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
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
Hypotension/Orthostatic Hypotension (see Hypotension)
Epidemiology
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Q-T Prolongation without Definite Association with Torsade (see Torsade)
Epidemiology
Considered to Have a Conditional Risk of Torsade (https://crediblemeds.org): when used at excessive dose, in patients with hypokalemia, when taken with interacting medications, or by creating conditions which facilitate or induce torsade (i.e. inhibition of metabolism of a QT-prolonging medication or by inducing an electrolyte disturbance which increases the risk of torsade)
Efficacy and safety of quetiapine in critically ill patients with delirium: a prospective, multicenter, randomized, double-blind, placebo-controlled pilot study. Crit Care Med 2010;38:419-27 [MEDLINE]
Atypical Antipsychotic Drugs and the Risk for Acute Kidney Injury and Other Adverse Outcomes in Older Adults: A Population-Based Cohort Study. Ann Intern Med. 2014;161(4):242-248. doi:10.7326/M13-2796
Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis. J Am Geriatr Soc. 2016 Apr;64(4):705-14. doi: 10.1111/jgs.14076 [MEDLINE]
Antipsychotics for Preventing Delirium in Hospitalized Adults: A Systematic Review. Ann Intern Med. 2019 Sep 3. doi: 10.7326/M19-1859 [MEDLINE]
Antipsychotics for Treating Delirium in Hospitalized Adults: A Systematic Review. Ann Intern Med. 2019 Sep 3. doi: 10.7326/M19-1860 [MEDLINE]