From the Guidelines
For individuals with Hallucinogen Persisting Perception Disorder (HPPD) who experience panic attacks with quetiapine, beta-blockers such as propranolol (10-40mg) are a recommended alternative PRN medication, as they can address the physical symptoms of panic attacks by blocking adrenaline effects, as supported by a recent study 1. When considering alternative PRN medications for HPPD patients who experience panic attacks with quetiapine, it's essential to prioritize medications that do not exacerbate visual disturbances.
- Benzodiazepines like lorazepam (0.5-2mg) are often considered for acute anxiety in HPPD, typically working within 30-60 minutes and lasting 4-8 hours depending on the specific medication, as suggested by a study from 2006 1.
- Non-benzodiazepine anxiolytics such as buspirone (5-10mg) may help with less addiction potential.
- Some patients respond well to certain antihistamines like hydroxyzine (25-50mg) which can reduce anxiety without worsening perceptual disturbances. However, the most recent and highest quality study 1 supports the use of beta-blockers for panic disorder, making propranolol (10-40mg) a preferred alternative PRN medication for HPPD patients with panic attacks. It's crucial to start with low doses of any medication for HPPD patients as they often show heightened sensitivity to psychoactive substances, and to work closely with a healthcare provider to monitor effects and adjust treatment accordingly.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Alternative PRNs for Quetiapine in HPPD Patients with Panic Attacks
If Quetiapine causes panic attacks in patients with Hallucinogen Persisting Perception Disorder (HPPD), alternative PRNs (as needed) can be considered. The following options are based on available evidence:
- Risperidone: Although there have been case reports suggesting worsening of symptoms with risperidone, a study 2 found that it may be effective in managing HPPD symptoms in some patients.
- Clonazepam: A study 3 found that high-potency benzodiazepines like clonazepam may be superior to low-potency benzodiazepines in treating LSD-induced HPPD.
- SSRIs: Selective serotonin reuptake inhibitors (SSRIs) like escitalopram and paroxetine have been found to be effective in treating panic disorder 4, 5.
- Benzodiazepines: Benzodiazepines like alprazolam and clonazepam have been found to be effective in treating panic disorder 4, 5.
- Vortioxetine: A study 5 found that vortioxetine may be an effective option for treating panic disorder.
- TMS: Transcranial magnetic stimulation (TMS) has been found to be effective in treating panic disorder in some studies 5.
Important Considerations
When considering alternative PRNs, it is essential to weigh the potential benefits and risks of each option. For example, benzodiazepines can cause tolerance and dependence 4, while SSRIs can exacerbate anxiety and panic early in the treatment course 4. Quetiapine augmentation has been found to be not superior to placebo in treating panic disorder 5.