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Quetiapine

    Brands

    DEA Class;  Rx

    Common Brand Names; Seroquel, Seroquel XR

    • Antipsychotics, 2nd Generation; 
    • Antimanic Agents
    Atypical antipsychotic; structurally similar to clozapine; low risk of EPS and hyperprolactinemia
    Used in adults for the treatment of schizophrenia, mania associated with bipolar I disorder, bipolar depression, maintenance of bipolar I disorder, and as an adjunct to antidepressants for treatment-resistant major depressive disorder
    Also used for schizophrenia in adolescents and for mania associated with bipolar I disorder in pediatric patients 10 years and older
    As with all antipsychotics, boxed warning regarding increased mortality risk in elderly patients with dementia-related psychosis
    Indicated for the treatment of major depression.
    For the treatment of bipolar disorder, including mania and bipolar depression.
    For the treatment of schizophrenia.
    For the adjunct treatment of refractory obsessive-compulsive disorder (OCD).
    For the treatment of neurocognitive symptoms (e.g., impulsivity, executive functioning) associated with borderline personality disorder.

    Documented hypersensitivity

    • Dizziness (1-18%)
    • Fatigue (3-14%)
    • Extrapyramidal symptoms (1-13%)
    • Increased diastolic blood pressure (41%)
    • Increased triglycerides (8-22%)
    • Increased total cholesterol (7-18%)
    • Increased appetite (2-12%)
    • Constipation (6-11%)
    • Dry mouth (9-44%)
    • Headache (7-21)
    • Somnolence (18-57%)
    • Abdominal pain (4-7%; dose related)
    • Dyspepsia (2-7%; dose related
    • Tremor (2-8%)
    • Back pain (3-5%)
    • Postural hypotension (2-7%)
    • Tachycardia (1-6%)
    • Pharyngitis (4-6%)
    • Rhinitis (3-4%)
    • Rash (4%)
    • Blurred vision (1-4%)
    • Arthralgia (1-4%)
    • Myalgia (2%)
    • Neck pain (2%)
    • Dyskinesia (4%)
    • Neutropenia (2%)
    • Hemorrhage (1%)
    • Priapism
    • Cardiomyopathy, myocarditis
    • QTc prolongation
    • Night mares
    • Pancreatitis
    • Rhabdomyolysis
    • Palpitation
    • Leukocytosis
    • Epistaxis
    • Exfoliative dermatitis

    Use with caution in cardiovascular and cerebrovascular disease

    May worsen hypotensive conditions

    Use with caution in breast cancer and history of seizure

    Increased risk of hyperglycemia and diabetes; in some cases, hyperglycemia concomitant with use of atypical antipsychotics has been associated with ketoacidosis, hyperosmolar coma, or death; monitor blood glucose of high-risk patients for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness; monitor glucose regularly in patients with diabetes or at risk for diabetes

    Increased incidence of cerebrovascular adverse effects, including stroke and TIAs, in elderly with dementia (not approved for the treatment of patients with dementia-related psychosis); see Black Box Warnings

    Neuroleptic malignant syndrome (NMS) reported with use

    Tardive dyskinesia possible after discontinuance

    Clinical worsening of depression and suicide ideation may occur despite treatment

    Hyperlipidemia may occur; appropriate clinical monitoring is recommended, including fasting blood lipid testing at the beginning of, and periodically, during treatment

    Weight gain may occur; monitoring of weight recommended

    Cataract may occur; monitor

    There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to atypical antipsychotics, including quetiapine, during pregnancy

    Limited data from published literature report the presence of drug in human breast milk at relative infant dose of <1% of maternal weight-adjusted dosage

    Adults

    Not definitive, 800 mg/day PO suggested. Debilitated and/or patients at risk for hypotension may require lower dosages.

    Geriatric

    Not definitive, 200—800 mg/day PO suggested. Debilitated and/or patients at risk for hypotension may require lower dosages.

    Adolescents

    800 mg/day PO.

    Children

    > = 10 years: 600 mg/day PO.
    < 10 years: Safety and effectiveness have not been established.

    Quetiapine fumarate

    tablet, immediate release

    • 25mg
    • 50mg
    • 100mg
    • 200mg
    • 300mg
    • 400mg

    tablet, extended release

    • 50mg
    • 150mg
    • 200mg
    • 300mg
    • 400mg