Can quetiapine (Quetiapine) cause frequent falls?

From the Guidelines

Yes, quetiapine can cause frequent falls, particularly in elderly individuals, due to its sedating effects, orthostatic hypotension, dizziness, and impaired balance. This antipsychotic medication can lead to falls through several mechanisms, including sedation, orthostatic hypotension (sudden drop in blood pressure when standing up), dizziness, and impaired balance, as noted in the study by 1. The risk is typically higher at the beginning of treatment or after dose increases, and is more pronounced with higher doses. Elderly patients are especially vulnerable due to age-related changes in drug metabolism and pre-existing balance issues.

Some key points to consider when taking quetiapine include:

• Sedation and orthostatic hypotension are common side effects, particularly in older adults, as discussed in 1
• Dose adjustments or timing changes may be necessary to minimize fall risk, and healthcare providers should be consulted immediately if falls occur
• Rising slowly from sitting or lying positions, avoiding alcohol, using assistive devices if needed, and ensuring adequate lighting can help reduce fall risk
• Never stopping quetiapine suddenly without medical supervision is crucial to avoid potential withdrawal effects

It's also important to note that age-related changes, such as reductions in thirst, ability to preserve sodium and water, baroreceptor response, and heart rate response to orthostatic stress, as well as autonomic dysfunction, can predispose elderly individuals to syncope and falls, as mentioned in 1. Therefore, careful monitoring and management of quetiapine therapy are essential to minimize the risk of falls and ensure patient safety.

From the FDA Drug Label

5.8 Falls Atypical antipsychotic drugs, including quetiapine, may cause somnolence, postural hypotension, motor, and sensory instability, which may lead to falls and, consequently, fractures or other injuries For patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy. 5.7 Hypotension Quetiapine may induce orthostatic hypotension associated with dizziness, tachycardia and, in some patients, syncope, especially during the initial dose-titration period, probably reflecting its α 1-adrenergic antagonist properties. Orthostatic hypotension, dizziness, and syncope may lead to falls

Yes, quetiapine can cause frequent falls due to its potential to induce orthostatic hypotension, somnolence, and motor instability.

• Key factors that may increase the risk of falls include:
  • Orthostatic hypotension
  • Somnolence
  • Motor instability
  • Sensory instability
  • Dizziness
  • Syncope
• Patient populations that may be at higher risk include those with diseases, conditions, or medications that could exacerbate these effects. 2

From the Research

Quetiapine and Falls

• Quetiapine has been associated with an increased risk of falls in older adults, as shown in a study comparing the safety of low-dose quetiapine versus trazodone or mirtazapine for insomnia in older adults 3.
• The study found that the quetiapine group had an increased risk of falls (hazard ratio 2.8,95% confidence interval 1.4-5.3; P < 0.05) compared to the trazodone group.
• Another study found that quetiapine resulted in significantly greater cognitive impairment, higher rates of falls and injury in patients with parkinsonism, but not in patients with dementia, compared to placebo 4.
• However, a study comparing the risk of falls and fractures associated with the use of risperidone, olanzapine, and quetiapine in community-dwelling adults aged ≥50 years found no statistically significant difference in the risk of falls or fractures between the three antipsychotic agents 5.

Mechanisms and Risk Factors

• The use of psychotropic drugs, including antipsychotics like quetiapine, has been consistently associated with an increased risk of falls in older adults 6, 7.
• The sedative effects of these drugs on postural control are thought to be a mediating factor for the increased fall risk, and are reversible with withdrawal of the drug 7.
• Factors that increase the risk of falls in older adults taking quetiapine include higher daily doses, longer half-lives, and longer duration of use 7.