The revised label, posted without fanfare last week on the F.D.A. Web site, says Seroquel and extended-release Seroquel XR “should be avoided” in combination with at least 12 other medicines linked to a heart arrhythmia that can cause sudden cardiac arrest.

Sandy Walsh, a spokeswoman for the F.D.A., said the statement was only a precaution for doctors, and should not be considered a complete ban against prescribing Seroquel with the other drugs.

Ms. Walsh said the label was changed after the F.D.A. received new information about reports of arrhythmia in 17 people who took more than the recommended doses of Seroquel. Though it should not be a problem at a normal dosage, she said, it may still be good advice to avoid using the drugs together.

The arrhythmia, known as prolongation of the QT interval, referring to two waves of the heart’s electrical rhythm, is estimated to cause several thousand deaths a year in the United States.

As AstraZeneca prepares to report its second-quarter earnings at the end of this month, it faces additional scrutiny this week. The F.D.A. is considering the London-based company’s dapagliflozin, a proposed diabetes drug with Bristol-Myers Squibb, and is expected to decide soon on Brilinta, an anticoagulant. The company is facing the loss of patents for Seroquel next year and for the heartburn drug Nexium in 2014.

Seroquel is one of the top-selling drugs in the world, at $5.3 billion last year, including $3.7 billion in the United States. Introduced in 1997, it has been approved for schizophrenia, bipolar disorder and severe depression. Seroquel has caused legal problems for AstraZeneca, including a $520 million payment in 2009 to settle government charges of illegal marketing. Thousands of lawsuits are pending over side effects like diabetes.

The previous Seroquel labels had mentioned the risk of a prolonged QT interval, but had not identified other drugs to avoid, Stephanie Andrzejewski, a spokeswoman for AstraZeneca, said Monday. The new warning also is separated from other warnings and precautions on the label, she said, “to provide some additional guidance to physicians” treating patients ”who are already at risk of QT prolongation.”

The new warning will be added to printed labels as soon as possible, Ms. Andrzejewski said.

The new label lists the other drugs to avoid as antiarrhythmic drugs like quinidine, procainamide, amiodarone and sotalel; antipsychotic drugs like ziprasidone, chlorpromazine and thioridazine; antibiotics like gatifloxacin and moxifloxacin; the anti-infective drug pentamidine; and synthetic opioids like levomethadyl acetate and methadone. The label also raises caution about use by the aged and people with heart disease.

James J. Pepper, a lawyer in Pennsylvania who is involved in drug litigation, has been arguing for months in letters to government officials that Seroquel has a potentially deadly interaction with methadone in regard to the QT interval.

“This is a huge, huge step,” Mr. Pepper said of the label change, though he said he thought it should be stronger.

Ms. Walsh said the F.D.A. action was unrelated to Mr. Pepper’s arguments.

Three months ago, Dr. Janet Woodcock, director of the F.D.A. Center for Drug Evaluation and Research, rejected those arguments in a letter to the Project on Government Oversight, a nonprofit group in Washington, which had also raised the issues. Dr. Woodcock wrote that a thorough agency review had found it “exceedingly unlikely” that patients faced an unreasonable risk from the interaction between Seroquel and methadone. The review found only one death that was probably caused by the interaction, she wrote.

Dr. Woodcock concluded that the F.D.A. would take no action to change the label. Ms. Walsh said that conclusion was still correct, because the F.D.A. had found no biological basis for a problem or unusual numbers of deaths at normal dosages.

Methadone use and deaths have increased drastically in recent years as more doctors prescribe it for chronic pain. The number of methadone prescriptions for pain in the United States rose to 4.3 million in 2010 from 2.2 million in 2006, IMS Health, an industry data firm, said Monday. The use for pain has surpassed that for heroin withdrawal and maintenance.

URL: http://www.nytimes.com/2011/07/19/health/19drug.html?_r=1

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I would like to address the subject of medicating students at the school’s “request” or demand is more like it. This is our family’s experience.

My 12-year-old grandson is ADHD and does have some social and some behavioral issues. We are well aware of his issues and do not try to dismiss them. The school has tried to insist that he be medicated. His mother has refused to medicate him because of the damage from the ADHD drugs to his older brother. This has been explained many, many times to the school personnel.

The side effects of the drugs, Concerta, Strattera, Ritalin and Seroquel vary and the intensity varies from person to person. My older grandson who has taken these various drugs has had severe reactions to them. Some of his reactions are delusions, paranoia, the need for higher doses consistently, mood swings, and when the doses were changed to higher levels, uncontrollable anger. My daughter’s refusal to medicate the younger son stems from the reactions of her older son to the drugs.

When the school was told no, they constantly asked the child if his mother had taken him to the doctor and told him he needs to be medicated. It is very sad that a child comes home and tells his parent that he needs to be medicated. In response to her refusal and the arguments that ensued over the issue, the school has exacted what in my opinion is revenge on the child for his mother’s decision to do what she believes is best for him in the long run.

They put in place a discipline plan that my daughter did not approve of or sign but it didn’t matter. I understand that some of detentions were deserved but I disagree with the nitpicking. Examples and these are just a few: Forgetting a pencil, being early to class, being put in detention for not spitting out gum when in fact the child had and the proof was in the trash can, telling another person that they don’t want him around and he can hear it. The detentions for these silly nitpicking items added up and have created a real problem on the child’s record.

The real topper for me is the fact that they allowed him to sign up for an overnight camping trip and then decided my grandson could not go because of his record and missing assignments. How strange when we checked online to see if there are any missing assignments, they show as completed.

There are many more details to this situation. The bottom line is that they have humiliated, belittled him openly and made this child feel very unwanted. No child reacts well to this type of treatment, no child deserves this. I believe that the school lacks education in some of these disorders and needs some training. If trained properly they would be able to identify that the social, behavioral issues and learning disabilities are a part of the complex disorder and there are better ways to handle the problems.

I would be curious to know how many children are medicated and how many times the school recommends the medication because it makes the staff’s life easier. They have no concept of the long-term effects of the drugs. They are not doctors. I would also be interested in knowing how many others had experiences like this.

I am sure that this will evoke a response again blaming all of the poor behavior on the child, but I think that the professionals should take a deep look at themselves and evaluate why they behave as they have.

Diana Strohm
Muskegon

URL: http://www.mlive.com/opinion/muskegon/index.ssf/2011/06/letters_should_a_school_insist.html

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