A randomized controlled trial of quetiapine versus placebo in the treatment of delirium

Tahir, Tayyeb A.; Eeles, Eamonn; Karapareddy, Venugopaul; Muthuvelu, Premraj; Chapple, Sian; Piasecki, Mathew; Adyemo, Toyin; Farewell, Daniel; Bisson, Jonathan I.

doi:10.1016/j.jpsychores.2010.05.006

Cited by 142 publications

(149 citation statements)

References 14 publications

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“…A small, randomized, placebocontrolled trial found significant improvement in noncognitive aspects of delirium with quetiapine. 9 Although haloperidol is the accepted standard for the treatment of delirious behavior, a study found that treatment with a low dose of quetiapine and haloperidol may be equally effective and safe for treating delirium. 10 Diagnosis of DILD generally depends upon a definite temporal association between a history of drug therapy and the onset and progression of respiratory complaints.…”

Section: Discussionmentioning

confidence: 99%

A Case of Drug-Induced Interstitial Pneumonia Potentially Related to Quetiapine (Seroquel) Therapy for Behavioral and Psychological Symptoms

et al. 2014

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Quetiapine is regarded as an effective and safe treatment for delirium. An 82-year-old man presented with a 1-week history of violent behavior and dizziness accompanied by weakness on the left side of his body. He was diagnosed with acute cerebral cortical infarction and delirium associated with alcohol abuse. After quetiapine treatment, he complained of fever and coughed up sputum, whereas his aggressive behavior improved. His symptoms persisted despite empirical antibiotic treatment. All diagnostic tests for infectious causes were negative. High-resolution computed tomography revealed bilateral consolidations and ground-glass opacities with predominantly peribronchial and subpleural distributions. The primary differential diagnosis was drug-associated interstitial lung disease, and therefore, we discontinued quetiapine and began methylprednisolone treatment. His symptoms and radiologic findings significantly improved after receiving steroid therapy. We propose that clinicians need to be aware of the possibility that quetiapine is associated with lung injury. Key words: quetiapine; alcohol abuse; interstitial pneumonia. [Respir Care 2014;59(10):e145-e148.

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Section: Discussionmentioning

confidence: 99%

A Case of Drug-Induced Interstitial Pneumonia Potentially Related to Quetiapine (Seroquel) Therapy for Behavioral and Psychological Symptoms

et al. 2014

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“…37 The ventral tegmental area contains both orexin-1 receptor and orexin-2 receptor messenger ribonucleic acids, 38 and dopaminergic cells of the ventral tegmental area have been shown to be activated by orexins through orexin-1 receptor. 39,40 An explanation for preventive effects of suvorexant on delirium can be associated with antidopaminergic activity like antipsychotics, which are clinically used for the treatment of delirium [41][42][43] and also documented to have effects on delirium prevention despite controversy. [5][6][7][8][9][10][11] It has been shown that administration of orexin-A increases the blood concentrations of corticotropin and corticosterone.…”

Section: E977mentioning

confidence: 99%

Preventive Effects of Suvorexant on Delirium

Hatta¹,

Kishi²,

Wada³

et al. 2017

J. Clin. Psychiatry

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Objective: No highly effective pharmacologic interventions to prevent delirium have been identified. We examined whether suvorexant, a potent and selective orexin receptor antagonist, is effective for the prevention of delirium. Methods: We conducted a multicenter, rater-blinded, randomized, placebo-controlled clinical trial in intensive care units and regular acute wards between April 2015 and March 2016. Eligible patients were 65 to 89 years old, newly admitted due to emergency, and able to take medicine orally and had an expected stay or life expectancy of 48 hours or more. Seventy-two patients were randomly assigned using the sealed envelope method to receive suvorexant (15 mg/d; 36 patients) or placebo (36 patients) every night for 3 days. The primary outcome measure was incidence of delirium as determined by the DSM-5. Trained psychiatrists assessed for delirium. Results: We found that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (0% [n/N = 0/36] vs 17% [6/36], respectively, P = .025).Comparison by log-rank test also showed that delirium developed significantly less often among patients taking suvorexant than among those taking placebo (χ 2 = 6.46, P = .011). Analysis of variance revealed a tendency for main effect of treatment (F = 3.79, P = .053) on the sleep-wake cycle disturbance score (item 1) of the Japanese version of the Delirium Rating Scale-Revised-98 (DRS-R-98-J). There were no significant differences in adverse events.

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“…When compared with those receiving placebo, patients receiving quetiapine experienced no difference in episodes of QTc prolongation. Investigators also found no episodes of EPS or NMS in either the placebo or quetiapine groups (Sasaki et al 2003;Devlin et al 2010;Tahir et al 2010).…”

Section: Safety and Potential Adverse Effectsmentioning

confidence: 99%

“…This is offlabel usage of an FDA-approved drug with respect to both the indication (delirium) and the patient population (children <10 years of age) (Quetiapine [Seroquel] [package insert]). There is growing evidence to support the safe use of quetiapine in the management of adult ICU delirium (Sasaki et al 2003;Devlin et al 2010;Tahir et al 2010). Case reports, case series, and retrospective reviews have reported the efficacy of quetiapine in the management of pediatric delirium in the ICU (Silver et al 2010;Turkel et al 2012;Traube et al 2013), but there has been no systematic report of safety in this patient population.…”

mentioning

confidence: 99%

Evaluation of the Safety of Quetiapine in Treating Delirium in Critically Ill Children: A Retrospective Review

Joyce

Witcher

Herrup

et al. 2015

Journal of Child and Adolescent Psychopharmacology

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Objective: Quetiapine is an atypical antipsychotic that has been used off-label for the treatment of intensive care unit (ICU) delirium in the adult population, with studies demonstrating both efficacy and a favorable safety profile. Although there is a potential role for quetiapine in the treatment of pediatric ICU delirium, there has been no systematic reporting to date of safety in this patient population. Methods: Pharmacy records were used to identify 55 consecutive pediatric ICU patients who were diagnosed with delirium and received quetiapine. A comprehensive retrospective medical chart review was performed to collect data on demographics, dosing, and side effects. Results: Fifty patients treated between January 2013 and November 2014 were included, and five patients were excluded from the study. Subjects ranged in age from 2 months to 20 years. Median daily dose was 1.3 mg/kg/day, and median duration of treatment was 12 days. There were three episodes of QTc prolongation that were clinically nonsignificant with no associated dysrhythmia: Two resolved over time without intervention, and one resolved with decrease in quetiapine dosage. There were no episodes of extrapyramidal symptoms or neuroleptic malignant syndrome. Conclusions: In this population of critically ill youth, short-term use of quetiapine as treatment for delirium appears to be safe, without serious adverse events. Further research is required to assess efficacy and evaluate for long-term effects. A prospective, randomized, placebo-controlled study of quetiapine in managing pediatric delirium is necessary.

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A randomized controlled trial of quetiapine versus placebo in the treatment of delirium

Cited by 142 publications

References 14 publications

A Case of Drug-Induced Interstitial Pneumonia Potentially Related to Quetiapine (Seroquel) Therapy for Behavioral and Psychological Symptoms

A Case of Drug-Induced Interstitial Pneumonia Potentially Related to Quetiapine (Seroquel) Therapy for Behavioral and Psychological Symptoms

Preventive Effects of Suvorexant on Delirium

Evaluation of the Safety of Quetiapine in Treating Delirium in Critically Ill Children: A Retrospective Review

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