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CNS Drugs

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01.01.2008 | Review Article

Quetiapine

Dose-Response Relationship in Schizophrenia

verfasst von: Anna Sparshatt, Sarah Jones, Prof. David Taylor

Erschienen in: CNS Drugs | Ausgabe 1/2008

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Abstract

Quetiapine is a widely used second-generation antipsychotic that is effective in the treatment of schizophrenia and bipolar mania. In recent years, various publications have suggested the possibility that, in some patients, higher than licensed dosages are necessary for full therapeutic effect. A ‘high-dose’ theory of quetiapine activity has developed, leading many prescribers to disregard the formal upper limit of the quetiapine dosage range (750 or 800 mg/day, depending on local labelling).

In this review, we examine the clinical and neuroimaging data relating to the use of quetiapine in acute exacerbations of schizophrenia. Fixed-dose efficacy studies of immediate-release (IR) quetiapine suggest dosages of quetiapine of 150–450 mg/day are more effective than placebo and no less effective than dosages of 600 or 750 mg/day. A fixed-dose study of extended-release quetiapine indicated that dosages of 600 and 800 mg/day were equally efficacious and numerically superior to 400 mg/day. Dosages of IR quetiapine averaging between 254 and 525 mg/day have been shown to be equivalent in efficacy to standard dosages of conventional and other atypical antipsychotics. Pooled data support these findings. Effectiveness studies using quetiapine in daily doses averaging between 565 and 653 mg revealed quetiapine to be somewhat less effective than some comparator drugs.

Support for the use of high-dosage quetiapine (>800 mg/day) is very limited: case reports, albeit numerous, describe quetiapine as showing therapeutic effects only at dosages above the licensed range; some data suggest widespread use of higher dosages in practice; and neuroimaging data suggest inadequate dopamine receptor occupancy at standard dosages (although these findings may reflect the low affinity of quetiapine for dopamine receptors).

Overall, robust controlled data strongly suggest that the standard dosage range for quetiapine is appropriate for clinical use. The balance of evidence does not support the belief that higher dosages are required for full therapeutic effect, although higher dosage trials are ultimately required to confirm or refute this hypothesis.

Citrome L, Jaffe A, Levine J, et al. Dosing of quetiapine in schizophrenia: how clinical practice differs from registration studies. J Clin Psychiatry 2005; 66(12): 1512–6PubMedCrossRef

Pierre JM, Wirshing DA, Wirshing WC, et al. High-dose quetiapine in treatment refractory schizophrenia. Schizophr Res 2005; 73(2-3): 373–5PubMedCrossRef

Khazaal Y, Tapparel S, Chatton A, et al. Quetiapine dosage in bipolar disorder episodes and mixed states. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31(3): 727–30PubMedCrossRef

Bobes J, Garcia-Portilla MP, Saiz PA, et al. High degree of tolerability for monotherapy with high doses of quetiapine: a case report. J Clin Psychiatry 2002; 63(11): 1048–9PubMedCrossRef

Hazra M, Culo S, Mamo D. High-dose quetiapine and photopsia. J Clin Psychopharmacol 2006; 26(5): 546–7PubMedCrossRef

Arvanitis LA, Miller BG. Multiple fixed doses of “Seroquel” (quetiapine) in patients with acute exacerbation of schizophrenia: a comparison with haloperidol and placebo. The Seroquel Trial 13 Study Group. Biol Psychiatry 1997; 42(4): 233–46

Guy W. The clinical global impressions scale. In: Guy W, editor. ECDEU assessment manual for psychopharmacology. Rev. ed. Rockville (MD): National Institute of Mental Health, 1976: 157–69

Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Rep 1962; 10(799): 799–812CrossRef

Kahn RS, Schulz SC, Palazov VD, et al. Efficacy and tolerability of once-daily extended release quetiapine fumarate in acute schizophrenia: a randomized, double-blind, placebo-controlled study. J Clin Psychiatry 2007; 68(6): 832–42PubMedCrossRef

10.

Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13(2): 261–76PubMedCrossRef

11.

Pirie W. Jonckheere tests for ordered alternatives. In: Kotz S, Johnson NL, editors. Encyclopedia of statistical sciences. New York: John Wiley and Sons, Inc., 1983: 315–8

12.

King DJ, Link CG, Kowalcyk B. A comparison of bd and tid dose regimens of quetiapine (Seroquel) in the treatment of schizophrenia. Psychopharmacology 1998; 137(2): 139–46PubMedCrossRef

13.

Barzega G, Bogetto F, Maina G, et al. Quetiapine in schizophrenic patients: a high- and low-dose double-blind comparison. Eur J Psychiatry 2000; 14(4): 221–32

14.

Andreasen N. Scale for the assessment of negative symptoms (SANS). Br J Psychiatry 1989; 155Suppl. 7: 53–8

15.

Small JG, Hirsch SR, Arvanitis LA, et al. Quetiapine in patients with schizophrenia: a high- and low-dose double-blind comparison with placebo. Seroquel Study Group. Arch Gen Psychiatry 1997; 54(6): 549–57CrossRef

16.

Fabre Jr LF, Arvanitis L, Pultz J, et al. ICI 204,636, a novel, atypical antipsychotic: early indication of safety and efficacy in patients with chronic and subchronic schizophrenia. Clin Ther 1995; 17(3): 366–78PubMedCrossRef

17.

Small JG, Kolar MC, Kellams JJ. Relationship between quetiapine dose and efficacy. Eur Neuropsychopharmacol 2002; 12Suppl. 3: 277CrossRef

18.

Borison RL, Arvanitis LA, Miller BG. ICI 204,636, an atypical antipsychotic: efficacy and safety in a multicenter, placebocontrolled trial in patients with schizophrenia. US SEROQUEL Study Group. J Clin Psychopharmacol 1996; 16(2): 158–69CrossRef

19.

Copolov DL, Link CG, Kowalcyk B. A multicentre, double-blind, randomized comparison of quetiapine (ICI 204,636, ‘Seroquel’) and haloperidol in schizophrenia. Psychol Med 2000; 30(1): 95–105PubMedCrossRef

20.

Mullen J, Jibson MD, Sweitzer D. A comparison of the relative safety, efficacy, and tolerability of quetiapine and risperidone in outpatients with schizophrenia and other psychotic disorders: the quetiapine experience with safety and tolerability (QUEST) study. Clin Ther 2001; 23(11): 1839–54PubMedCrossRef

21.

Zhong KX, Sweitzer DE, Hamer RM, et al. Comparison of quetiapine and risperidone in the treatment of schizophrenia: a randomized, double-blind, flexible-dose, 8-week study. J Clin Psychiatry 2006; 67(7): 1093–103PubMedCrossRef

22.

Peuskens J, Link CG. A comparison of quetiapine and chlorpromazine in the treatment of schizophrenia. Acta Psychiatr Scand 1997; 96(4): 265–73PubMedCrossRef

23.

Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol 1967; 6(4): 278–96PubMedCrossRef

24.

Margolese HC, Chouinard G, Beauclair L, et al. Therapeutic tolerance and rebound psychosis during quetiapine maintenance monotherapy in patients with schizophrenia and schizoaffective disorder. J Clin Psychopharmacol 2002; 22(4): 347–52PubMedCrossRef

25.

Velligan DI, Prihoda TJ, Sui D, et al. The effectiveness of quetiapine versus conventional antipsychotics in improving cognitive and functional outcomes in standard treatment settings. J Clin Psychiatry 2003; 64(5): 524–31PubMedCrossRef

26.

Sacchetti E, Panariello A, Regini C, et al. Quetiapine in hospitalized patients with schizophrenia refractory to treatment with first-generation antipsychotics: a 4-week, flexible-dose, single-blind, exploratory, pilot trial. Schizophr Res 2004; 69(2-3): 325–31PubMedCrossRef

27.

Emsley RA, Raniwalla J, Bailey PJ, et al. A comparison of the effects of quetiapine (‘seroquel’) and haloperidol in schizophrenic patients with a history of and a demonstrated, partial response to conventional antipsychotic treatment. PRIZE Study Group. Int Clin Psychopharmacol 2000; 15(3): 121–31CrossRef

28.

Hellewell JS. Treatment-resistant schizophrenia: reviewing the options and identifying the way forward. J Clin Psychiatry 1999; 60 Suppl. 23: 14–9

29.

Gefvert O, Bergstrom M, Langstrom B, et al. Time course of central nervous dopamine-D2 and 5-HT2 receptor blockade and plasma drug concentrations after discontinuation of quetiapine (Seroquel) in patients with schizophrenia. Psychopharmacology 1998; 135(2): 119–26PubMedCrossRef

30.

Kapur S, Zipursky R, Jones C, et al. A positron emission tomography study of quetiapine in schizophrenia: a preliminary finding of an antipsychotic effect with only transiently high dopamine D2 receptor occupancy. Arch Gen Psychiatry 2000; 57(6): 553–9PubMedCrossRef

31.

Tauscher-Wisniewski S, Kapur S, Tauscher J, et al. Quetiapine: an effective antipsychotic in first-episode schizophrenia despite only transiently high dopamine-2 receptor blockade. J Clin Psychiatry 2002; 63(11): 992–7PubMedCrossRef

32.

Kapur S, Seeman P. Antipsychotic agents differ in how fast they come off the dopamine D2 receptors: implications for atypical antipsychotic action. J Psychiatry Neurosci 2000; 25(2): 161–6PubMed

33.

Kessler RM, Ansari MS, Riccardi P, et al. Occupancy of striatal and extrastriatal dopamine D2 receptors by clozapine and quetiapine. Neuropsychopharmacology 2006; 31(9): 1991–2001PubMedCrossRef

34.

Tauscher J, Kufferle B, Asenbaum S, et al. Previous treatment as a confounding variable in studies with novel antipsychotics: two cases of high dopamine-2 receptor occupancy with quetiapine. Psychopharmacology 1997; 133(1): 102–5PubMedCrossRef

35.

Gefvert O, Lundberg T, Wieseigren IM, et al. D2 and 5HT2 receptor occupancy of different doses of quetiapine in schizophrenia: a PET study. Eur Neuropsychopharmacol 2001; 11(2): 105–10PubMedCrossRef

36.

Nagy J. Efficacy, safety and tolerability of quetiapine: short-term high doses with long-term follow-up. Int J Psychiatry Clin Pract 2005; 9(1): 16–21CrossRef

37.

Vesely C, Kufferle B, Brucke T, et al. Remission of severe tardive dyskinesia in a schizophrenic patient treated with the atypical antipsychotic substance quetiapine. Int Clin Psychopharmacol 2000; 15(1): 57–60PubMedCrossRef

38.

National Institute of Mental Health. Abnormal involuntary movement scale (AIMS). Washington, DC; US Government Printing Office, 1974. US Public Health Service publication no. MH-9-17

39.

Robertson JB, Treosti L, Walker KD. Successful use of high dose quetiapine in a patient with a psychiatric disorder resistant to olanzapine. Eur Neuropsychopharmacol 2000; 10(3): 319–20CrossRef

40.

Arango C, Bobes J. Managing acute exacerbations of schizophrenia: focus on quetiapine. Curr Med Res Opin 2004; 20(5): 619–26PubMedCrossRef

41.

Buckley PF. Efficacy of quetiapine for the treatment of schizophrenia: a combined analysis of three placebo-controlled trials. Curr Med Res Opin 2004; 20(9): 1357–63PubMedCrossRef

42.

Buckley PF. Maintenance treatment for schizophrenia with quetiapine. Hum Psychopharmacol 2004; 19(2): 121–4PubMedCrossRef

43.

Kasper S, Brecher M, Fitton L, et al. Maintenance of long-term efficacy and safety of quetiapine in the open-label treatment ofschizophrenia. Int Clin Psychopharmacol 2004; 19(5): 281–9PubMedCrossRef

44.

Kasper S. First-episode schizophrenia: the importance of early intervention and subjective tolerability. J Clin Psychiatry 1999; 60 Suppl. 23: 5–9

45.

Lieberman JA, McEvoy JP, Swartz MS, et al. Effectiveness of antipsychotic drags in patients with chronic schizophrenia. N Engl J Med 2005; 353: 1209–23PubMedCrossRef

46.

McEvoy JP, Lieberman JA, Stroup TS, et al. Effectiveness of clozapine versus olanzapine, quetiapine, and risperidone in patients with chronic schizophrenia who did not respond to prior atypical antipsychotic treatment. Am J Psychiatry 2006; 163: 600–10PubMedCrossRef

47.

Stroup TS, Lieberman JA, McEvoy JP, et al. Effectiveness of olanzapine, quetiapine, risperidone, and ziprasidone in patients with chronic schizophrenia following discontinuation of a previous atypical antipsychotic. Am J Psychiatry 2006; 163(4): 611–22PubMedCrossRef

48.

McCue RE, Waheed R, Urcuyo L, et al. Comparative effectiveness of second-generation antipsychotics and haloperidol in acute schizophrenia. Br J Psychiatry 2006; 189: 433–40PubMedCrossRef

49.

Davis JM, Chen N. Dose response and dose equivalence of antipsychotics. J Clin Psychopharmacol 2004; 24(2): 192–208PubMedCrossRef

50.

Ezewuzie N, Taylor D. Establishing a dose-response relationship for oral risperidone in relapsed schizophrenia. J Psychopharmacol 2006; 20(1): 86–90PubMedCrossRef

51.

Taylor D. Establishing a dose-response relationship for haloperidol decanoate. Psychiatr Bull 2005; 29(3): 104–7CrossRef

52.

Citrome L, Volavka J. Optimal dosing of atypical antipsychotics in adults: a review of the current evidence. Harv Rev Psychiatry 2002; 10(5): 280–91PubMedCrossRef

53.

Kapur S, Zipursky R, Jones C, et al. Relationship between dopamine D2 occupancy, clinical response, and side effects: a double-blind PET study of first-episode schizophrenia. Am J Psychiatry 2000; 157(4): 514–20PubMedCrossRef

54.

Seeman P, Tallerico T. Rapid release of antipsychotic drags from dopamine D2 receptors: an explanation for low receptor occupancy and early clinical relapse upon withdrawal of clozapine or quetiapine. Am J Psychiatry 1999; 156(6): 876-84PubMed

Titel: Quetiapine
Dose-Response Relationship in Schizophrenia
verfasst von: Anna Sparshatt
Sarah Jones
Prof. David Taylor
Publikationsdatum: 01.01.2008
Verlag: Springer International Publishing
Erschienen in: CNS Drugs / Ausgabe 1/2008
Print ISSN: 1172-7047
Elektronische ISSN: 1179-1934
DOI: https://doi.org/10.2165/00023210-200822010-00004

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