From 1 December 2010 the streamlined authority listings of quetiapine (Seroquel) and quetiapine extended-release tablets (Seroquel XR) will include monotherapy for maintenance treatment of bipolar I disorder. The extended listings are based on equivalent cost and efficacy to that of olanzapine (Zyprexa) tablets.1

Immediate-release quetiapine was PBS listed for acute mania (as monotherapy) in December 2007 and for maintenance treatment in bipolar I disorder (in combination with lithium or valproate) in August 2009. See the NPS RADAR In Brief Quetiapine (Seroquel) PBS listed for acute mania for more information. The PBS listings for extended-release tablets were expanded to match those for the immediate release tablets in April 2010.

PBS listings for bipolar disorder vary between atypical antipsychotics

Quetiapine, olanzapine, risperidone (Risperdal) and ziprasidone (Zeldox) have distinct PBS authority listings for use in bipolar disorder (Table 1). The differences in listings mean that some people may need to switch drugs when shifting from acute to maintenance treatment or if changing from monotherapy to combination therapy. This is no longer the case for quetiapine.

Table 1.
Indications and PBS listings for atypical antipsychotic drugs in bipolar disorder

Drug

TGA-approved indication(s)

PBS listing

Acute mania

Maintenance

Acute mania

Maintenance

Olanzapine
(Zyprexa, Zyprexa Zydis)

Yes

Yes

No

Yes

Olanzapine injection (Zyprexa IM)

Yes

No

No

No

Olanzapine depot injection
(Zyprexa Relprevv)

No

No

No

No

Quetiapine
(Seroquel)

Yes

Yes

Yes
(monotherapy only)

Yes

Quetiapine extended-release
(Seroquel XR)

Yes

Yes

Yes
(monotherapy only)

Yes

Risperidone
(Ozidal, Resdone, Rispa, Risperdal, Risperdal Quicklet, Rixadone)

Yes

No

Yes
(adjunct only)

No

Risperidone depot injection
(Risperdal Consta)

No

Yes

No

No

Ziprasidone
(Zeldox)

Yes
(monotherapy only)

No

Yes
(monotherapy only)

No