Seroquel

Seroquel is an atypical antipsychotic medication primarily used to treat schizophrenia, bipolar disorder, and as an add-on treatment for major depressive disorder. It is the brand name for the compound quetiapine, which was developed by the pharmaceutical company AstraZeneca and first approved for medical use in the United States in 1997. The drug functions as an antagonist at several neurotransmitter receptors in the brain, including those for dopamine and serotonin.

Medical uses

Seroquel is approved by the Food and Drug Administration for the treatment of schizophrenia in adults and adolescents, and for bipolar disorder including both manic and depressive episodes. It is also indicated as an adjunctive therapy with antidepressants like fluoxetine or venlafaxine for major depressive disorder. Off-label, it is sometimes prescribed for conditions such as generalized anxiety disorder, insomnia, and as part of treatment regimens in certain personality disorders. Clinical guidelines from organizations like the American Psychiatric Association often include it among recommended pharmacological options.

Adverse effects

Common adverse effects include sedation, dizziness, dry mouth, constipation, and weight gain, with the latter being a significant concern for metabolic syndrome. More serious risks include tardive dyskinesia, neuroleptic malignant syndrome, and hyperglycemia, which may lead to diabetes mellitus. The medication carries a black box warning from the FDA regarding increased mortality in elderly patients with dementia-related psychosis. Other notable risks include orthostatic hypotension, cataracts observed in animal studies, and potential for QT prolongation on the electrocardiogram.

Pharmacology

Quetiapine acts primarily as an antagonist at dopamine D2 and serotonin 5-HT2A receptors, with a higher affinity for the latter, which is characteristic of atypical antipsychotics. It also has antagonistic activity at histamine H1, alpha-1 adrenergic, and 5-HT2C receptors, contributing to its side effect and therapeutic profile. The active metabolite, norquetiapine, also acts as a norepinephrine reuptake inhibitor. The drug is extensively metabolized in the liver via the cytochrome P450 system, primarily by CYP3A4.

History

Quetiapine was discovered and developed by scientists at Imperial Chemical Industries, which later became part of AstraZeneca. It was granted approval by the FDA in 1997 for the treatment of schizophrenia. Subsequent approvals included bipolar disorder in 2004 and adjunctive treatment for major depressive disorder in 2007. The development of its extended-release formulation, Seroquel XR, provided a once-daily dosing option. The drug has been the subject of numerous clinical trials and has played a significant role in the evolution of psychopharmacology.

Society and culture

Seroquel has been a top-selling drug for AstraZeneca, generating billions in annual revenue at its peak. It has been involved in notable litigation, including settlements with the U.S. Department of Justice over allegations of off-label marketing. The medication is available as a generic drug in many markets, increasing its accessibility. It has been referenced in various media, including television shows like Law & Order and in discussions about mental health treatment in popular culture. Its use, particularly off-label for insomnia, has been a point of debate within the medical community.

Category:Antipsychotics Category:AstraZeneca Category:World Health Organization essential medicines