Delirium (see Delirium)

Clinical Efficacy-Quetiapine for the Prevention of Delirium

• Systematic Review of the Use of Antipsychotics for the Prevention of Delirium in Hospitalized Patients (Ann Intern Med, 2019) [MEDLINE]: n = 14 randomized controlled trials
  • For Haloperidol vs Placebo, There Were No Differences in Delirium Incidence or Duration, Hospital Length of Stay (High Strength of Evidence, and Mortality
  • Little or No Evidence was Found to Determine the Effect of Haloperidol on Cognitive Function, Delirium Severity (Insufficient Strength of Evidence), Inappropriate Continuation, and Sedation (Insufficient Strength of Evidence)
  • There is Limited Evidence that Second-Generation Antipsychotics May Decrease the Incidence of Delirium in the Postoperative Settings
  • There is Little Evidence that Short-Term Use of Antipsychotics was Associated with Neurologic Harm
    • In Some of the Trials, Potentially Harmful Cardiac Effects Occurred More Frequently with Antipsychotic Use

Clinical Efficacy-Quetiapine for the Treatment of Delirium

• Trial of Quetiapine (Added to Haloperidol PRN) in Established Delirium in Critically Ill Patients (Crit Care Med, 2010) [MEDLINE]
  • Quetiapine (Added to Haloperidol PRN) Decreased the Time to Resolution of Delirium, Resulted in Less Agitation, and Resulted in Greater Rates of Transfer to Home or Rehabilitation
  • No Differences in the Rates of QT Prolongation Between the Groups, Although the Quetiapine Group was More Somnolent
• Systematic Review of the Use of Antipsychotics for Treatment of Delirium in Hospitalized Adults (Ann Intern Med, 2019) [MEDLINE]” n = 16 RCT’s and 10 observational studies
  • Across 16 RCT’s and 10 Observational Studies, For Second-Generation Antipsychotics vs Placebo and Haloperidol vs Placebo, There was no Difference in Sedation Status Low and Moderate Strength of Evidence), Duration of Delirium, Hospital Length os Stay (Moderate Strength of Evidence), or Mortality Rate
  • There was No Difference in Delirium Severity (Moderate Strength of Evidence) and Cognitive Functioning (Low Strength of Evidence) for Haloperidol vs Second-Generation Antipsychotics, with Insufficient or No Evidence for Antipsychotics vs Placebo
  • For Direct Comparisons of Different Second-Genration Antipsychotics, There was No Difference in Mortality and Insufficient or No Evidence for Multiple Other Outcomes
  • There was Little Evidence Demonstrating Neurologic Harm Associated with Short-Term Antipsychotic Use for the Treatment of Delirium in Adult Inpatients, But Potentially Harmful Cardiac Effects Tended to Occur More Frequently
  • Heterogeneity was Present in Terms of Dose and Administration Route of Antipsychotics, Outcomes, and Measurement Instruments

Psychosis (see Psychosis)

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Quetiapine is a Dibenzothiazepine Atypical Anti-Psychotic Agent

• Brain Serotonin 5-HT1A and 5-HT2, Dopamine D1 and D2, Histamine H1, and α1 and α2 Adrenergic Receptor Antagonism (see Serotonin 5-HT3 Receptor Antagonists)
  • Quetiapine’s Antipsychotic Activity is Probably Mediated Via a Combination of Dopamine D2 and Serotonin 5-HT2 Antagonism
• No Appreciable Affinity at Cholinergic Muscarinic and Benzodiazepine Receptors
  • Norquetiapine, an Active Metabolite, Differs from its Parent Molecule by Exhibiting High Affinity for Muscarinic M1 Receptors

Physiologic Effects

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Metabolism

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