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Published Online, 18 March 2009, www.theannals.com, DOI 10.1345/aph.1L320.
 The Annals of Pharmacotherapy: Vol. 43, No. 4, pp. 707-713. DOI 10.1345/aph.1L320
© 2009 Harvey Whitney Books Company.
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DRUG INFORMATION ROUNDS

Effects of Quetiapine on Sleep in Nonpsychiatric and Psychiatric Conditions

Jessica N Wine, PharmD

Pharmacy Practice Resident, Miami Veterans Affairs Healthcare System, Miami, FL

Christina Sanda, PharmD

Pharmacy Practice Resident, Miami Veterans Affairs Healthcare System, Miami, FL

Joshua Caballero, PharmD

Assistant Professor, College of Pharmacy, Nova Southeastern University, Ft. Lauderdale, FL; Clinical Pharmacy Faculty, Mental Health Pharmacy Services, Jackson Health Systems

Reprints: Dr. Caballero, Nova Southeastern University, College of Pharmacy, 3200 South University Dr., Ft. Lauderdale, FL 33328, fax 954/262-2278, jcaballe{at}nsu.nova.edu

OBJECTIVE: To evaluate the use of immediate-release quetiapine for the treatment of insomnia.

DATA SOURCES: Pre-MEDLINE and MEDLINE were searched (1966 to October 2008) using the terms quetiapine, sleep, insomnia, and antipsychotics.

STUDY SELECTION AND DATA EXTRACTION: All studies and case reports evaluating insomnia as a primary endpoint were reviewed.

DATA SYNTHESIS: The role of quetiapine for improving sleep in various patient populations is uncertain. Quetiapine has moderately sedative properties, and doses used in treatment of insomnia have ranged from 12.5 to 800 mg. Results of clinical trials and observations in case studies have revealed possible beneficial effects of quetiapine on several subjective and objective sleep parameters. In most studies, significant improvements in sleep were found in areas of total sleep time, sleep efficiency, and subjective sleep scores. However, some of these results may not be clinically significant. Also, quetiapine has been found to have adverse effects such as periodic leg movements, akathisia, and metabolic complications. Additionally, changes in rapid eye movement (REM) and percentage of REM sleep have been noted in different populations and need further study. Despite quetiapine's sedative properties, current data do not appear to support its use as first-line treatment for sleep complications. However, it may be useful for treatment of insomnia in patients with psychiatric disorders (eg, bipolar, schizophrenia) who do not respond to primary or secondary treatments.

CONCLUSIONS: Further studies are needed to define the placement, dose, and adverse effects of quetiapine for the treatment of sleep problems.

Key Words: insomnia, quetiapine, sleep

Published Online, March 18, 2009. www.theannals.com, DOI 10.1345/aph.1L320




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