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

Abstract

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.

Delirium and Mortality in Critically Ill Children: Epidemiology and Outcomes of Pediatric Delirium*

“…For those children who remain delirious after the clinician has addressed these factors, pharmacologic treatment may be considered. The atypical antipsychotics (in particular, quetiapine) have been used safely for treatment of delirium in critically ill children (46–48). …”

Consensus Report by the Pediatric Acute Lung Injury and Sepsis Investigators and Pediatric Blood and Marrow Transplantation Consortium Joint Working Committees on Supportive Care Guidelines for Management of Veno-Occlusive Disease in Children and Adolescents, Part 3: Focus on Cardiorespiratory Dysfunction, Infections, Liver Dysfunction, and Delirium

“…A retrospective review studied the use of quetiapine, an atypical antipsychotic, to treat pediatric delirium (Appendix A in Part 2). Short-term use appears to be safe, with no serious adverse events reported in 50 patients aged 2 months to 20 years [144]. No previous studies have evaluated safety specifically in children with VOD and impaired hepatic function, in whom CYP3 inhibitors are routinely used and affect drug metabolism.…”

Detection and Management of Delirium in the Neonatal Unit: A Case Series

“…Short-term use of quetiapine to treat delirium in critically ill children seems to be safe. 17 In the present case series, addition of quetiapine allowed for weaning of benzodiazepines and opiates, which are believed to be toxic. 18 Less agitation and sedation also allowed for improved oxygenation and rapid weaning of ventilator support.…”