Approximately two million Americans take a common medicine, which is frequently used off-label as a sleep aid. Research has revealed that this prescription can have potentially harmful adverse effects that last into the next day.
Although quetiapine, an antipsychotic medication marketed under the brand name Seroquel, is allowed to treat schizophrenia, it is often taken off-label for sleeplessness. Instead of using quetiapine for its prescribed purposes, about 75% of patients use it for sleep-related problems.
According to a world-first clinical experiment conducted in Australia, quetiapine dramatically reduces alertness and driving performance in patients who take the medication before bed.
Flinders University researchers discovered that although a 50-milligram dose of quetiapine slightly lessened the severity of obstructive sleep apnea (OSA) and somewhat improved sleep quality, it also significantly lowered driving ability and caused tiredness the following day.
Over 10 million prescriptions for low-dose quetiapine are written annually in the United States alone.
Previous studies have demonstrated that using antipsychotic drugs off-label to treat insomnia and less severe sleep problems might result in unpleasant morning side effects, such as breathing difficulties and low productivity at work.
Concerns regarding the medication’s safety are becoming more widespread, especially for those who use machines or drive the morning after taking it.Low-dose quetiapine is thought to be a somewhat safe method of promoting sleep, according to Dr. Cricket Fauska, the study’s lead author from Flinders University. “Our findings indicate that it’s not that easy.”
Approximately 75% of patients are administered quetiapine (marketed as Seroquel) off-label for sleeplessness, despite the medication’s approval for bipolar disorder and schizophrenia (stock image).
Iframes are not supported by your browser.
He continued by saying that although participants slept for longer periods of time and had fewer nightly awakenings, their performance in simulated driving the next morning clearly declined and their reaction times slowed.
As an atypical antipsychotic, quetiapine is a member of a more recent class of antipsychotic medications that have a different receptor-binding profile from more traditional “typical” antipsychotics and typically cause fewer side effects linked to movement, such as tardive dyskinesia.
However, because of its strong antihistamine effects, quetiapine is often used off-label for insomnia at low doses.
The medication mostly blocks the brain’s histamine H1 receptors, which is how many first-generation antihistamines used in sleep aids function.
Quetiapine helps people fall and remain asleep by attaching to and inhibiting these receptors, which decreases wakefulness and increases sedation.
However, as the drug’s effects can persist long after sleep, this histamine blockage also explains the notable next-day sedation and cognitive impairment seen in studies, including this most recent one.
Even at low dosages, quetiapine’s wider receptor profile can cause adverse effects like weight gain or metabolic abnormalities, in contrast to conventional sleep aids that target GABA receptors.
In the most recent study, which was published in the Annals of the American Thoracic Society, researchers at Australia’s Flinders University carried out a short but thorough experiment with 15 individuals who had both trouble falling asleep and obstructive sleep apnea (OSA).
Previous research has shown that taking antipsychotic medications off-label for insomnia or mild sleep issues might have unpleasant side effects the following day, like shallow breathing and decreased productivity at work.
About a week apart, each participant spent two nights in a sleep lab.
One night, they took 50 mg of quetiapine before bed; the other night, they took a placebo tablet.
particular medication was administered on particular night was unknown to both the subjects and the researchers.
Everyone finished a 10-minute reaction-time test and a 30-minute driving simulator assignment the following morning, around 8.5 to 9.5 hours after taking the medicine, which was intended to replicate a tedious rural nighttime trip.
The medication’s effects were inconsistent.
Positively, quetiapine decreased the frequency of breathing pauses, or the apnea-hypopnea index, by almost 24% when compared to a placebo. It also increased sleep efficiency, which means that individuals spent more time asleep and less time awake at night.
The drawbacks were substantial, though. On the alertness test the following morning, participants’ reaction times were slower.
They crashed almost twice as frequently on the driving simulator—55 crashes after quetiapine compared to 27 after a placebo—and their ability to stay in their lane significantly deteriorated. However, the increase in crashes was not statistically significant.
One person is represented by each line. Their steering deviation is seen on the left end following a placebo and on the right end following quetiapine. Driving became difficult as lines angled upward.The average for healthy drivers is indicated by the purple arrow, and it is roughly 30 to 40 cm. Although individual results varied greatly, quetiapine reduced average steering by 24 cm (72 vs. 96).
A participant in the study is represented by each line, and their reaction time following a placebo is displayed at the left end of the line. Their reaction time following quetiapine use is displayed on the right end.Participants who took quetiapine responded considerably more slowly than those who received a placebo on a 10-minute reaction time test (382 milliseconds versus 336 milliseconds). Additionally, the large range of results indicates that some persons are far more damaged than others.
“The fact that some people didn’t feel particularly sleepy the next day, despite performing worse on objective tests, was particularly concerning,” Fauska stated.
“There is a significant safety risk, particularly when it comes to driving, because of this discrepancy between how people feel and how they actually function.”
The authors of the study came to the conclusion that although a low dosage of quetiapine may provide slight benefits for breathing and sleep during the night, it obviously reduces alertness and driving ability the following day.
They cautioned that for at least 9.5 hours after taking the medication, people should refrain from operating a vehicle or engaging in other activities that could endanger their safety.
Dr. Danny Ecker, senior author and professor of sleep health at Flinders University, stated, “What we’re learning is that treatment needs to be tailored – using the right approach, or combination of approaches for the individual rather than defaulting to sedating medications.”
