Patterns and indications for quetiapine prescribing in Dutch primary care

Abstract

BACKGROUND: Quetiapine, an antipsychotic, is registered for schizophrenia, bipolar disorder, and as an add-on therapy for major depressive disorder. Its anxiolytic and sedative effects make it attractive for off-label uses like insomnia, despite cardiovascular and metabolic side effects. The global increase in quetiapine use over the past decade warrants an examination of its prescribing patterns, especially off-label. AIM: This study investigates quetiapine prescribing trends in Dutch primary care, with a focus on off-label use. DESIGN & SETTING: A retrospective database study using national and regional prescribing data from the Netherlands. METHOD: National prescribing trends from 2003-2022 were analysed using data from the Drug Information Project database, focusing on the top 10 antipsychotics. Regional data from the Radboudumc Technology Centre Health Database provided detailed quetiapine prescribing patterns from 2012-2021, categorized by daily dose. Indications for quetiapine prescriptions between 2020-2022 were derived from the detailed RTC patient records, including free-text portions, with specific attention for use in sleep problems. RESULTS: Antipsychotic use increased from 1510 to 2061 per 100 000 between 2003-2022, largely due to a 13-fold increase in quetiapine (66 to 870 per 100000). Detailed regional data revealed a 3.3-fold increase in quetiapine use from 2012-2021, particularly at doses<100 mg/day. Among new quetiapine users in 2020-2022 from a subset of practices, 76.6% were for off-label indications, and sleep problems were the primary reason for starting quetiapine in 46.9% of cases. CONCLUSION: Off-label quetiapine prescribing, particulary for sleep problems, is rising in the Netherlands, despite guideline warnings. Further research on the drivers and long-term effects of this practice is needed.