Talk:Quetiapine

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Contents

[edit] Suspicious Edits

This page has been the subject of a news story regarding Suspicious editing by a drug company. —Preceding unsigned comment added by Mabu2 (talk • contribs) 19:54, August 30, 2007 (UTC) Removal of negative information about Seroquel, possibly by employees of Astra Zeneca, is denying patients important information about the risks and side effects of Seroquel. Clinical trials for Seroquel, along with Risperdal and Zyprexa, have shown an extremely high rate of suicidal ideation, suicide attempt and completed suicide. While taking Seroquel this author had several periods of SI/HI that progressed much too far and lasted for months at a time. Putting the profits of a $75 billion corporation ahead of the safety of patients and those around them is disgusting.

[edit] Incidence of Akathisia

This article as currently written (Nov 12, 2006) looks like an advertisement right from Astra Zeneca - the maker of quetiapine. I've removed text from the Uses heading that is unrelated and uncitied as well as biased in the drugs favour. Please add citations to this information if you want to re-add it, preferably from studies that are not funded by Astra Zeneca. The assertion of "placebo-level occurrence of EPS (including akathisia)" is incorrect as well. The only study I found supporting this was funded by Astra Zeneca, and there are many studies showing cases of akathisia with quetiapine use, for example: http://psy.psychiatryonline.org/cgi/content/abstract/46/4/291

and a report of a case of severe akathisia from quetiapine use: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12784279&dopt=Abstract

-Jamie

In considering your above changes I would like to add the following point of view. The presence of case studies indicating that quetiapine can cause akasthisia does not invalidate the previous finding by the manufacturer that it occurs similar to the level of placebo. This is because the placebo level is not 0%. In other words people who are on placebo still get akasthisia. So when researchers report cases of the presence of akasthisia in a person taking quetiapine it is still consistent with the orginal research. If a researcher did a large placebo controlled study that found that the incidence of akasthisia was higher or much higher than previously reported then this would be grounds to alter a statment suggesting that the incidence was close to placebo and viewing such statements as biased. Also, keep in mind that your second citation Akathisia as a side effect of antipsychotic treatment with quetiapine in a patient with Parkinson's disease. is a single case report of a person who already suffers from Parkinson's disease. This complicates the issue since Parkinson's disease involves movement and the dopamine system (i.e. this is a special or exceptional case). I think the statement could be modified to:
placebo-level occurrence of EPS (including akathisia) Quetiapine in patients with schizophrenia. A high- and low-dose double-blind comparison with placebo. Seroquel Study Group. However, the incidence is not 0% and case reports have emerged describing the occurrence of akathisia in patients while taking quetiapine Acute Akathisia Associated With Quetiapine Use.
This I think would be more consistent with Wikipedia guidelines based on NPOV and verifiability.--Psychofarm 15:35, 23 November 2006 (UTC)

[edit] Off-Label Uses of Quetiapine

I am thinking of adding a note that using seroquel to treat non-schizophrenic symptoms is more of a short-term solution for extreme accute cases. When I was frequently showing mania, or having my panic attacks closer and closer together I was put on it. --user not clearly identified

The section on uses includes a statment about off-label uses. That statement essential encompasses the additional non-schizophrenic uses that you describe though it does use broad categories. As a basic information source "anxiety disorders" would include panic attacks. Treatment of the manic phase is explicitely covered in the use section.--Psychofarm 15:35, 23 November 2006 (UTC)

[edit] Treating Quetiapine-induced Akathisia

I have taken seroquel twice a day for about 4 years (since I was first diagnosed with schizophrenia). My initial dose was 300mg twice a day and I now take 250mg twice a day (500mg/day) and I have always experienced the extrapyramidal side effects of akathisia which when acute feels literally like dying. This side effect has always occured in the several hours after taking each dose and it then disappears until the next dose. I recently read a study that used high doses of vitamin B6 (600mg twice a day) to treat acute akathisia and I am now taking 500mg of vitamin B6 once a day and this has relieved my side effects almost fully for the first time in 4 years which has made a very positive difference in my daily life. I may increase the dose of vitamin B6 to that used in the study but it seems to be effective for me at 500mg per day. Here is a link to the study: [1]

I would like to put some of the above information on the main seroquel page and on the general neuroleptic page as this information would be very helpful to people taking these medications and suffering the extrapyramidal side effects, which is estimated conservatively at 30% of people taking neuroleptics in the above referenced study.

Jamie

[edit] Anecdotal Self Report (moved here from article)

Someone wrote "A report suggests that a dose of 800mg everyday of quetiapine causes minor brain damage [2]."

Thanks for this link. I think that report is very worth reading, although the above statement neither follows from the report, nor is that "fact" in the report proved by anything at all. The report does not even say what caused the author to believe that she is suffering "minor brain damage", such as a CT or MRI scan. But even if it were true, the author has been given so many medications that it were not possible to tell which one caused what. --David Andel 10:11, 21 April 2006 (UTC)

I haven't written that it was a fact, only suggests. Criticism of the article which has not been published elsewhere is original research. Whereas we don't have to include every link in the article, I think that all reports of adverse effects have to be given consideration. --Mihai cartoaje 13:33, 21 April 2006 (UTC)
I agree. I just think that the appropriate place is here on the talk page. --David Andel 19:00, 21 April 2006 (UTC)
I agree as well, especially when considering Wikipedia:No original research

[edit] Drugbox

moved here from User_talk:Moop_stick

Hey man, why did you replace my version using the marvellous drugbox template again with that old version with the ugly syntax?! Just for the Seroquel logo being on top? I don't think it belong there anyway. The Seroquel logo would be best on a Seroquel page, since it is the commercial product, not the substance Quetiapine. I don't think it makes much sense to just replace each other's version, that's why I am writing you here. What have been your exact reasons for replacement? I think they could be met using the drugbos template as well, and that would make the drug pages somehow consistent. Otherwise it's just a mess... --David Andel 19:02, 23 April 2006 (UTC)

Actually, its much more easier to read the information. Nearly every drug page with the logo on it has the logo above the chemical structure. (Before you edited them). Your edits to the drug box were also unessasary. You dont need a template to display information. The "mess" is more editable. Displaying The drug logo in a seperate box can also cause messes like these, such as the one on the Sertaline page. Old Zoloft Page Newer Zoloft page . --Moop stick 20:21, 23 April 2006 (UTC)

I don't agree. Even if you think the information is easier to read - obviously a matter of taste - using the table syntax means lots of redundancy and less uniformity, since then it's easy to add or remove arbitrary elements to or from the table. And I don't know where you took your Zoloft examples. The recent Zoloft page doesn't look like the "newer" one of your examples. --David Andel 21:47, 23 April 2006 (UTC)

Depends on the browser you use. I use IE 7, and thats how it renders at 1280x1024 res. --Moop stick 22:25, 23 April 2006 (UTC)

Since I couldn't reach an agreement with Moop stick I am asking here now for support from someone else. I really think that the Drugbox templete is great: IMHO it makes the drug pages standardized and the syntax more clear! And since there is no majority between two people I am asking for others to tell their opinion. --David Andel 08:47, 28 April 2006 (UTC)

Ok, so nobody voiced his or her opinion on this issue for a month now. But in the meantime the drugbox get updated by someone to be even prettier than before. So I've moved it back to drugbox now - I mean, all the other drugs are in this format for quite a while now and nobody but Moop stick changed any of them (and Moop stick himself changed Quetiapine only). So I assume that he is in the minority. David Andel 21:41, 1 June 2006 (UTC)

[edit] Experimentation on Children

There is currently a study underway to test the effect of this drug on 4-6 year old children. I know this violates "neutral point of view", but how can somone not be outraged by this?

http://www.clinicaltrials.gov/ct/show/NCT00181883?order=1

http://blogs.abcnews.com/theblotter/2006/05/tots_used_as_hu.html

  • Well.. amphetamines are being perscribed to children for ADHD. Amphetamines are serious drugs, and can cause sudden death, and my grandma went on them for weight loss in the 50s and got really bad psychosis.

--Moop stick 19:01, 15 May 2006 (UTC)

[edit] Why do you keep taking off those links?

What's wrong with those links in the "external links" section? I think there is some real controversy surrounding this drug.

So Dr. Zak is just taking off those links without giving a reason why? They are totally related to that drug. Who appointed Dr. Zak and PHenry as censors anyway?

Take the controversy on clinical trials on young children to clinical trials, please! Actually, the fact that clinical trials most often involve young men is a problem, it shifts the sample to, well, young men. In women, aged people and young children the drug may be metabolized at a different rate. Dr Zak 06:00, 4 June 2006 (UTC)

[edit] Could someone explain this?

"...a series of neuroleptics known as "atypical antipsychotics", which have, over the last four decades, become increasingly popular alternatives to "typical antipsychotics""

as far as I know, the very first atypical beeing marketed was clozapine (Clozaril, Leponex) in 1972; the second was Risperdal in 1994. What four decades of atypicals? Clozapine gained never a broad-band use due to its myelotoxic side effects, the era of atypicals began in early 90's.--84.163.108.243 22:13, 27 July 2006 (UTC)

[edit] Bad Drug?

I have seen several commercials where a lawyer is asking for people who have taken Seroquel and have complications to join a lawsuit. Why is nothing on that here? —The preceding unsigned comment was added by 67.110.221.182 (talk) 08:51, 11 February 2007 (UTC).

Probably because Seroquel is not the only medicine the law firms are trying to sue. And their case is not a good one. They're saying it might cause diabetes but this is very well known by its users already and it's a risk you have to take. You can take pre-caution of course. --84.230.176.116 04:21, 13 March 2007 (UTC)

I think it's not causing diabetes, but causing "extreme harm" to those with diabetes. Either way, I personally think it's just the work of scumbag lawyers. Jmlk17 11:22, 21 April 2007 (UTC)
Some antipsychotics are elevating the risk of gainig diabetes; that's why the FDA issued the compulsory "blackbox" warning for all antipsychotics indiscriminately; while e.g. olanzapine (Zyprexa) is linked to significant increase in exacerbations of diabetes among patients taking it, quetiapine does not, or minimaly.--84.163.121.160 04:08, 24 April 2007 (UTC)
Law firms are always trying to sue for some drug or another though. Jmlk17 07:51, 6 May 2007 (UTC)
An example is here. (GARDINER HARRIS, BENEDICT CAREY and JANET ROBERTS, "Psychiatrists, Children and Drug Industry’s Role", New York Times May 10, 2007) This NY Times article also explains possible methodological flaws in a study that led to popularization of Seroquel.--C S (Talk) 18:35, 10 May 2007 (UTC)

__

Might I remind everyone that a talk page is for discussing the article itself, not the article content? I guarantee that for every Seroquel sob story there's another person who owes their life to this drug, (like myself, for that matter) that's just the way it is with these medicines. You should only be taking this drug if you are pretty sick already, and if the side effects aren't worth it, don't take it in the first place! It's just that simple. Now, can we return to the matter at hand (article quality) please? L'Aquatique talktome 07:29, 21 October 2007 (UTC)

[edit] Origin of the SEROQUEL brand name?

Does anyone know, what should "SEROQUEL" mean? Why did AstraZeneca pick this name, or better asked, what is this brand name's meaning? It is clearly not straight derived from the INN Quetiapine, maybe stands "SERO-" for "Serenity"...? Anyone have an idea? Thanks.--84.163.108.96 03:32, 30 April 2007 (UTC)

Not sure on this end. It's simply a brand name that they chose, perhaps somewhat along the lines of what you were thinking. I googled it, and tried searching online for a bit, but found little information. Sorry. I'm pretty interested myself though. Jmlk17 03:53, 30 April 2007 (UTC)
Naming of drugs is generally commercially driven (just think of Exubera, an inhaled insulin preparation - an obvious reference to "exuberant", or Januvia with its allusion to rejuvenating one's diabetic control). No sensible drug company will release this information into the public domain; it would undermine their capability of naming their products in a fashion that will make them commercially appealing. Speculation on the subject here on Wikipedia is generally original research unless very explicit references are available. JFW | T@lk 18:58, 1 May 2007 (UTC)

The idea behind the majority of drug names is to include a "Q", "X", or "Z" because it sounds scientific and impressive.

What's your basis on that? Jmlk17 21:55, 20 August 2007 (UTC)

Seems like it's probably a portmanteau of Serenity and Tranquility? L'Aquatique talktome 07:30, 21 October 2007 (UTC)

[edit] 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)

[edit] Benzodiazepines do lower seizure threshold?

As with some other antipsychotics, quetiapine may lower the seizure threshold, and should be taken with care in combination with drugs such as bupropion and the benzodiazepines (e.g., lorazepam), as they also lower the seizure threshold.

While an abrupt benzodiazepine withdrawal does lower the seizure threshold and may lead to an epileptoid, and while some benzodiazepines (e.g. nitrazepam) do carry a risk of inducing some forms of seizures (notably, partial/focal paroxysms), the statement, that "the benzodiazepines [also] lower the seizure threshold" is wrong; in fact, benzodiazepines are mostly diminishing the risk of an epileptoid if administred concomitantly to an seizure threshold-lowering medication. If no one has objections, I would change this statement in next few days.--84.163.78.126 16:34, 16 August 2007 (UTC)

[edit] Quetiapine implicated in priapism (case report)

I'm not going to go to the effort of incorporating this into the main article text, but if someone else wants to, have at it. There is an interesting case report (available at http://www.medworksmedia.com/psychopharmbulletin/pdf/18/117-119_PB_V39N1_Harrison.pdf) describing the case of a 45 year old patient who developed an 18+ hour priapism apparently due to a combination of a higher-than-prescribed dose of quetiapine and methamphetamine. Authors explore correlations among quetiapine, methamphetamine abuse and HIV infection. 199.4.74.16 (talk) 23:55, 6 February 2008 (UTC)

[edit] Critical research of neuroleptics

I would like to add a section citing from the large pool of research that has been critical of neuroleptics. I believe that the current page presents as though no such negative research exists. Specifically, I would like to cite the WHO studies, Hegarty (1994) and Mosher's research from Soteria House that show neuroleptic use being correlated with poorer outcome measures in the long term. Postcrypto (talk) 00:32, 23 March 2008 (UTC)

See my opinion at User_talk:MeekMark#Neuroleptic_Deletions; I feel that the information is potentially useful, but the information perhaps belongs at a higher category, perhaps atypical antipsychotic. MeekMark (talk) 13:55, 24 March 2008 (UTC)
I would encourage the creation of a section on the long term use of antipsychotics.--Mark v1.0 (talk) 19:58, 14 May 2008 (UTC)