US EPA

3200597 

Journal Article 

Evaluation of the Safety of Quetiapine in Treating Delirium in Critically Ill Children: A Retrospective Review 

Joyce, C; Witcher, R; Herrup, E; Kaur, S; Mendez-Rico, E; Silver, G; Greenwald, BM; Traube, C 

2015 

Yes 

Journal of Child and Adolescent Psychopharmacology
ISSN: 1044-5463
EISSN: 1557-8992 

25 

9 

666-670 

English 

26469214 

10.1089/cap.2015.0093 

OBJECTIVE: Quetiapine is an atypical antipsychotic that has been used off-label for the treatment of intensive care unit (ICU) delirium in the adult population, with studies demonstrating both efficacy and a favorable safety profile. Although there is a potential role for quetiapine in the treatment of pediatric ICU delirium, there has been no systematic reporting to date of safety in this patient population.

METHODS: Pharmacy records were used to identify 55 consecutive pediatric ICU patients who were diagnosed with delirium and received quetiapine. A comprehensive retrospective medical chart review was performed to collect data on demographics, dosing, and side effects.

RESULTS: Fifty patients treated between January 2013 and November 2014 were included, and five patients were excluded from the study. Subjects ranged in age from 2 months to 20 years. Median daily dose was 1.3 mg/kg/day, and median duration of treatment was 12 days. There were three episodes of QTc prolongation that were clinically nonsignificant with no associated dysrhythmia: Two resolved over time without intervention, and one resolved with decrease in quetiapine dosage. There were no episodes of extrapyramidal symptoms or neuroleptic malignant syndrome.

CONCLUSIONS: In this population of critically ill youth, short-term use of quetiapine as treatment for delirium appears to be safe, without serious adverse events. Further research is required to assess efficacy and evaluate for long-term effects. A prospective, randomized, placebo-controlled study of quetiapine in managing pediatric delirium is necessary.