It is not uncommon for people to find other uses for a drug other than the use for which it was licensed. In many countries it is perfectly legal for a doctor to prescribe a medicine off-label, that is, to prescribe a medicine for a condition for which it has not been licensed.
Often times, this off-label use is leveraging on a side effect of the drug which may be desirable. There has been evidence to suggest that Seroquel, a major and popular brand of Quetiapine, is being used in the management of insomnia (inability to sleep). This article examines the drug Seroquel, its licensed use, its use in sleep, and everything else you should know.
What Is Seroquel?
Seroquel is a second-generation antipsychotic medication, used in the treatment of bipolar disorders and schizophrenia, and as an adjunct in the management of depression or generalized anxiety disorders. It belongs to the class of atypical antipsychotics.
It is prescribed at a recommended daily dose of 200mg – 800mg. Seroquel is an antagonist of dopamine receptors, histamine H1 receptors, and serotonin type 2A receptors. It blocks these receptors in the brain and prevents them from being activated, in an attempt to normalize the chemical composition of the brain which had been altered by conditions such as schizophrenia.
Should Seroquel Be Used to Aid Sleep?
Due to its action in the brain, Seroquel can make you feel sleepy. Its blockade of the histamine H1 receptors is believed to account for this ability. However, Seroquel should not be used to induce or aid sleep as it can put you at risk of unnecessary harm.
Usually, it is prescribed at a lower dose of 100mg or 25mg for off-label uses, however, even at such low doses, its risks still outweigh its benefits and it is best avoided.
Reasons You Should Not Take Seroquel for Sleep.
1. It Is Not Approved For Sleep
This reason is very basic, isn’t it? The Food and Drugs Administration of the United States (US FDA), approves the drugs released into the market. After reviewing data from standard clinical trials, the FDA approved Seroquel for the treatment of schizophrenia, major depressive disorders, and bipolar disorders, but NOT for sleep.
The first study on the use of quetiapine for primary insomnia showed no significant change in sleep patterns at 25mg of Quetiapine. Another study looked at the sleep-promoting properties of quetiapine and observed an increase in the induction of sleep and continuity of sleep in standard conditions.
However, the study itself admitted that asking patients about their sleep pattern is largely subjective. Though the conclusion establishes an association between Seroquel use and improved sleep quality, the Food and Drug Administration has not approved the medication to be prescribed to induce sleep.
While an off-label prescription is legal, off-label marketing is not. In 2010, the FDA fined AstraZeneca, the company manufacturing Seroquel, for marketing Seroquel for off-label uses, which includes the management of sleeplessness. At the time of writing this article, the FDA has not approved Seroquel to be used to induce or aid sleep, so let’s just say it is wise to trust the judgment of the FDA.
2. Risk Of Metabolic Side Effects
The use of Seroquel carries a significant risk of development of metabolic abnormalities, though the exact mechanism is not known. Hence, even when prescribed appropriately, it is advisable to regularly monitor the patient in order to enable early detection of any abnormalities and thereby prevent the development of complications.
A 2016 study also reported that the use of Seroquel even at low doses for sleep could result in negative metabolic consequences such as increased blood pressure, weight gain, increased body mass index, increased blood glucose and dyslipidemia, which puts the patient at risk of developing type 2 diabetes and hypertension, and increased levels of cholesterol and triglycerides in the body which could lead to clinically morbid obesity.
The study concludes that the use of Seroquel as a medication for sleep or first-line therapy for insomnia should be avoided. Furthermore, in 2014, a case report clearly implicating Seroquel in the development of metabolic side effects was published. In the light of these side effects, using Seroquel to induce sleep is not worth the risk.
3. Side Effects Of Seroquel
Aside from the aforementioned metabolic side effects, Seroquel has other side effects which can be quite worrisome. Some of these include –
- Suicidal thoughts
- Panic Attacks
- Worsened depression
- Extreme worry
- Irrational behavior
Using Seroquel to induce sleep already suggests that your health is not at its best. It is therefore not advisable to further complicate the condition by adding any of the above side effects.
4. Scary Black Box Warning
The Food and Drug Administration of the United States has two black box warnings on Seroquel
- People who have dementia should not use it. Dementia is a mental health condition that causes decreased memory, confused thinking, changes in mood and personality. People with dementia are at risk of death if placed on Seroquel.
- Seroquel increases the risk of suicidal thoughts and is usually increased for younger people under the age of 24.
These warnings suggest that the use of Seroquel, even when prescribed, should be with caution. Using the medication for uses not approved may put your health at risk in many ways.
Sleeping Without Seroquel
If you are considering using Seroquel for sleep, chances are you have been having issues getting a good night’s sleep. This article elaborates extensively on 10 reasons why you may be having trouble with your sleep and provides practical solutions for each of them. However, if you have tried any of the methods listed and you still have trouble sleeping, it is best to see a doctor.
Given these undesirable effects of Seroquel for sleep, if one is not using Seroquel for its antipsychotic effect, it is better to use alternative medications for first-line therapy of insomnia and avoid using Seroquel for its sedative effects.
A lot of alternatives are available with a lower side effect profile and lesser risks when compared to Seroquel. You may need to check in with your doctor for these alternatives.
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