Off-Label Use of Atypical Antipsychotics: An Update
Results: Atypical Antipsychotics in Substance Abuse Treatment
Atypical antipsychotics were studied for benefits as adjuncts to substance abuse treatment.
In alcohol abuse studies, aripiprazole and quetiapine were compared with placebo, using the percentage of patients completely abstinent as the outcome measure. Three trials with a total of 386 patients were reviewed. No statistically significant difference between the treatment and control groups was found. The rate of abstinence with treatment lies between 2.8-fold greater with placebo to 5.7-fold greater with an atypical antipsychotic. The strength of evidence is moderate for aripiprazole and low for quetiapine.
In cocaine abuse, olanzapine and risperidone were compared with placebo, using the ASI composite score as the outcome measure in 3 trials with a total of 129 patients. No statistically significant difference between the treatment and control groups was found. The score lies between 0.04 lower with treatment to 0.04 higher with treatment. The strength of evidence is low. For patients with either cocaine or opiate abuse, 1 study of 31 patients examined risperidone given as a 25 mg-per-week injection as an adjunct to methadone treatment. The ASI score was the measured outcome. No statistically significant difference between the treatment and control groups was found. The strength of evidence is low.
In summary, atypical antipsychotics are not effective as adjuncts in treating substance abuse.
Keywords: alcohol | aripiprazole | atypical antipsychotics | cocaine | off-label | olanzapine | opiate | quetiapine | risperidone | second generation | substance abuse | antipsychotics
- Maglione M, Ruelaz Maher A, Hu J, et al. Off-Label Use of Atypical Antipsychotics: An Update. Comparative Effectiveness Review No. 43 (Prepared by the Southern California RAND Evidence-based Practice Center under Contract No. HHSA 290-2007-10062-I). Rockville, MD: Agency for Healthcare Research and Quality; September 2011. AHRQ Publication No. 11(12)-EHC087-EF. Available at www.effectivehealthcare.ahrq.gov/offlabelantipsych.cfm.
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