Combined treatment with quetiapine and sertindole in therapy refractory insomnia after clozapine discontinuation.
Insomnia associated with chronic schizophrenia and after clozapine discontinuation represents a common, but mostly not predominant, complaint and often does not respond sufficiently to classical hypnotics. We report the case of a 46-year-old patient with schizophrenia who developed a rebound insomnia confirmed by polysomnography after discontinuation of long-term treatment with clozapine and changing to sertindole therapy. Zolpidem, zolpiclone and chloral hydrate only led to short-term improvement of subjective sleep quality. An add-on therapy with 300 mg quetiapine resulted in improved subjective quality of sleep regarding sleep latency and the number of nocturnal awakenings. The combination of the two neuroleptics did not lead to increased QTc intervals (normal QTc < 450 ms) or metabolic side effects. In conclusion, the combination of sertindole and quetiapine might be a safe and effective combination in therapy-refractory insomnia after clozapine discontinuation in schizophrenia.
Hanisch
F
F
Klinik und Poliklinik für Neurologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany. Frank.hanisch@medizin.uni-halle.de
Friedemann
J
J
Pillmann
F
F
D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003024:Clozapine / Q000009:adverse effects / Q000627:therapeutic use*; D003987:Dibenzothiazepines / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology; D007093:Imidazoles / Q000627:therapeutic use*; D007211:Indoles / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D000069348:Quetiapine Fumarate; D012559:Schizophrenia / Q000188:drug therapy; D012890:Sleep / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced* / Q000188:drug therapy*
D014150:Antipsychotic Agents; D003987:Dibenzothiazepines; D006993:Hypnotics and Sedatives; D007093:Imidazoles; D007211:Indoles; D000069348:Quetiapine Fumarate; C066304:sertindole; D003024:Clozapine