Seroquel as Candy

[BidingMyTime]

I have noticed an increasing, disturbing trend, of nurse practitioners (and I've only seen this with nurse practitioners) prescribing Seroquel like its candy (prescribing it for insomnia in someone who hasn't tried anything else but OTC drugs, prescribing it for depression in someone who hasn't tried anything else, prescribing it for "menstrual difficulties") Any ideas if this is being promulgated by drug reps, or was their some drug article on the miracleousness of Seroquel that is being misinterpreted? I think Seroquel is a pretty heavy drug to be given out so lightly, and I've had more than one patient come back freaked out after reading the patient information sheet and wondering why they would have been prescribed that.

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[Pharmavixen]

Seroquel is very sedating even at sub-anti-psychotic doses and has been used for the past 10 years or so as a "non-addictive" alternative to BDZs as a sedative-hypnotic. As it turns out, it's not so non-addictive, and is being crushed and snorted or injected in jails, where there are reports that it even has a street name, "Suzie-Q."

People even will fake psychotic symptoms to get Seroquel. Google "quetiapine abuse." And send the links to those nurse practitioners.

 

[Carboxide]

IMO the adverse effects are significant and it should not be prescribed unless the patient has failed BDZs and zolpidem.

 

[PharMed2016]

Seroquel is very sedating even at sub-anti-psychotic doses and has been used for the past 10 years or so as a "non-addictive" alternative to BDZs as a sedative-hypnotic. As it turns out, it's not so non-addictive, and is being crushed and snorted or injected in jails, where there are reports that it even has a street name, "Suzie-Q."

People even will fake psychotic symptoms to get Seroquel. Google "quetiapine abuse." And send the links to those nurse practitioners.

 

[rxlea]

Seroquel is very sedating even at sub-anti-psychotic doses and has been used for the past 10 years or so as a "non-addictive" alternative to BDZs as a sedative-hypnotic. As it turns out, it's not so non-addictive, and is being crushed and snorted or injected in jails, where there are reports that it even has a street name, "Suzie-Q."

People even will fake psychotic symptoms to get Seroquel. Google "quetiapine abuse." And send the links to those nurse practitioners.

This. The detox patients on my first rotation shared this bit with me. Though they did complain about the munchies and subsequent weight gain....

 

[knight on horse]

No way I would ever take Seroquel

 

[samuricool]

You'd have to be crazy to take Seroquel.

 

[type b pharmD]

I knew a guy once with severe bipolar who snorted and abused seroquel .. is it one of those things where people who abuse it are receiving a therapeutic effect like with nicotine and schizophrenia?

Not saying it isn't abused.. I've heard of it too . Its strange that an anti dopamine drug would cause enjoyment .. but you hear of people getting high on the strangest things.

 

[ciestar]

Seroquel knocked me out. Mine was also prescribed by a CRNP. (I was 16)
Tried Trazodone first though, didnt work.

 

[zelman]

Seroquel knocked me out. Mine was also prescribed by a CRNP. (I was 16)
Tried Trazodone first though, didnt work.

Nobody is saying it won't work as a sleep aid. It's just that being well rested with tardive dyskinesia isn't so appealing, and many prescribers seem to disregard this potentially permanent adverse effect.

 

[Pharmavixen]

We had a discussion about quetiapine for sleep @ P & T. The psychiatrist suggests doxepin or clonidine as non-BDZ alternatives. We're not so fond of trazodone d/t priapism, a rare AE, but when it happens it tends not to be treated expediently enough in the jail and permanent damage ensues, resulting in litigation.

The psychiatrist says he deals with requests for Seroquel by detailing its AEs, getting into the wt gain, potential for EPS, lactation. He finds that many of them are shocked, and change their minds.

I've proposed that our drs only prescribe quetiapine for its on-label indications (in Canada, that would be bipolar mania, bipolar depression, schizophrenia). Most of the drs concur, though some feel that the furor over quetiapine abuse is overblown.

 

[Pharmavixen]

From one of the references I used for my presentation at the Pharmacy and Therapeutics Committee meeting:

While presently designated as a non- controlled substance, there have been a series of case reports indicting quetiapine as a potential substance of misuse/abuse. Note that the majority has involved younger male subjects and that the entire cohort is riddled with past substance abuse, particularly the abuse of benzodiazepines. The routes of misuse/abuse have included oral, intranasal, and intravenous entries, with the latter two methods mediated by crushing tablets. While not noted in the table, the majority of reported subjects were either incarcerated or psychiatric inpatients.

 

[Praziquantel86]

From one of the references I used for my presentation at the Pharmacy and Therapeutics Committee meeting:

The APA just put out a list of "don'ts" with antipsychotics, and using them as a sleep aid is one of them.

 

[ciestar]

I find it funny I was initially put on it to help me sleep..
and like 6 years later a psychiatrist diagnosis me with Biopolar II.
Now I get lamictal for that and ambien for my sleep issues.

 

[rxlea]

I knew a guy once with severe bipolar who snorted and abused seroquel .. is it one of those things where people who abuse it are receiving a therapeutic effect like with nicotine and schizophrenia?

Not saying it isn't abused.. I've heard of it too . Its strange that an anti dopamine drug would cause enjoyment .. but you hear of people getting high on the strangest things.

It's not solely "anti dopamine".

 

[eagles22]

I knew a guy once with severe bipolar who snorted and abused seroquel .. is it one of those things where people who abuse it are receiving a therapeutic effect like with nicotine and schizophrenia?

Not saying it isn't abused.. I've heard of it too . Its strange that an anti dopamine drug would cause enjoyment .. but you hear of people getting high on the strangest things.

It's not that it causes a high like street drugs, but rather it causes sedation which could be desirable in some instances. You see the drug abused in prison because they have easy access to it and it sedates them for a while and makes being in jail less ****ty.

 

[zelman]

Guess the APA noticed the problem http://click.mail.medscape.com/?qs=3dad3d8852a10702869748f3d36d51bf8346f48f70cae00af782208205a116a8c0e95f6b5eaab814

 

[njac]

One of the ED NPs I work with has been raving about seroquel for sleep lately.

 

[rxlea]

One of the ED NPs I work with has been raving about seroquel for sleep lately.

It works but lots of patients I've seen complain about vivid dreams and the addicts have dreams about using, sometimes waking up thinking there is beer in their fridge because they dreamed about buying a 40.

 

[Pharmavixen]

Guess the APA noticed the problem]

Thanks for that, zelman; I'm on the Medscape Pharmacists mailing list, but I'd missed that article. I've saved it in a pdf and will be sending it round to P & T members.

Some of the drs on P & T feel that quetiapine is a reasonable choice for a sedative and will continue using it. I've suggested TCAs like doxepin instead. We try to avoid BDZs because the prevalence of substance use disorder amongst inmates approaches 80%, and once we start them on BDZs it's hard to get them off. Same problem with zopiclone.

 

[rxlea]

Thanks for that, zelman; I'm on the Medscape Pharmacists mailing list, but I'd missed that article. I've saved it in a pdf and will be sending it round to P & T members.

Some of the drs on P & T feel that quetiapine is a reasonable choice for a sedative and will continue using it. I've suggested TCAs like doxepin instead. We try to avoid BDZs because the prevalence of substance use disorder amongst inmates approaches 80%, and once we start them on BDZs it's hard to get them off. Same problem with zopiclone.

There is always hydroxyzine as a viable alternative for sleep. I usually just have that recommendation ready if it's ok for the patient. If the patient is on some other atypical/mood stabilizer (or on quetiapine already), I ask them to switch it to night, and make sure to move any more activating agents to the day (SNRIs, SSRIs, etc.).