A quetiapina: 3 medicamentos em uma única molécula: uma breve revisão e atualização
DOI:
https://doi.org/10.25118/2763-9037.2023.v13.1054Palavras-chave:
fumarato de quetiapina, quetiapina, farmacologia, psicopatologia, uso off-labelResumo
Introdução: O conhecimento sobre a neurobiologia dos transtornos psiquiátricos tem aumentado nas últimas décadas, da mesma forma que a psicofarmacologia tem gerado novos insights sobre o mecanismo de ação e aplicação de antipsicóticos modernos. Objetivo: A quetiapina se destaca como uma das principais e mais difundidas moléculas do grupo, razão pela qual merece ser mais bem compreendida nos seus vários aspectos, motivo dessa atualização. Método: Conduzimos uma breve revisão e atualização sobre vários aspectos da quetiapina, desde componentes de sua ação farmacológica, efeitos colaterais recentemente descritos, até novas indicações na psiquiatria moderna. Resultados: A molécula quetiapina é muito versátil, tendo amplo espectro de ações e indicações, não se restringindo à sua classe de antipsicótico e extrapolando para situações clínicas como insônia, depressão unipolar e bipolar, transtornos de ansiedade, transtorno de personalidade limítrofe, delirium, abuso de substâncias comórbidas, e outras. A quetiapina tem efeitos hipnóticos em doses baixas, efeitos sobre o humor em doses intermediárias e efeitos antipsicóticos em doses mais altas. Sua segurança na gravidez e amamentação, bem como na infância e em idosos, amplia ainda mais seu conjunto de indicações. Cuidados devem ser tomados com a síndrome de descontinuação e com seus efeitos metabólicos, mas a sedação e o ganho de peso são seus principais efeitos colaterais. Conclusões: A quetiapina se revela uma molécula altamente útil para várias condições psiquiátricas que representam problemas de saúde pública, dada sua prevalência global. Sua segurança e boa tolerabilidade, além de amplo espectro de indicações, a tornam uma molécula promissora para uso desde a atenção básica até cenários clínicos de transtornos psiquiátricos graves e resistentes aos tratamentos convencionais.
Downloads
Métricas
Referências
Hager T. Dez drogas: as plantas, os pós e os comprimidos que mudaram a história da medicina. São Paulo: Todavia; 2019.
Shorter E. A history of psychiatry: from the era of the asylum to the age of Prozac. New Jersey: John Wiley & Sons; 1997.
Procyshyn RM, Bezchlibnyk-Butler KZ, Jeffries JJ, editors. Clinical handbook of psychotropic drugs. 23rd ed. Göttingen: Hogrefe; 2019. https://doi.org/10.1027/00561-000 DOI: https://doi.org/10.1027/00561-000
Carney AC. Efficacy of quetiapine off-label uses: data synthesis. J Psychosoc Nurs Ment Health Serv. 2013;51(8):11-8. https://doi.org/10.3928/02793695-20130709-01 PMID:23848159 DOI: https://doi.org/10.3928/02793695-20130709-01
Stahl SM. Stahl's essential psychopharmacology: prescriber's guide. 7th ed. New York: Cambridge University Press; 2020. https://doi.org/10.1017/9781108921275 DOI: https://doi.org/10.1017/9781108921275
Zohar J, Blier P, Stahl S, Moller HJ, Kupfer D, Correl C, Yamawaki S, Uchida H, Drago F, Goodwin G, Nutt D. NbN 2R: neuroscience based nomenclature. 2nd ed. Utrecht: European College of Neuropsychopharmacology; 2019.
Kuehn BM. Questionable antipsychotic prescribing remains common, despite serious risks. JAMA. 2010;303(16):1582-4. https://doi.org/10.1001/jama.2010.453 PMID:20424239 DOI: https://doi.org/10.1001/jama.2010.453
DeVane CL, Nemeroff CB. Clinical pharmacokinetics of quetiapine: an atypical antipsychotic. Clin Pharmacokinet. 2001;40(7):509-22. https://doi.org/10.2165/00003088-200140070-00003 PMID:11510628 DOI: https://doi.org/10.2165/00003088-200140070-00003
Mauri MC, Paletta S, Di Pace C, Reggiori A, Cirnigliaro G, Valli I, Altamura AC. Clinical Pharmacokinetics of atypical antipsychotics: an update. Clin Pharmacokinet. 2018;57(12):1493-528. https://doi.org/10.1007/s40262-018-0664-3 PMID:29915922 DOI: https://doi.org/10.1007/s40262-018-0664-3
Curry DE, Richards BL. A brief review of quetiapine. Am J Psychiatry Resid J. 2022;18(2):20-2. https://doi.org/10.1176/appi.ajp-rj.2022.180207 DOI: https://doi.org/10.1176/appi.ajp-rj.2022.180207
Thase ME, Macfadden W, Weisler RH, Chang W, Paulsson B, Khan A, Calabrese JR; BOLDER II Study Group. Efficacy of quetiapine monotherapy in bipolar I and II depression: a double-blind, placebo-controlled study (the BOLDER II study). J Clin Psychopharmacol. 2006;26(6):600-9. https://doi.org/10.1097/01.jcp.0000248603.76231.b7 PMID:17110817 DOI: https://doi.org/10.1097/01.jcp.0000248603.76231.b7
Arvanitis LA, Miller BG. Multiple fixed doses of "Seroquel" (quetiapine) in patients with acute exacerbation of schizophrenia: a comparison with haloperidol and placebo. The Seroquel Trial 13 Study Group. Biol Psychiatry. 1997;42(4):233-46. https://doi.org/10.1016/s0006-3223(97)00190-x PMID:9270900 DOI: https://doi.org/10.1016/S0006-3223(97)00190-X
Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, Sharma V, Goldstein BI, Rej S, Beaulieu S, Alda M, MacQueen G, Milev RV, Ravindran A, O'Donovan C, McIntosh D, Lam RW, Vazquez G, Kapczinski F, McIntyre RS, Kozicky J, Kanba S, Lafer B, Suppes T, Calabrese JR, Vieta E, Malhi G, Post RM, Berk M. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97-170. https://doi.org/10.1111/bdi.12609 PMID:29536616 - PMCID:PMC5947163 DOI: https://doi.org/10.1111/bdi.12609
Young AH, McElroy SL, Bauer M, Philips N, Chang W, Olausson B, Paulsson B, Brecher M; EMBOLDEN I (Trial 001) Investigators. A double-blind, placebo-controlled study of quetiapine and lithium monotherapy in adults in the acute phase of bipolar depression (EMBOLDEN I). J Clin Psychiatry. 2010;71(2):150-62. https://doi.org/10.4088/jcp.08m04995gre PMID:20122369 DOI: https://doi.org/10.4088/JCP.08m04995gre
Bauer M, Pretorius HW, Constant EL, Earley WR, Szamosi J, Brecher M. Extended-release quetiapine as adjunct to an antidepressant in patients with major depressive disorder: results of a randomized, placebo-controlled, double-blind study. J Clin Psychiatry. 2009;70(4):540-9.
https://doi.org/10.4088/jcp.08m04629 PMID:19358791 DOI: https://doi.org/10.4088/JCP.08m04629
Yatham LN, Chakrabarty T, Bond DJ, Schaffer A, Beaulieu S, Parikh SV, McIntyre RS, Milev RV, Alda M, Vazquez G, Ravindran AV, Frey BN, Sharma V, Goldstein BI, Rej S, O'Donovan C, Tourjman V, Kozicky JM, Kauer-Sant'Anna M, Malhi G, Suppes T, Vieta E, Kapczinski F, Kanba S, Lam RW, Kennedy SH, Calabrese J, Berk M, Post R. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations. Bipolar Disord. 2021;23(8):767-88. https://doi.org/10.1111/bdi.13135 PMID:34599629 DOI: https://doi.org/10.1111/bdi.13135
Wang Z, Zhang D, Du Y, Wang Y, Huang T, Ng CH, Huang H, Pan Y, Lai J, Hu S. Efficacy of quetiapine monotherapy and combination therapy for patients with bipolar depression with mixed features: a randomized controlled pilot study. Pharmaceuticals (Basel). 2023;16(2):287. https://doi.org/10.3390/ph16020287 PMID:37259431 - PMCID:PMC9966274 DOI: https://doi.org/10.3390/ph16020287
Tassniyom K, Paholpak S, Tassniyom S, Kiewyoo J. Quetiapine for primary insomnia: a double blind, randomized controlled trial. J Med Assoc Thai. 2010;93(6):729-34. PMID:20572379
Lin CY, Chiang CH, Tseng MM, Tam KW, Loh EW. Effects of quetiapine on sleep: a systematic review and meta-analysis of clinical trials. Eur Neuropsychopharmacol. 2023;67:22-36. https://doi.org/10.1016/j.euroneuro.2022.11.008 PMID:36463762 DOI: https://doi.org/10.1016/j.euroneuro.2022.11.008
Maneeton N, Maneeton B, Woottiluk P, Likhitsathian S, Suttajit S, Boonyanaruthee V, Srisurapanont M. Quetiapine monotherapy in acute treatment of generalized anxiety disorder: a systematic review and meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2016;10:259-76. https://doi.org/10.2147/dddt.s89485 PMID:26834458 - PMCID:PMC4716733 DOI: https://doi.org/10.2147/DDDT.S89485
Black DW, Zanarini MC, Romine A, Shaw M, Allen J, Schulz SC. Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2014;171(11):1174-82. https://doi.org/10.1176/appi.ajp.2014.13101348 PMID:24968985 DOI: https://doi.org/10.1176/appi.ajp.2014.13101348
Ray LA, Heydari A, Zorick T. Quetiapine for the treatment of alcoholism: scientific rationale and review of the literature. Drug Alcohol Rev. 2010;29(5):568-75. https://doi.org/10.1111/j.1465-3362.2010.00185.x PMID:20887583 DOI: https://doi.org/10.1111/j.1465-3362.2010.00185.x
Kelly M, Dornan T, Pringsheim T. The lesser of two evils: a qualitative study of quetiapine prescribing by family physicians. CMAJ Open. 2018;6(2):E191-6. https://doi.org/10.9778/cmajo.20170145 PMID:29712643 - PMCID:PMC7869656 DOI: https://doi.org/10.9778/cmajo.20170145
Adityanjee, Schulz SC. Clinical use of quetiapine in disease states other than schizophrenia. J Clin Psychiatry. 2002;63 Suppl 13:32-8. PMID:12562145
Ferrari M, Godio M, Martini S, Callegari C, Cosentino M, Marino F. Effect of quetiapine on inflammation and immunity: a systematic review. Int J Psychiatry Clin Pract. 2023;27(2):196-207. https://doi.org/10.1080/13651501.2022.2101928 PMID:35913757 DOI: https://doi.org/10.1080/13651501.2022.2101928
Kasper S, Müller-Spahn F. Review of quetiapine and its clinical applications in schizophrenia. Expert Opin Pharmacother. 2000;1(4):783-801. https://doi.org/10.1517/14656566.1.4.783 PMID:11249516 DOI: https://doi.org/10.1517/14656566.1.4.783
Peuskens J, Link CG. A comparison of quetiapine and chlorpromazine in the treatment of schizophrenia. Acta Psychiatr Scand. 1997;96(4):265-73. https://doi.org/10.1111/j.1600-0447.1997.tb10162.x PMID:9350955 DOI: https://doi.org/10.1111/j.1600-0447.1997.tb10162.x
Stahl SM. Stahl's essential psychopharmacology: prescriber's guide. 5th ed. New York: Cambridge University Press; 2014.
Larsen ER, Damkier P, Pedersen LH, Fenger-Gron J, Mikkelsen RL, Nielsen RE, Linde VJ, Knudsen HE, Skaarup L, Videbech P; Danish Psychiatric Society; Danish Society of Obstetrics and Gynecology; Danish Paediatric Society; Danish Society of Clinical Pharmacology. Use of psychotropic drugs during pregnancy and breast-feeding. Acta Psychiatr Scand Suppl. 2015;(445):1-28. https://doi.org/10.1111/acps.12479 PMID:26344706 DOI: https://doi.org/10.1111/acps.12479
Solmi M, Murru A, Pacchiarotti I, Undurraga J, Veronese N, Fornaro M, Stubbs B, Monaco F, Vieta E, Seeman MV, Correll CU, Carvalho AF. Safety, tolerability, and risks associated with first- and second-generation antipsychotics: a state-of-the-art clinical review. Ther Clin Risk Manag. 2017;13:757-77. https://doi.org/10.2147/tcrm.s117321 PMID:28721057 - PMCID:PMC5499790 DOI: https://doi.org/10.2147/TCRM.S117321
Findling RL, McKenna K, Earley WR, Stankowski J, Pathak S. Efficacy and safety of quetiapine in adolescents with schizophrenia investigated in a 6-week, double-blind, placebo-controlled trial. J Child Adolesc Psychopharmacol. 2012;22(5):327-42. https://doi.org/10.1089/cap.2011.0092 PMID:23083020 DOI: https://doi.org/10.1089/cap.2011.0092
Suttajit S, Srisurapanont M, Maneeton N, Maneeton B. Quetiapine for acute bipolar depression: a systematic review and meta-analysis. Drug Des Devel Ther. 2014;8:827-38. https://doi.org/10.2147/dddt.s63779 PMID:25028535 - PMCID:PMC4077390 DOI: https://doi.org/10.2147/DDDT.S63779
Monahan K, Cuzens-Sutton J, Siskind D, Kisely S. Quetiapine withdrawal: a systematic review. Aust N Z J Psychiatry. 2021;55(8):772-83. https://doi.org/10.1177/0004867420965693 PMID:33059460 DOI: https://doi.org/10.1177/0004867420965693
Klein L, Bangh S, Cole JB. Intentional recreational abuse of quetiapine compared to other second-generation antipsychotics. West J Emerg Med. 2017;18(2):243-50. https://doi.org/10.5811/westjem.2016.10.32322 PMID:28210359 - PMCID:PMC5305132 DOI: https://doi.org/10.5811/westjem.2016.10.32322
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2023 Leonardo Caixeta, Ciro Mendes Vargas , Yanley Lucio, Leonardo Baldaçara, Suzy Mara Maia dos Reis Alfaia, Arthur Rabahi , Victor de Melo Caixeta
Este trabalho está licenciado sob uma licença Creative Commons Attribution-NonCommercial 4.0 International License.
Debates em Psiquiatria permite que o (s) autor (es) mantenha(m) seus direitos autorais sem restrições. Atribuição-NãoComercial 4.0 Internacional (CC BY-NC 4.0) - Debates em Psiquiatria é regida pela licença CC-BY-NC
