Classes
DEA Class; Rx
Common Brand Names; Seroquel, Seroquel XR
- Antipsychotics, 2nd Generation;
- Antimanic Agents
Description
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
Indications
Contraindications
Documented hypersensitivity
Adverse Effects
- 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
Warnings
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
Pregnancy and Lactation
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
Maximum Dosage
Not definitive, 800 mg/day PO suggested. Debilitated and/or patients at risk for hypotension may require lower dosages.
Not definitive, 200—800 mg/day PO suggested. Debilitated and/or patients at risk for hypotension may require lower dosages.
800 mg/day PO.
> = 10 years: 600 mg/day PO.
< 10 years: Safety and effectiveness have not been established.
How supplied
Quetiapine fumarate
tablet, immediate release
- 25mg
- 50mg
- 100mg
- 200mg
- 300mg
- 400mg
tablet, extended release
- 50mg
- 150mg
- 200mg
- 300mg
- 400mg