| QUETIAPINE FUMARATE
Seroquel, Seroquel XR
Classifications: psychotherapeutic agent; antipsychotic, atypical; Therapeutic: atypical antipsychotic
Pregnancy Category: C
25 mg, 100 mg, 200 mg tablets; 50 mg, 200 mg, 300 mg, 400 mg extended release tablets
Antagonizes multiple neurotransmitter receptors in the brain including serotonin (5-HT1A and 5-HT2) as well as dopamine D1 and D2 receptors.
Therapeutic effectiveness indicated by a reduction in psychotic behavior.
Management of schizophrenia and bipolar disorder.
Management of agitation and dementia.
Hypersensitivity to quetiapine; pregnancy (category C), lactation; alcohol use; suicidal ideation.
Dementia-related psychosis; liver function impairment, older adults, cardiovascular disease (history of MI or ischemic heart
disease, heart failure, arrhythmias, CVA, hypotension, dehydration, treatment with antihypertensives; history of seizures
or suicide; breast cancer; Alzheimer's, Parkinson's disease; concurrent use of centrally acting drugs; patient at risk
for aspiration pneumonia; debilitated patients; cerebrovascular disease; adolescents and children with major depression or
Route & Dosage
|Bipolar Depression (Immediate Release Only)
Adult: PO Day 1: 50 mg at bedtime, Day 2: 100 mg at bedtime, Day 3: 200 mg at bedtime, then 300 mg q.d. at bedtime
Adult: PO (Immediate release) Start 25 mg b.i.d., may increase by 2550 mg b.i.d. to t.i.d. on the second or third day as tolerated to a target
dose of 300400 mg/d divided b.i.d. to t.i.d., may adjust dose by 2550 mg b.i.d. q.d. as needed (max: 800 mg/d);
(Extended release) 300 mg q.d. at bedtime, titrate up to 400800 mg q.d. (max: 800 mg/d)
Acute Manic Episodes in Bipolar Disorder (Immediate Release Only)
Adult: PO Start with total of 100 mg (in two doses) day 1, increase to 400 mg/d (in two doses) by day 4
Geriatric: Titrate more slowly due to risk of orthostatic hypotension
Start with 25 mg dose and increase by 2550 mg/d
- Titrate dose over 4 d usually to a target range of 300400 mg/d. Make further dose adjustments of 2550 mg 2 times/d
at intervals of at least 2 d.
- Retitrate to desired dose when patient has been off the drug for >1 wk.
- Follow recommended lower doses and slower titration for the older adults, the debilitated, and those with hepatic impairment
or a predisposition to hypotension.
- Store at 15°30° C (59°86° F).
Adverse Effects (≥1%)Body as a Whole:
Asthenia, fever, hypertonia, dysarthria, flu syndrome
, weight gain, peripheral edema, increased risk of suicidal thinking
. CNS: Dizziness, headache, somnolence. CV:
Postural hypotension, tachycardia, palpitations. GI:
Dry mouth, dyspepsia, abdominal pain, constipation
, anorexia. Metabolic:
Rhinitis, pharyngitis, cough, dyspnea
Rash, sweating. Hematologic: Leukopenia
, carbamazepine, phenytoin, rifampin, thioridazine
may increase clearance of quetiapine. Quetiapine may potentiate the cognitive and motor effects of alcohol,
enhance the effects of antihypertensive agents
, antagonize the effects of levodopa
and dopamine agonists
. Ketoconazole, itraconazole, fluconazole, erythromycin
may decrease clearance of quetiapine. Drugs that increase the QT interval (e.g., amiodarone, clarithromycin, antiarrhythmics
) increase risk of cardiac effects. Other antipsychotics
increase the risk of adverse effects. Herbal: St. John's wort
may cause serotonin syndrome
(see Appendix F).
Rapidly and completely absorbed from GI tract. Peak:
1.5 h. Distribution:
83% protein bound. Metabolism:
In liver (CYP3A4). Elimination:
73% in urine, 20% in feces. Half-Life:
Assessment & Drug Effects
- Monitor diabetics for loss of glycemic control.
- Monitor for changes in behavior that may indicate suicidality.
- Reassess need for continued treatment periodically.
- Withhold the drug and immediately report S&S of tardive dyskinesia or neuroleptic malignant syndrome (see Appendix F).
- Lab tests: Periodically monitor liver function, lipid profile, thyroid function, blood glucose, CBC with differential.
- Monitor ECG periodically, especially in those with known cardiovascular disease.
- Perform baseline cataract exam when therapy is started and at 6 mo intervals thereafter.
- Monitor patients with a history of seizures for lowering of the seizure threshold.
Patient & Family Education
- Carefully monitor blood glucose levels if diabetic.
- Exercise caution with potentially dangerous activities requiring alertness, especially during the first week of drug therapy
or during dose increments.
- Make position changes slowly, especially when changing from lying or sitting to standing to avoid dizziness, palpitations,
- Avoid alcohol consumption and activities that may cause overheating and dehydration.
- Inform physician immediately if you become pregnant.