PURPOSE: Although quetiapine is indicated for treatment of schizophrenia and bipolar disease, it is often prescribed off-label in the intensive care unit (ICU) setting. The purpose of this study was to describe quetiapine use in the ICU population of an academic medical center.
METHODS: This was a retrospective cohort study consisting of all adults admitted to Creighton University Medical Center’s ICUs during 2007 and 2008. To be included patients had to receive at least two doses of quetiapine on at least two consecutive days while in the ICU. Patients prescribed quetiapine as a continuation of their home medication were excluded. Abstracted information included indication for use, prescribing team, mean dosage, discharge disposition and continuation of quetiapine therapy at discharge.
RESULTS: In all, 71 patients met the inclusion/exclusion criteria. Quetiapine-treated patients averaged 57 years of age, had a male to female ratio of 2:1 and a mean length of stay of 26 days. None of the patients received quetiapine for an FDA-approved indication: the most common indication was agitation (65%). The majority of quetiapine prescriptions were written by the psychiatry (50%) or ICU team (33%). Overall, 44% were ultimately discharged from the hospital on quetiapine. A documented response to quetiapine therapy was significantly correlated with fewer days in the ICU (p=0.01) as well as discharge on quetiapine (p< 0.001).
CONCLUSION: Despite the common off-label use of quetiapine in the ICU, this agent was continued through discharge in 44% of patients. The significant correlation between discharge on quetiapine and documentation of a clinical response suggests that much of this off-label use was appropriate.
CLINICAL IMPLICATIONS: Further studies are needed to better delineate the appropriateness of off-label indications of quetiapine in the ICU.
DISCLOSURE: Cara Olsen, No Financial Disclosure Information; No Product/Research Disclosure Information