Although polypharmacy is common among these patients, it does not in itself explain why

quetiapine XR and IR are used simultaneously, but may indicate that quetiapine XR and IR are sometimes used in a complementary as opposed to a substitutional fashion. That interpretation is further supported by the fact that 14 out of these 18 patients used quetiapine XR in considerably higher doses than IR. Clearly, Inhibitors,research,lifescience,medical quetiapine IR is more often used as an add-on medication in these patients, potentially for its sedative effect. One may also notice that, in the patients who used quetiapine XR and IR sequentially, switches from quetiapine IR to XR were far more common than switches in the other direction. A differential

use of the two formulations of quetiapine in clinical practice of schizophrenia may be explained by their different pharmacological properties. Quetiapine XR, with Inhibitors,research,lifescience,medical its smoother plasma concentration profile than quetiapine IR allowing for faster titration [Figueroa et al. 2009], reduces the time Inhibitors,research,lifescience,medical required to reach optimal dose [Peuskens et al. 2007]. A recent study investigated if the pharmacokinetic differences translate into different time curves for central D2 dopamine receptor occupancy. Peak D2 receptor occupancy was significantly higher with the IR formulation than quetiapine XR and may explain pharmacodynamic differences [Nord et al. 2011]. A divergence in receptor occupancy between the quetiapine formulations may be expected to translate to some differences in clinical effects. In fact, quetiapine XR has been associated with a lower intensity of self-reported sedation than quetiapine IR [Datto et al. 2009] as well as less orthostatic Inhibitors,research,lifescience,medical dizziness [Mamo et al. 2008]. This study has important strengths. First, our naturalistic study avoided the highly selected patient populations and arguably unrealistic setting of RCTs by enrolling schizophrenia inpatients faced by psychiatrists Inhibitors,research,lifescience,medical in their

everyday clinical practice. Clinical practice differs substantially from the context of RCTs in terms of characteristics the of patients (e.g. comorbidities), drug exposure (e.g. monotherapy versus polypharmacy), dosage and compliance. In addition, 50% of patients were women, which is not common in RCTs [Philip et al. 2008; Johnsen et al. 2010]. Second, there was no bias in patient selection also due to the fact that informed consent was not required. Third, a retrospective data analysis of medical records ensured that treatment choice for patients was not influenced and thus Sotrastaurin supplier real-life clinical data were collected. Fourth, patients from 14 geographically spread out psychiatric clinics participated in the study and therefore the results should be representative for Sweden. There are also some limitations. First, the results build on reports by the healthcare professionals and may not be fully accurate.