A case of dose escalation of quetiapine in persistent insomnia disorder

Abstract

Quetiapine, an atypical antipsychotic drug, is recommended for the treatment of schizophrenia and mood disorders. In addition, given its sedative effects, a low dose of the agent is also widely used in the treatment of anxiety disorders, personality disorders, substance abuse, and sleep disturbances. In this case study, quetiapine was the first effective drug in reducing chronic insomnia in a male patient with a long treatment history. Because its effect declined over time, in the course of two years, a gradual dose increase led to a posology 50 times higher than the off-label dosage used to obtain sedation, i.e. 25-100 mg quetiapine administered once daily. This case raises awareness of the ease with which dose escalation of quetiapine occurs. The risk of side effects and, possibly, dependence and abuse underlines the importance of regular and careful patient monitoring. Given the unexpected effectiveness of the agent and the absence of side effects in the described case, we argue that in treatment-resistant insomnia, a high dose of quetiapine may be justifiable in selected cases but also urge that further research on the long-term effects and potential adverse events of quetiapine for this indication is of the utmost importance.

Quetiapine dose optimisation during gestation: a pharmacokinetic modelling study

“…Although a dose increase to 500 mg twice daily would be sufficient to ensure 30–50% of subjects attained the upper therapeutic window of 100 ng/ml (Table ), a dose increase to 700 mg twice daily was identified as satisfying the requirement to attain both the 50 and 100 ng/ml lower windows (Figure ), with attainment of >95 and >62% of subjects, respectively. While trials have suggested an upper dose of 800 mg/day, higher doses of between 800 and 2000 mg/day have been reported to be tolerated in acute and maintenance therapy. Further, sparse case reports are available of significantly higher overdoses of least 20–24 g being ingested with little acute effects …”

Kvetiapin er ikke en sovemedisin

“…Vi er ikke kjent med retningslinjer som tilrår bruk av kvetiapin for behandling av insomni Studier utover to uker finnes ikke, slik at langtidseffekt av lavdose kvetiapinbehandling er ukjent. Doseeskalering er rapportert ved bruk av kvetiapin mot primaer insomni, og mange pasienter rapporterer om problemer med å seponere kvetiapin etter lavdosert bruk (13). Det er også holdepunkter for at kvetiapin har misbrukspotensial (20).…”

Quetiapine as a Potential Treatment for Insomnia: The Road Ahead

“…When quetiapine is used to treat primary insomnia, dosage escalation has also been reported. 4,5 Well-designed study is needed to verify the effectiveness of quetiapine for insomnia in order to maximize the therapeutic effect and avoid side effects in clinical fields. It would also be beneficial to look into the impacts on specific demographics, such as the elderly, delirium, and sedative addiction.…”