Marcela Gottschald Pereira

*Corresponding Author: Marcela Gottschald Pereira, Clinical pharmacist, Specialist in mental health, Universidad Nacional de La Plata, La Plata, Argentina.

Abstract
Misuse and dependence on psychotropic medications are considered global health problems, with several implications for the health of users and the public budget. Thus, the development of new ways of handling the problem is necessary, since the existing treatments are often not very effective, in addition to having low adherence by users.

This article aims to investigate the use of Quetiapine in the treatment of dependence on benzodiazepines, a drug with great addictive potential and whose use has been increasing worldwide.

Keywords: Benzodiazepines, Clinical Pharmacy, Mental Health, Substance-Related Disorders, Prescription Drug Misuse

This class of medication are commonly prescribed for the elderly as a treatment for insomnia and anxiety, disorders that are highly prevalent in this population [3], despite the risks involved [4] and the proven existence of tolerance, dependence, withdrawal syndrome [5,6]. Withdrawal symptoms include tremors, muscle pain, gastrointestinal symptoms such as diarrhea, nausea, vomiting, and psychological symptoms such as insomnia, anxiety, agitation, irritability, difficulty concentrating, and dysphoria [7].

The increase in the prevalence of drug abuse goes hand in hand with the increase in prescriptions for these [8,9], often made by medical professionals who do not work in the field of psychiatry, such as general practitioners and gynecologists, and without meeting the criteria required by specific legislation [10].

Considering the above, this article aims to suggest a new pharmacotherapeutic approach, with the use of Quetiapine, an atypical antipsychotic drug, as the drug of choice for the management of dependence and withdrawal symptoms.

The use of Quetiapine (Quetiapine Fumarate), an atypical antipsychotic drug commonly used in the treatment of schizophrenia, bipolar disorder, and acute mania, has been suggested to be effective in the treatment of insomnia, when used in low doses [11,12], showing favorable effects in healthy individuals [13] and patients with depression [14].

The usual dose of Quetiapine needed to achieve antipsychotic and antimanic effects is commonly above 300mg/day. However, lower doses, such as 25mg initially, which can be increased up to 100mg/day, have been described as sufficient for the treatment of insomnia and anxiety [11,12,13,14]. In addition, Quetiapine has a good tolerability profile and few side effects, especially at low doses (up to 100mg/day) [11].

Therefore, due to the above, Quetiapine can be a good option for the treatment of benzodiazepine dependence, especially in cases where there are psychiatric comorbidities involved, such as depression, insomnia, and anxiety. These comorbidities are commonly considered “gateways” to the abusive use of benzodiazepines and treating them is fundamental for the success of addiction treatment.

However, despite being a drug considered safe, when used rationally and with medical advice and monitoring, Quetiapine might have the potential to be abused and even to cause dependence, although it is something rare [16].

For that reason, the use of this drug as a treatment for benzodiazepine dependence should be done with caution and close monitoring, preferably by a multidisciplinary team.

Although there are no large-scale clinical trials that validate such an intervention, the available evidence from case reports and studies with small numbers of patients demonstrates [11,12,13,14,15] the potential benefits of using Quetiapine for the treatment of benzodiazepine dependence.

However, further research is needed on the use of Quetiapine for the treatment of benzodiazepine and possibly other substance use disorder, given the small number of studies found on the subject.

Conflicts of interest: The author declares that there is no conflict of interest.