Desperately Seeking Sleep!

"Can the next doctor wanting to prescribe Seroquel for sleep, just not?"
"Over the last decade, I have seen several patients who have had quetiapine as part of, or one of the contributing causes to NMS [neuroleptic malignant syndrome]."
"I've certainly seen people who have been diagnosed with Parkinson's disease that I'm confident were from quetiapine. It's getting to the point now where, when I admit a patient with Parkinson's, I reflexively look at their other medications to see, 'Are they on quetiapine?'"
"But what's really driving this is a societal expectation that we should all get eight hours of sleep a night, a pill is a way to go about it, and the willingness of some providers to accede to requests for sleeping pills."
Dr. David Juurlink, clinical toxicologist, Sunnybrook Health Sciences Centre, Toronto

David Juurlink‏Verified account @DavidJuurlink  

David Juurlink Retweeted David Juurlink

Feeling the need to repeat this after rounds this morning ...

David Juurlink added,

David JuurlinkVerified account @DavidJuurlink

Can the next doctor wanting to prescribe Seroquel “for sleep” just not because diabetes DVT Parkinson’s akathisia dystonia sudden death?

"It's popping up as a patient's typical medication for insomnia all the time."
"It's not well supported by any science for use in sleep, it has significant side effects and yet it's massively prescribed."
Dr. Ian Mitchell, emergency physician, Kamloops, British Columbia

"Seroquel is not benign."
"It may be more dangerous than our standard sleeping pills, but without research we cannot know or quantify its risks."
Dr. David Gardner, professor of psychiatry and pharmacology, Dalhousie University, Halifax, N.S.

Seroquel, an antipsychotic drug intended to treat schizophrenia and bipolar disorder.
THE CANADIAN PRESS/Michelle Siu

The drug in question was developed as an antipsychotic medication, not a medication to treat insomnia, yet it is commonly prescribed by attending physicians to treat insomnia. Its trade name is Seroquel, among other more generic types and the active ingredient is quetiapine, which has been approved for use in Canada to treat schizophrenia, bipolar disorder and serious depression, and those conditions only.

Experts in drug safety have taken due note of its common use for a condition having nothing whatever to do with the drug's properties gearing it as an antipsychotic medication, and its increasingly prescribed use as a sleeping pill has caused bells of alarm to ring in the realization that there has been a tenfold increase in quetiapine prescriptions between 2004 and 2012, to treat insomnia.

Although the drug has sedating properties, making people drowsy, it comes complete with a smorgasbord of potential side effects, some of which are extremely worrisome. Some of which include Parkinson's-like tremors and abnormalities in movement; weight gain, high blood sugar impacting on diabetes and rarely but alarmingly, heart arrhythmia which can progress to sudden cardiac death.

Another rare, but life-threatening reaction to the drug which is particularly nasty is a condition known as neuroleptic malignant syndrome, potentially life-threatening. A Health Canada review recently recognized a link between quetiapine and allied 'atypical' antipsychotics to increased risk of sleep apnea. Little wonder that Dr. Juurlink and other health professions have been alerted and are warning of the dire inappropriateness of its use.

One quarter of the 33 million prescriptions for tranquilizers that leave pharmacies in the hands of users were for quetiapine, according to IMS Brogan, a drug market research company. And while doctors claim the drug has been prescribed in low-dose formulations to people without psychiatric conditions, to ameliorate their inability to sleep normally, it was discovered that 48 percent of B.C. quetiapine prescriptions in 2010 were for the 25 mg tablet, whereas the range dose of 150 to 180 mg per day relates to prescriptions for psychiatric conditions for which the drug was formulated.

Side effects like tardive dyskinesia, the abnormal movements of the face and jaw have been reported resulting from low-dose regimens of the drug, according to the UBC Therapeutics Initiative. Additionally, non-medical abuse of quetiapine is on the rise, with people inhaling or injecting crushed or dissolved tablets whose street names mask quetiapine in cute street talk like "Suzy Q" and "baby heroin".

Needless to say, no small amount of responsibility in this situation must be acknowledged by the pharmaceutical industry. Its public relations and sales representatives are all geared toward influencing the sale of drugs, for purposes both appropriate and clearly not. Their major concern is not patient health or furthering the cause of achieving relief from the effects of various conditions, but to persuade both prescribing physicians and pharmacists that their product should be considered first and foremost.

It is their profit and that alone that commands their attention.