 63 (Suppl 13): 5–11. PMID 12562141.
  87.  Kasper S, Müller-Spahn F (May 2000). "Review of quetiapine and its clinical applications in schizophrenia". Expert Opinion on Pharmacotherapy. 1 (4): 783–801. doi:10.1517/14656566.1.4.783. PMID 11249516. S2CID 22978385.
  88.  Morón JA, Brockington A, Wise RA, Rocha BA, Hope BT (2002). "Dopamine Uptake through the Norepinephrine Transporter in Brain Regions with Low Levels of the Dopamine Transporter: Evidence from Knock-Out Mouse Lines". The Journal of Neuroscience. 22 (2): 389–395. doi:10.1523/JNEUROSCI.22-02-00389.2002. PMC 6758674. PMID 11784783.
  89.  "Seroquel" (PDF). FDA. Archived from the original (PDF) on 14 February 2011. Retrieved 23 January 2019.
  90.  Warawa, E. J.; Migler, B. M.; 1988, U.S. patent 4,879,288.
  91.  "AstraZeneca Submits an NDA For Sustained Release Formulation Seroquel XR. For the treatment of schizophrenia" (Press release). AstraZeneca. 18 July 2006. Archived from the original on 5 November 2006. Retrieved 1 January 2007.
  92.  "AstraZeneca Submits EU and Canadian Regulatory Filings for Sustained Release Formulation Seroquel XR for the Treatment of Schizophrenia" (Press release). AstraZeneca. 19 October 2006. Archived from the original on 7 November 2006. Retrieved 1 January 2007.
  93.  "FDA Approves AstraZeneca's Once-Daily Seroquel Xr Extended-Release Tablets For The Treatment Of Schizophrenia" (Press release). AstraZeneca. 18 May 2007. Archived from the original on 28 September 2007. Retrieved 2 August 2007.
  94.  "Second Quarter and Half Year Results 2007" (Press release). AstraZeneca. 26 July 2007. Archived from the original on 24 August 2007. Retrieved 2 August 2007.
  95.  "Seroquel XR Receives Approval from FDA for Maintenance Treatment of Schizophrenia" (Press release). AstraZeneca. 16 November 2007. Archived from the original on 4 December 2007. Retrieved 3 December 2007.
  96.  Notice of Compliance Information - Seroquel XR[permanent dead link] 27 September 2007, retrieved 3 December 2007
  97.  "Biovail Announces Filing of ANDA for Quetiapine XR Tablets" (Press release). Biovail. 1 December 2008. Archived from the original on 9 August 2007.
  98.  "AstraZeneca Receives FDA Complete Response Letter on Seroquel XR for Major Depressive Disorder" (Press release). AstraZeneca. 24 December 2008. Archived from the original on 26 October 2010. Retrieved 28 December 2008.
  99.  "Pharmaceutical Giant AstraZeneca to Pay $520 Million for Off-label Drug Marketing". Justice news, US Department of Justice. 27 April 2010. Archived from the original on 13 July 2012. Retrieved 16 July 2012.
  100.  Guzman F. "Quetiapine Indications: FDA-Approved and Off-label Uses". Psychopharmacology Institute. Archived from the original on 22 January 2014. Retrieved 19 January 2013.
  101.  "QUETIAPINE FUMARATE". Electronic Orange Book. Food and Drug Administration. April 2007. Archived from the original on 5 January 2009. Retrieved 24 May 2007.
  102.  "AstraZeneca Receives FDA Approval for SEROQUEL in Bipolar Mania" (Press release). AstraZeneca. 13 January 2004. Archived from the original on 8 June 2011.
  103.  AstraZeneca (2013). "Pioneering science, life-changing medicines". www.sec.gov. Archived from the original on 6 March 2016. Retrieved 26 March 2017.
  104.  Knef A (2 August 2007). "Seroquel suit claims 'so much' is poured into marketing and away from research". The Madison / St. Clair Record. Archived from the original on 21 August 2008.
  105.  Milford P (11 March 2009). "AstraZeneca May Link Seroquel, Diabetes, Doctor Says". Bloomberg.com. Bloomberg L.P. Archived from the original on 24 September 2015.
  106.  "AstraZeneca wins bellwether Seroquel case". FiercePharma. 19 March 2010. Archived from the original on 14 March 2012. Retrieved 9 July 2012.
  107.  "AstraZeneca pays out million dollar damages". The Local. 9 August 2010. Archived from the original on 17 August 2010.
  108.  "Questions loom over drug for sleepless vets - Marine Corps News | News from Afghanistan & Iraq". Marine Corps Times. Archived from the original on 2 June 2013. Retrieved 9 July 2012.
  109.  Wilson D (19 July 2011). "Heart Warning Added to Label on Popular Antipsychotic Drug". NyTimes. Archived from the original on 2 July 2012. Retrieved 9 July 2012.
  110.  Elliott C (September–October 2010). "The Deadly Corruption of Clinical Trials". Mother Jones. Archived from the original on 17 November 2012. Retrieved 2 December 2012.
  111.  Couzin-Frankel J (7 December 2010). "Minnesota bioethicists critique their university". Science. Archived from the original on 21 February 2013. Retrieved 2 December 2012.
  112.  "Press release, 25 August 2011" (Press release). MHRA. Archived from the original on 19 March 2012. Retrieved 9 July 2012.
  113.  "Drug Alerts". MHRA. Archived from the original on 19 March 2012. Retrieved 9 July 2012.
  114.  "Nurofen Plus tampering: Christopher McGuire jailed". BBC News. 28 May 2012. Archived from the original on 14 June 2012. Retrieved 9 July 2012.
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