Seroquel was the 5th grossing drug in 2009, with revenue of $4.2 billion. That’s more money than any pain-killer, antidepressant or erectile dysfunction medication. And my guess is that many of you reading this right now, are on it.
And I also guess almost none of you have taken the time to read the prescribing information on Seroquel.
Some Psychotropic Drug Facts
According to the May 2010 issue of Pharmacy Times:
- Seroquel is the highest grossing psychotropic medication. (FYI, $4.2B doesn’t include the sales of Seroquel XR, which are also substantial.)
- Other top performers include Abilify at $4 million and Cymbalta at $2.8 million.
- 6 of the top 20 grossing drugs in 2009 are psychotropic and 3 are antipsychotics.
- Antipsychotics are the highest-grossing class of mediations pulling in $14.6 billion in 2009.
Patient Information on Seroquel
Patient information is available all over the place for any drug. Your pharmacy probably gave you a printed sheet when you got your prescription. And there’s nothing wrong with this information per se, it just isn’t nearly enough on which to base an educated decision.
But It’s Patient Information. I’m a Patient. Why Wouldn’t I Want That?
Well, it’s up to you but these information sheets omit certain important facts and don’t provide any realistic information on how likely it is you’ll experience certain side-effects, or how impactful those side-effects may be. They don’t tend to list necessary tests to be done while on medication and they provide so little detail it’s not clear what they really mean. A pile of 40 side-effects in a big list isn’t that handy. What’s a lot more handy is a prioritized list with probabilities.
There’s a Colossal Pile of Prescribing Information
Yes, I know. Sorry about that. That’s the kind of thing that the FDA requires. But if you take some time to look at this information then at least you know you are getting the most accurate information at the time and not a subset that someone considered “relevant” to the patient.
These are medications you might be on for years. It’s worth taking the time to understand at least one complete medication information sheet. If you never look at another prescription information sheet for the rest of your life, at least you know you’ve taken a look at what they have to offer.
Full Prescribing Information on Seroquel
Seroquel is an atypical antipsychotic and is commonly used to treat bipolar, schizophrenia and depression. This drug has received a lot of positive press in terms of efficacy and lots of negative press due to debilitating side-effects and questionable advertising practices.
This is part one in looking at the full prescribing information on Seroquel, section by section. (This full sheet can be found in multiple locations online, lest you think I’m partial to only what is on HealthyPlace.)
Warnings
Yes, there are warnings on drugs and on drugs used to treat depression there’s always a warning of suicide. I think these are overstated and misused, but that’s a discussion for another day.
Indications and Usage
This section gives information on the approved uses of the medication. Your doctor may have prescribed this medication for a different reason. That can be OK, and is a point of discussion with your doctor.
Dosage and Administration
Now here IS something to care about. You should know:
- What strengths the drugs are available in
- The typical starting dose for the drug
- When the drug is typically given (day/night)
If your doctor has chosen something different for you, that’s a discussion you can have with him. Keep in mind the dosing schedule listed is almost always too aggressive for people. (It’s the kind of schedule they’d give you in the hospital.) In other words, if you followed that schedule you would likely find the side-effects intolerable in your everyday life.
Here’s how you might use this information: If your doctor started you on 100mg of Seroquel but you couldn’t tolerate that dose due to side-effects, you can see that 50mg and 25mg pills are also available. You could start on a lower dose and work your way up. Getting onto a medication can be hard work and seriously impact your life so you may need to take a while to do it.
Should you doctor give you this option? Probably. But I can’t promise they will.
(Never cut or crush a drug unless you’ve asked your doctor about it. Some drugs are designed with specific layers extending absorption times and you should not mess with that. Seriously.)
Contraindications
Always good to check out. In this case, none.
In part II we’ll be discussing Seroquel warnings and precautions. And in part III I discuss Seroquel adverse reactions and just why you should know this information anyway. Stay tuned, it’s just getting good.
[I should remind you that I am not a health care professional and anything concerning to you should be discussed with your doctor.]
You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.
Yes, thanks Natasha. One of the best but worst drugs. OK, taking the side effects in mind it does “haul me down.” Good thing? Debatable. I have a real love hate relationship (surprise) as with most all I take. M
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Hi Buzz,
I personally despise this drug. I think it does all kinds of nasty things to people. Of course, it does save people’s lives as well, so it’s give and take.
The point though is to illustrate the information available on every medication. The point is to make people aware that this is out there, and they can get it any time they like. And the point is to show how little information is typically shared with a patient by a physician or a pharmacist.
I appreciate how busy and how stressed professionals are, but this is the sort of information that just shouldn’t be skipped over. Patients at least deserve the chance to be made aware so they can ask questions and make educated decisions for themselves.
- Natasha
To me, Seroquel has been amazing and I have seen absolutely no downsides to it. In fact, I am frustrated beyond all reason as to why only the negative side to the debate is coming out. There are a lot of us who have had success with Seroquel and I find it amazing that the news media and most blogs are censoring that.
It just frustrates me that only one side is being allowed to have a voice.
On a side note, your post was very well written and had a lot of great information!
Dave.
(P.s I am on 600mg of Seroquel)
Hi David,
I understand your frustration and think you make a great point. I say it all the time, Seroquel has saved lives. Period. Seroquel can also ruins lives though and people deserve to know the facts around it.
I try to make it clear whenever I talk about medication that it’s a personal issue and no medication is “good” or “bad” per se. Each person has to individually assess the risks and benefits. Everyone is different and has different health concerns. Medications are all appropriate or inappropriate depending on the person.
I picked Seroquel because it’s the highest-grossing psychotropic medication and many people are on it for all sorts of reasons. I want to make clear what the real information is about it, how to get this information, and why people should work to understand it. I try to promote education and personal responsibility and decision-making. And I agree, media work to sensationalize and don’t represent all sides of an issue.
I understand that most people don’t want to do the kind of research I do, and that’s OK, but I do think people should at least know the information is available.
All that being said, you are not the only one for whom Seroquel has been a miracle, and I hope it works for you for as long as you need.
[And as a side note, I also hope that more educated patients will force doctors into more accountability for the information they deliver when handing out drugs. I'm tired of doctors not advising people of the risks and not even doing the _bare_minimum_ of testing required while on a medication. And no one can blame Seroquel for that.]
- Natasha
Just a note — at a low dosage (25 – 50 mg) – seroquel acts on histamines — in other words it will be like taking an anti-histamine (like benadryl) and knock your butt out — but generally does not have that effect at higher dosages like 150 mg +. My hubby is living proof of that (and our pdoc confirmed that — was not the pdoc at the time of incident) when he was on only 25mg — was definitely helping him sleep and resulted in the dreaded zombification often complained about with serohaze. Scott now takes 300 mg of Seroquel XR (7 yrs later after discontinuing — know the years cuz he took 25 mg the night my water broke and I went into labor with my baby girl Melissa — talk about trying to wake the dead !!) and it works beautifully — so we are enjoying while we can — it is not perfect but has been the best mood stabilizer since he was on depakote and got the dreaded black-box rash. can you tell we do nothing normal LOL
Hi Cat,
Yes, Seroqeul is often prescribed off-label for sleep. I don’t recall any specific information on histamine interaction but that may be included in the pharmacokinetc section, which I’m not terribly familiar with.
(As you found, altering histamines for sleep does have a number of side-effects long-term.)
It’s great you found something that’s working.
- Natasha
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Cat (or for anyone who’s curious),
I stumbled on some information on Seroquel and histamines: http://en.wikipedia.org/wiki/Seroquel#Dosage
- Natasha
I never had any idea that the ownership pharmaceutical company of
“Seroquel” has grossed 4.2 billion dollars in total sales! After reading
that, I wish I was an employee of Seroquel and Seroquel XR!
I am amazed that the antipsychotics are the highest-grossing medications pulling in $14.6 billion in 2009!
Its to bad that I’m not a volunteer worker, nor a minimal part time hourly employee and earning a salary from the SEROQUEL company and the international worldwide antipsychotics treatment pharmaceutical
companies!
Seroquel has given me a sense of normalcy I have never known before. Would they have developed it w/o the money involved? This is America.
Hi Joe,
In a word, yes.
Drug companies are always going to make drugs, it’s their raison d’etre. Drug companies do just fine in countries where what they can charge for their product is regulated. Drug research goes on in every corner of the globe.
I’m not suggesting drug companies shouldn’t make money, of course they should, maybe even truckloads. But $14 billion + on antipsychotics – by definition a drug given to extremely desperate people who would do almost anything to get better – sounds more like a guy in a long black trench coat that stands on the street corner than it does an upstanding corporation.
But that’s me.
- Natasha
I just found your blog, and so far I love it! I just wanted to contribute to the drug/Seroquel discussion…
I am on Seroquel, and my doctor told me to go look at the website and read the information about the drug before starting it, so I would know about all the potential side effects. I also did a bit of research online and got opinions about it from people who were on it (their opinions would not have swayed me either way on taking it, I just wanted to hear them). I’m currently on 400mg XR daily, and it still makes me sleep like it did when I started it, but that’s fine for me because I also suffer from insomnia.
In all my research, I found out about the Physician’s Desk Reference. It’s not that I don’t trust doctors, but I currently have 3 doctors prescribing 6 daily maintenance medications, not counting extra drugs when I’m sick. I just know that not all doctors are 100% knowledgeable about drugs and interactions, and don’t always have time to check. So I went to the used bookstore and got myself a copy of the PDR for $10, which has helped immensely. I’ve read the PI sheets for all the drugs I’m taking, and when something new is prescribed, before I start taking it, I look through all the sheets again to make sure that they are safe to take together. It has helped my anxiety a lot too, because before I would worry that something would interact with something and cause problems.
Anyway, that was a long ramble, sorry about that! But I think that for us bipolars, since we tend to be the guinea pigs at the mercy of the doctors and drug companies, it is very important that we know what we are dealing with in terms of our medications.
Hi Juliet,
The PDR is simply a compendium of full prescribing information for the drug. It’s the FDA prescribing information available on multiple web sites (just as the version I linked to). Of course, you might find it handy to have it in book form, but because this information is updated frequently, books become obsolete almost as soon as they are printed.
Regarding interactions, the PDR is a good place to start, but it’s not complete. Physicians these days usually rely on computers to get this sort of information because, as you’ve pointed out, if you’re on multiple medications, it can get pretty complex.
I agree completely that we are often guinea pigs and we should take some responsibility for researching medication. Personally, I don’t really trust doctors. But I’ve been messed with them pretty badly in the past, so your experiences may differ.
- Natasha
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Seroquel at 100 MG works for me taken in the PM, in the AM I take 50 MG of Zoloft. I feel better today than I have in 10 years….also I exercise, attend Church, small group bible study, joined the DAR, have a great family, and continue to try and understand bipolar mental illness. Don’t get me wrong I have my days….sometimes many days, but I stay in One Day At A Time.
Thank you for your blog.
Pam
My feelings about this drug are mixed. On the one hand it may do enough harm to shorten someone’s life or make the latter parts of it poor because Seroquel has been linked to several very serious side effects, including a 3x increased risk of diabetes, increased blood sugar and weight gain, plus high cholesterol, all of which are likely to cause vascular problems – e.g. heart disease and heart attacks, strokes, cerebral vascular dementia. (This information is available on the Web.) On the other hand, if one is suffering intolerably with the mood swings, anything is welcome! However, someone in the worst of BP is often quite unable to research the risks because their mind is so disturbed, and we cannot rely on our doctors to inform us about them.