Can I use Seroquel (quetiapine) for insomnia?

From the Guidelines

Quetiapine (Seroquel) is not recommended as a first-line treatment for insomnia. While it can cause sedation as a side effect, it is primarily an antipsychotic medication approved for conditions like schizophrenia, bipolar disorder, and as an add-on treatment for depression. Using quetiapine solely for sleep problems is considered "off-label" and carries significant risks including weight gain, metabolic changes, movement disorders, and potential cardiac effects. For insomnia, it's better to start with non-medication approaches like sleep hygiene improvements, cognitive behavioral therapy for insomnia (CBT-I), or if medication is needed, consider shorter-term options specifically designed for sleep like low-dose doxepin, trazodone, or in some cases short-term use of medications like zolpidem or eszopiclone. Quetiapine works by blocking multiple neurotransmitter receptors including dopamine, serotonin, and histamine - it's the antihistamine effect that causes drowsiness, but the other receptor actions can lead to unnecessary side effects when used just for sleep. According to the 2020 study 1, nonpharmacologic behavioral interventions are more effective than pharmacologic therapies for treatment of chronic insomnia disorder. The work group recognized that pharmacotherapy, such as low-dose doxepin or nonbenzodiazepine benzodiazepine receptor agonists (BZRAs), may be considered in patients who are unable or unwilling to receive CBT-I. However, quetiapine is not recommended due to its potential risks and lack of evidence supporting its efficacy for insomnia treatment, as stated in the 2017 study 1. If you're struggling with insomnia, consult with a healthcare provider who can recommend appropriate treatment options based on your specific situation.

Some key points to consider:

• Non-medication approaches like CBT-I are recommended as the first-line treatment for insomnia 1
• Medications like low-dose doxepin or BZRAs may be considered for short-term use in patients who are unable or unwilling to receive CBT-I 1
• Quetiapine is not recommended for insomnia treatment due to its potential risks and lack of evidence supporting its efficacy 1
• It's essential to consult with a healthcare provider to determine the best course of treatment for insomnia, taking into account individual circumstances and medical history.

From the FDA Drug Label

Somnolence (18%), dizziness (11%), dry mouth (9%), constipation (8%), Somnolence (57%) dry mouth (44%), dizziness (18%), constipation (10%), and lethargy (5%) Somnolence (34%), dry mouth (19%), asthenia (10%), constipation (10%),

The FDA drug label does not answer the question.

From the Research

Use of Seroquel for Insomnia

• Seroquel (quetiapine) is sometimes used off-label to treat insomnia, despite limited evidence supporting its efficacy for this purpose 2, 3, 4.
• The use of quetiapine for insomnia is often considered when patients have comorbid psychiatric disorders, but its use in primary insomnia is not well-studied 5, 3.
• Studies have shown that quetiapine may not significantly improve sleep parameters compared to placebo in primary insomnia, despite a trend towards clinical improvements 4.
• The safety of low doses of quetiapine for insomnia is a concern, with potential adverse effects including weight gain, metabolic changes, and serious events such as fatal hepatotoxicity 6.

Efficacy of Seroquel for Insomnia

• There is limited evidence to support the use of quetiapine for insomnia, with few clinical trials and limited data on its efficacy 3, 4.
• One study found that quetiapine did not significantly improve sleep parameters compared to placebo in primary insomnia, despite a trend towards clinical improvements 4.
• Another study found that quetiapine was associated with significant increases in weight compared to baseline, which is a concern for patients with insomnia 6.

Safety Concerns

• The use of quetiapine for insomnia is associated with potential safety concerns, including weight gain, metabolic changes, and serious events such as fatal hepatotoxicity 2, 6.
• Low doses of quetiapine (25-200 mg/day) are commonly used for insomnia, but the safety of these doses is not well-studied 6.
• Patients using quetiapine for insomnia should be closely monitored for adverse effects and potential interactions with other medications 2, 6.