Health & Medical Medications & Drugs

Quetiapine Offers Promise for Difficult-to-Treat Psychosis

´╗┐Quetiapine Offers Promise for Difficult-to-Treat Psychosis
Quetiapine is a dibenzothiazepine atypical antipsychotic closely resembling clozapine. The promise of oral quetiapine in the management of psychosis complicating Parkinson's disease (PD) has recently been demonstrated in small noncomparative trials.

Quetiapine is associated with a minimal risk of causing or exacerbating extrapyramidal symptoms (EPS), and does not worsen motor function in patients with PD. Importantly, the efficacy of quetiapine is maintained over 12 months. Furthermore, quetiapine is effective even in patients who have not responded to other atypical antipsychotics.

Although data are limited in patients with PD, quetiapine appears to be well tolerated when used in patients with schizophrenia. Dosages should be titrated slowly, and typically low target dosages are sufficient in patients with psychosis complicating PD.

Should more robust evaluation confirm its early promise, quetiapine may ultimately become an atypical antipsychotic of choice in the management of difficult-to-treat psychosis complicating PD.

Psychosis is a common complication of PD, occurring in 40 to 60% of patients. Symptoms of psychosis may be caused either by the underlying disease pathology or by the dopaminergic agents used to manage PD.

Traditionally either the dosage of antiparkinsonian drugs was reduced or the drugs were withdrawn, or typical antipsychotics were used. However, neither strategy met with much success. The former was limited by worsening of motor function, and the latter by the risk of EPS and the potential to cause cognitive impairment.

Atypical antipsychotics such as clozapine and olanzapine have a lower propensity to cause EPS than typical antipsychotics. They have, thus, replaced typical antipsychotics in the management of psychosis complicating PD. Quetiapine is a new dibenzothiazepine atypical antipsychotic closely resembling clozapine. As such its role in the management of PD-related psychoses is of interest.

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