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The antipsychotic agent quetiapine is increasingly not used as such: dispensed prescriptions in Norway 2004–2015

  • Pharmacoepidemiology and Prescription
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European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The antipsychotic agent quetiapine was introduced in Norway in 2003. We have assessed changes in dispensed prescriptions, including dosing, of quetiapine in Norway from 2004 to 2015.

Methods

Data on the sales of antipsychotics and antidepressants were drawn from the Norwegian Prescription Database. A total of 47,474 outpatients filled 195,622 prescriptions of quetiapine. Reimbursement codes, use of antipsychotics or antidepressants 12 months prior to the first prescription of quetiapine and estimated mean volume used measured as defined daily doses (DDDs) per day were used as proxies for diagnoses. We conducted a regression analysis with DDD per day as a function of possible explanatory variables.

Results

The number of users filling at least two prescriptions of quetiapine per year increased from 584 in 2004 to 8506 in 2015 and the mean dose declined from 1.58 DDD per day (SD 8.00) to 0.48 DDD per day (SD 2.27). The latter is much lower than recommended for treatment of psychoses. In 2015, 60.1% of the 8506 quetiapine users did not seek reimbursement for the treatment of a major psychiatric disorder and only 2.6% of the patients were prescribed 1 DDD or more per day and reimbursed in accordance with the drug’s primary indication, psychosis. A reported diagnosis of psychosis was not associated with higher quetiapine doses.

Conclusions

In 2015, the pattern of quetiapine dispensing in Norway most likely reflects predominant off-label use. This is unsettling considering poorly documented effects in non-psychotic disorders, profound side effects, significant toxicity and growing concern regarding abuse.

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Acknowledgements

The study was funded by the Johanne and Einar Eilertsen research foundation in the memory of their son Johan Eilertsen (Johanne og Einar Eilertsens forskningsfond til sønnen Johan Eilertsens minne), the Thora and Sverre Lofthus foundation (Thora og Sverre Lofthus’ legat) and internal funds from the Institute of Laboratory Medicine, Children’s and Women’s Health, the Norwegian University of Science and Technology.

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Authors and Affiliations

  1. Department of Psychiatry, Telemark Hospital, Skien, Norway

    Pål Gjerden

  2. Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorder, Innlandet Hospital Trust, Hamar, Norway

    Jørgen G. Bramness

  3. The Norwegian Computing Center, Oslo, Norway

    Ingunn Fride Tvete

  4. Department of Laboratory Medicine, Children’s and Women’s Health, Norwegian University of Science and Technology, Trondheim, Norway

    Lars Slørdal

  5. Department of Clinical Pharmacology, St. Olav’s University Hospital, Trondheim, Norway

    Lars Slørdal

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  1. Pål Gjerden
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  2. Jørgen G. Bramness
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  3. Ingunn Fride Tvete
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  4. Lars Slørdal
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Correspondence to Pål Gjerden.

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The authors declare that they have no conflict of interest.

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Gjerden, P., Bramness, J.G., Tvete, I.F. et al. The antipsychotic agent quetiapine is increasingly not used as such: dispensed prescriptions in Norway 2004–2015. Eur J Clin Pharmacol 73, 1173–1179 (2017). https://doi.org/10.1007/s00228-017-2281-8

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  • DOI: https://doi.org/10.1007/s00228-017-2281-8

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