SEROQUEL XR is Now Available to Treat Bipolar Depression

AstraZeneca today launched its once-daily SEROQUEL XR(R) (quetiapine fumarate) Extended-Release Tablets for the acute treatment of the depressive episodes associated with bipolar disorder and the manic and mixed episodes associated with bipolar I disorder, as well as the maintenance treatment of bipolar I disorder as adjunctive therapy to lithium or divalproex. SEROQUEL XR is also now available in two new tablet strengths, 50-mg and 150-mg.(1) Once-daily SEROQUEL XR is the only medication FDA-approved for the treatment of acute depressive, manic, and mixed episodes of bipolar disorder.(2) "Bipolar depression is a serious and debilitating illness with few approved treatment options," said Dr. Trisha Suppes, Professor of Psychiatry and Behavioral Sciences, Medical Center and VA Palo Alto Health Care System. "People with bipolar disorder are known to struggle more frequently with the depressive rather than the manic symptoms. SEROQUEL XR has been shown to be effective as a monotherapy in treating bipolar depressive symptoms, such as sadness, loss of interest, and feelings of worthlessness." Approximately 8 million American adults may be affected by bipolar disorder, also known as manic-depressive illness, a serious psychiatric condition characterized by recurring episodes of depression and mania.(3,4) For many patients with bipolar disorder, the depressive symptoms are more disruptive than the manic symptoms.(5) "When symptomatic, people with bipolar disorder experience depressive symptoms more than three times longer than manic symptoms, and this may interfere with daily activities," said Dr. Arthur Lazarus, Senior Director, Clinical Development for AstraZeneca. "The approval of SEROQUEL XR for the treatment of bipolar disorder provides patients with the only medication that has been proven to treat the acute depressive, manic, and mixed episodes of bipolar disorder." Today's announcement follows the October 2008 FDA approval of SEROQUEL XR for these indications in bipolar disorder. SEROQUEL XR is now available in 50-mg, 150-mg, 200-mg, 300-mg, and 400-mg tablet strengths. SEROQUEL XR is also approved for the acute and maintenance treatment of schizophrenia.(1) For the full prescribing information, go to www.SEROQUELXR.com. Approximately 8 million American adults may be affected by bipolar disorder, a serious psychiatric condition also known as manic depressive illness.(3,4) Bipolar disorder consists of recurring episodes of mania and depression.(6) Bipolar I disorder is characterized by one or more manic or mixed episodes, often with one or more episodes of major depression, whereas bipolar II disorder is distinguished by one or more major depressive episodes accompanied by at least one hypomanic episode.(6) Patients with bipolar I disorder experience depressive symptoms approximately three times longer than manic symptoms.(7) Similarly, patients with bipolar II disorder spend almost forty times longer in the depressed state than in hypomania.(8) Up to 50 percent of patients with bipolar disorder attempt suicide, and approximately 15 to 20 percent complete suicide.(9) Bipolar disorder is often misdiagnosed as major depressive disorder. This misdiagnosis can lead to unfocused treatment that may exacerbate the disease. In fact, many patients face ten years or more before a correct diagnosis is made.(10) Prior to initiating treatment with an antidepressant, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.(1,11) Bipolar disorder is typically managed through a treatment strategy with several phases - including acute and maintenance phases. In the acute phase, the aim is to improve the acute symptoms of the patient; the maintenance treatment phase aims to reduce the risk of recurrence of future episodes.(12) SEROQUEL XR is indicated for the treatment of acute depressive episodes associated with bipolar disorder, acute manic or mixed episodes associated with bipolar I disorder as monotherapy and as an adjunct to lithium or divalproex; maintenance treatment of bipolar I disorder as adjunct therapy to lithium or divalproex, and acute and maintenance treatment of schizophrenia. Patients should be periodically reassessed to determine the need for continued treatment and the appropriate dose. Hyperglycemia, in some cases extreme and associated with ketoacidosis, hyperosmolar coma, or death, has been reported in patients treated with atypical antipsychotics, including quetiapine. The relationship of atypical use and glucose abnormalities is complicated by the possibility of increased risk of diabetes in the schizophrenic population and the increasing incidence of diabetes in the general population. However, epidemiological studies suggest an increased risk of treatment-emergent, hyperglycemia-related adverse reactions in patients treated with atypical antipsychotics. Patients starting treatment with atypical antipsychotics who have or are at risk for diabetes should undergo fasting blood glucose testing at the beginning of and periodically during treatment. Patients who develop symptoms of hyperglycemia should also undergo fasting blood glucose testing. In long-term clinical trials of quetiapine, hyperglycemia (fasting glucose greater than or equal to 126 mg/dL) was observed in 10.7% of patients receiving quetiapine (mean exposure 213 days) vs. 4.6% in patients receiving placebo (mean exposure 152 days). Clinically significant increases in cholesterol (4%-16% for quetiapine vs. 2%-7% for placebo) and triglycerides (8%-23% for quetiapine vs. 6%-16% for placebo) have been observed in clinical trials. The proportion of patients in clinical trials meeting a weight gain criterion of greater than or equal to 7% of body weight was 5%-23% for quetiapine vs. 0%-7% for placebo. A potentially fatal symptom complex, sometimes referred to as Neuroleptic Malignant Syndrome (NMS), has been reported in association with administration of antipsychotic drugs, including quetiapine. Rare cases of NMS have been reported with quetiapine. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatine phosphokinase, myoglobinuria (rhabdomyolysis), and acute renal failure. The management of NMS should include immediate discontinuation of antipsychotic drugs. Leukopenia, neutropenia, and agranulocytosis (including fatal cases), have been reported temporally related to atypical antipsychotics, including quetiapine. Patients with a pre-existing low white blood cell (WBC) count or a history of drug induced leukopenia/neutropenia should have their complete blood count monitored frequently during the first few months of therapy. In these patients, SEROQUEL XR should be discontinued at the first sign of a decline in WBC absent other causative factors. Patients with neutropenia should be carefully monitored, and SEROQUEL XR should be discontinued in any patient if the absolute neutrophil count is < 1000/cubic mm. Tardive dyskinesia (TD), a potentially irreversible syndrome of involuntary dyskinetic movements, may develop in patients treated with antipsychotic drugs. The risk of developing TD and the likelihood that it will become irreversible are believed to increase as the duration of treatment and total cumulative dose of antipsychotic drugs administered to the patient increase. TD may remit, partially or completely, if antipsychotic treatment is withdrawn. Quetiapine should be prescribed in a manner that is most likely to minimize the occurrence of TD. Warnings and Precautions also include the risk of orthostatic hypotension, cataracts, seizures, hyperprolactinemia, and possibility of suicide attempts. Examination of the lens by methods adequate to detect cataract formation, such as slit lamp exam or other appropriately sensitive methods, is recommended at initiation of treatment or shortly thereafter, and at 6-month intervals during chronic treatment. The possibility of a suicide attempt is inherent in schizophrenia, and close supervision of high risk patients should accompany drug therapy. The most commonly reported adverse reactions associated with the use of SEROQUEL XR vs. placebo in clinical trials for schizophrenia and bipolar disorder were somnolence (25%-52% vs. 10%-13%), dry mouth (12%-37% vs. 1%-7%), constipation (6-10% vs. 3-6%), dyspepsia (5-7% vs. 1-4%), dizziness (10-13% vs. 4-11%), orthostatic hypotension (7% vs. 5%), weight gain (7% vs. 1%), increased appetite (12% vs. 6%), fatigue (6-7% vs. 2-4%), dysarthria (5% vs. 0%), and nasal congestion (5% vs. 1%). SEROQUEL XR. AstraZeneca is engaged in the research, development, manufacturing and marketing of meaningful prescription medicines and in the supply of healthcare services. AstraZeneca is one of the world's leading pharmaceutical companies with global healthcare sales of $ 31.6 billion and is a leader in gastrointestinal, cardiovascular, neuroscience, respiratory, oncology and infectious disease medicines. In the United States, AstraZeneca is a $13.5 billion dollar healthcare business.