Quetiapine

Quetiapine

PEP Topic 
Sleep-Wake Disturbances
Description 

Quietiapine is an antipsychotic that has been used to treat schizophrenia and biopolar disorder. It  is a dopamine, serotonin, and adrenergic antagonist and a potent antihistamine.  Quietiapine was studied in patients with cancer for its effect on sleep disturbance.

Effectiveness Not Established

Research Evidence Summaries

Pasquini, M., Speca, A., & Biondi, M. (2009). Quetiapine for tamoxifen-induced insomnia in women with breast cancer. Psychosomatics, 50, 159–161.

doi: 10.1176/appi.psy.50.2.159
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Study Purpose:

To determine if quetiapine, an atypical antipsychotic, would improve insomnia in patients with breast cancer being treated with tamoxifen (tamoxifen-related insomnia).

Intervention Characteristics/Basic Study Process:

Quetiapine was initiated at 25 mg/day, given one hour before bedtime. Dosages were titrated up to 100 mg/day based on patient tolerance and response to medication. Patients were assessed using tools for depression and insomnia at baseline and weeks 1 and 6 weeks into therapy.

Sample Characteristics:

  • The sample was comprised of six women.
  • Age ranged from 38 to 52 years.
  • Patients were women with localized breast cancer (stage II–III-A) receiving tamoxifen (20 mg) 3 to 12 months after definitive primary therapy, including adjuvant chemotherapy and radiotherapy.
  • Four of six patients were married.
  • Patients had taken no psychotropic medications in the preceding month.

Setting:

  • Single site  
  • Italy

Phase of Care and Clinical Applications:

Patients were undergoing the transition phase of care after initial treatment.

Study Design:

This was a single-group, repeated measure, case study.

Measurement Instruments/Methods:

  • Structured Clinical Interview for DSM-IV (SCID-I)
  • Beck Depression Inventory (BDI)
  • Hamilton Rating for Depression (HAM-D)
  • Insomnia Severity Index (ISI), Italian version

Results:

Five of six patients had rapid (at one week) improvement in insomnia based on ISI scores. This effect maintained improvement at six weeks.

Conclusions:

Quetiapine may be a useful agent in treating tamoxifen-related or tamoxifen-induced insomnia in women with breast cancer.

Limitations:

  • This was a case study or case report only.
  • The study had a small sample size.
  • No statistical analysis was performed.
  • The study lacked biobehavioral assessments and objective sleep measures.
  • Dosages of quetiapine were variable.

Nursing Implications:

Quetiapine, an atypical antipsychotic, may be a potential option for treating tamoxifen-related insomnia without depression. A larger study is required.


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