Background: Quetiapine is an antipsychotic with dose-related receptor affinity, which is commonly prescribed by specialties outside of psychiatry. Quetiapine can have adverse effects including weight gain, hyperglycemia, and falls. Therefore, quetiapine is a good focus medication to assess the need for an antipsychotic stewardship protocol.
Objective: To assess the need for an antipsychotic stewardship protocol at a large, urban academic medical center by evaluating quetiapine usage.
Design: A retrospective review of quetiapine dispensing history for all strengths (immediate release: 25, 50, 100, 200, 300 mg; extended release: 50, 150, 200, 300 mg) over 1 year (1 December 2021 to 30 November 2022) in patients aged 18 and older was conducted at a large, urban academic medical center.
Methods: An antipsychotic protocol for safe and effective quetiapine use was developed utilizing its package insert, clinical guidelines, and primary peer-reviewed literature. Once identified by prescription fill, a retrospective chart review was completed for quetiapine indication, dose, and frequency. Each prescription was reviewed for appropriateness using the antipsychotic stewardship protocol.
Results: Out of 521 quetiapine prescriptions for 181 unique patients, 67% of scripts were inappropriate. The costs associated with this inappropriate use were extrapolated to be over $350,000 per year when accounting for long-term harms associated with the development of type 2 diabetes mellitus and falls in older adults.
Conclusion: Promoting the safe and effective use of antipsychotics through developing and implementing an antipsychotic stewardship protocol may reduce patient harm and associated costs from inappropriate use.
Keywords: antipsychotic; medication safety; quetiapine.
Inappropriate quetiapine use at a large academic medical center Psychotropic stewardship aims to improve patient outcomes and minimize side effects associated with psychotropic use – including antipsychotics. Studies have investigated psychotropic stewardship in elderly patients but have not reviewed its utility in the general adult population. Quetiapine is an antipsychotic with dose-related receptor affinity, meaning that at different doses of the medication, it acts on different receptors and exerts different clinical effects as a sedative, antidepressant, or antipsychotic. Quetiapine is commonly prescribed across medical specialties and can have significant adverse effects, including weight gain, hyperglycemia, and falls. Therefore, quetiapine is a suitable focus medication to assess the need for an antipsychotic stewardship protocol. We developed a protocol for safe and effective quetiapine use utilizing its package insert, clinical guidelines, and primary peer-reviewed literature. We reviewed the dispensing history of quetiapine over one year at two pharmacies at a large, urban academic medical center. Once identified by prescription fill, we completed a retrospective chart review for quetiapine indication, dose, and frequency. We reviewed each prescription for appropriateness using our antipsychotic stewardship protocol. Of 521 quetiapine prescriptions for 181 unique patients filled over one year, 67% of scripts were inappropriate. We extrapolated the costs associated with this inappropriate use to be over $350,000 per year when accounting for long-term harms associated with quetiapine use, including the development of type 2 diabetes mellitus and falls in older adults. Our findings illustrate that promoting the safe and effective use of antipsychotics through developing and implementing an antipsychotic stewardship protocol may reduce patient harm and associated costs from inappropriate use. Psychiatric pharmacists are well-positioned to manage these stewardship program’s development, implementation, and dissemination.
© The Author(s), 2023.