From the Guidelines
Quetiapine (Seroquel) is less likely to be associated with muscle twitching or extrapyramidal symptoms (EPSEs) compared to first-generation antipsychotics, but it can still occur. According to the study published in the Annals of Oncology in 2018 1, olanzapine, quetiapine, and aripiprazole appear less likely to be associated with EPSEs than first-generation antipsychotics. However, it is essential to note that quetiapine can still cause sedation, which may be advantageous in patients with hyperactive delirium.
Some key points to consider when prescribing quetiapine include:
- The use of pharmacological interventions in the management of delirium in adults should be limited to patients who have distressing delirium symptoms or if there are safety concerns where the patient is a potential risk to themselves or others 1.
- Medications should be used in the lowest effective dose and for a short period of time only to achieve the appropriate balance between benefit and potential harm 1.
- The risk of movement disorders, including muscle twitching, may increase with higher doses and longer treatment duration, and certain populations like elderly patients may be more vulnerable to these side effects.
If a patient experiences muscle twitching while taking quetiapine, it is crucial to contact their healthcare provider promptly rather than stopping the medication suddenly. The healthcare provider may adjust the dosage, switch medications, or prescribe additional medication to manage these side effects.
From the FDA Drug Label
Twitching 4% 1%
The following adverse reactions have also been reported with quetiapine: ... elevations in serum creatine phosphokinase (not associated with NMS), ...
Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue.
Four methods were used to measure EPS: (1) Simpson-Angus total score (mean change from baseline) which evaluates Parkinsonism and akathisia, (2) Barnes Akathisia Rating Scale (BARS) Global Assessment Score, (3) incidence of spontaneous complaints of EPS (akathisia, akinesia, cogwheel rigidity, extrapyramidal syndrome, hypertonia, hypokinesia, neck rigidity, and tremor), and (4) use of anticholinergic medications to treat emergent EPS.
Quetiapine (Seroquel) is associated with muscle twitching, as evidenced by the incidence of twitching (4% vs 1% in the placebo group) in patients treated with quetiapine in a clinical trial 2. Additionally, quetiapine has been reported to cause elevations in serum creatine phosphokinase and dystonic symptoms, which may be related to muscle twitching 2.
From the Research
Quetiapine and Muscle Twitching
- There is limited direct evidence linking quetiapine (Seroquel) to muscle twitching 3, 4, 5, 6, 7.
- However, some studies suggest that quetiapine may produce fewer movement disorders, such as extrapyramidal symptoms, compared to other atypical antipsychotics like olanzapine, risperidone, and ziprasidone 3, 5.
- One case report describes an 85-year-old woman who developed serotonin syndrome, characterized by tremors, after increasing her quetiapine dose from 12.5mg to 25mg per day 7.
- Another study found that quetiapine was associated with somnolence, dizziness, headache, postural hypotension, and weight gain in older adults, but did not specifically mention muscle twitching as an adverse event 6.
Adverse Effects of Quetiapine
- Common adverse effects of quetiapine include somnolence, dizziness, headache, postural hypotension, and weight gain 6.
- Quetiapine may also increase the risk of cognitive impairment, falls, and injury in older adults, particularly when compared to placebo or other atypical antipsychotics like risperidone and olanzapine 6.
- The risk of serotonin syndrome, a potentially life-threatening condition, may be increased when quetiapine is combined with serotonergic agents or when the dose is increased 7.