Second-generation antipsychotics (SGAPs), such as olanzapine and quetiapine, have sedative properties, and are often prescribed off-label for complaints of insomnia. These drugs carry significant risk of potential side-effects including weight gain and metabolic complications, even at low doses used to treat insomnia. In patients with dementia, they can also potentially cause serious side-effects of increased risk of cerebrovascular event and increased risk of death.
Sources:
Agency for Healthcare Quality and Research. Off-Label Use of Atypical Antipsychotics: An Update [Internet]. 2011 Sep [cited 2017 May 5].
Coe HV, et al. Safety of low doses of quetiapine when used for insomnia. Ann Pharmacother. 2012 May;46(5):718-22. PMID: 22510671.
Hermes ED, et al. Use of second-generation antipsychotic agents for sleep and sedation: a provider survey. Sleep. 2013 Apr;36(4):597-600. PMID: 23565006.
Shah C, et al. Controversies in the use of second generation antipsychotics as sleep agent. Pharmacol Res. 2014 Jan;79:1-8. PMID: 24184858.
Related Resources:
Toolkit: When Psychosis Isn’t the Diagnosis – A toolkit for reducing inappropriate use of antipsychotics in long-term care