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quetiapine (Rx)Brand and Other Names:Seroquel, Seroquel XR

 
 
 

Dosing & Uses

AdultPediatricGeriatric

Dosage Forms & Strengths

tablet, immediate release

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

tablet, extended release

  • 50mg
  • 150mg
  • 200mg
  • 300mg
  • 400mg
more...

Schizophrenia

Immediate release

  • Day 1: 50 mg/day PO divided q12hr
  • Days 2-3: Dose increased daily in increments of 25-50 mg q8-12hr to 300-400 mg by day 4; further adjustments can be made in increments of 25-50 mg q12hr at intervals ≥2 days 
  • Dosage range: 150-750 mg/day

Extended release

  • Day 1: 300 mg/day PO; subsequently, may be increased by up to 300 mg/day at intervals ≥1 day 
  • Maintenance (monotherapy): 400-800 mg/day
  • Patients who have discontinued therapy for >1 week should have their dose retitrated following initiation of therapy; patients may reinitiate at their previous maintenance dose if discontinued therapy <1 week

Bipolar I Disorder, Mania

Administered as monotherapy or as adjunct to lithium or divalproex

Immediate release

  • Day 1: 100 mg/day PO divided q12hr
  • Day 2: 200 mg/day PO divided q12hr
  • Day 3: 300 mg/day PO divided q12hr
  • Day 4: 400 mg/day PO divided q12hr
  • Further dosage adjustments, up to 800 mg/day by day 6, should be in increments ≤200 mg/day
  • Dosage range: 400-800 mg/day; not to exceed 800 mg/day

Extended release

  • Day 1: 300 mg PO once daily
  • Day 2: 600 mg PO once daily
  • Maintenance (day 3 onward): 400-800 mg/day PO

Bipolar Disorder, Depressive Episodes

Either immediate-release or extended-release tablets may be given; dosage titrated upward over 4 days

Day 1: 50 mg PO at bedtime

Day 2: 100 mg PO at bedtime

Day 3: 200 mg PO at bedtime

Maintenance (day 4 onward): 300 mg PO at bedtime

Bipolar I Disorder, Maintenance

Administered as adjunct to lithium or divalproex

Immediate release: 400-800 mg/day PO divided q12hr

Extended release: 400-800 mg/day PO in single dose

Generally, in maintenance phase, patients continue to receive same dosage on which they were stabilized

Major Depressive Disorder

Extended-release formulation administered as adjunct to antidepressants

Days 1 and 2: 50 mg PO in evening

Day 3: May be increased to 150 mg PO in evening

Dosage range: 150-300 mg/day

Alcohol Dependence (Off-label)

25-50 mg PO at bedtime; may be titrated; not to exceed 300 mg

Insomnia (Off-label)

Usually, 25 mg/day PO at bedtime initially

Administration

Preferably, take in evening without food or with light meal

Switching from immediate release to extended release

  • Convert to extended release tablets at equivalent immediate release total daily dose; administer once daily; individual adjustments may be necessary

Dosage Forms & Strengths

tablet, immediate release

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

tablet, extended release

  • 50mg
  • 150mg
  • 200mg
  • 300mg
  • 400mg
more...

Schizophrenia

<12 years

  • Safety and efficacy not established

>12 years (monotherapy, immediate release)

  • Day 1: 50 mg/day PO divided q12hr
  • Day 2: 100 mg/day PO divided q12hr
  • Day 3: 200 mg/day PO divided q12hr
  • Day 4: 300 mg/day PO divided q12hr
  • Day 5: 400 mg/day PO divided q12hr; further adjustments should be in increments ≤100 mg/day
  • Dosage range: 400-800 mg/day
  • Depending on response and tolerance, daily dose may be divided q8hr

>12 years (monotherapy, extended release)

  • Day 1: 50 mg/day PO once daily
  • Day 2: 100 mg/day PO once daily
  • Day 3: 200 mg/day PO once daily
  • Day 4: 300 mg/day PO once daily
  • Day 5: 400 mg/day PO once daily; further adjustments should be in increments ≤100 mg/day

Bipolar I Disorder, Mania

<10 years

  • Safety and efficacy not established

>10 years (monotherapy, immediate release)

  • Day 1: 50 mg/day PO divided q12hr
  • Day 2: 100 mg/day PO divided q12hr
  • Day 3: 200 mg/day PO divided q12hr
  • Day 4: 300 mg/day PO divided q12hr
  • Day 5: 400 mg/day PO divided q12hr; further adjustments should be in increments ≤100 mg/day
  • Dosage range: 400-600 mg/day
  • Depending on response and tolerance, daily dose may be divided q8hr

>10 years (monotherapy, extended release)

  • Day 1: 50 mg/day PO once daily
  • Day 2: 100 mg/day PO once daily
  • Day 3: 200 mg/day PO once daily
  • Day 4: 300 mg/day PO once daily
  • Day 5: 400 mg/day PO once daily; further adjustments should be in increments ≤100 mg/day
  • Dosage range: 400-600 mg once daily

Not approved for dementia-related psychosis, because of increased risk of cardiovascular or infectious related deaths (see Black Box Warnings)

Schizophrenia, Bipolar Disorder

Immediate release: 50-200 mg/day PO; may be increased by 25-50 mg/day

Extended release: 50 mg/day PO; may be increased by 50 mg/day

Psychosis, Agitation Related to Alzheimer Dementia (Off-label)

12.5-50 mg/day PO initially; may be gradually increased as tolerated; not to exceed 200-300 mg/day

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Interactions

Interaction Checker

quetiapine and

No Results

     
     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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            Adverse Effects

            >10%

            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%)

            1-10%

            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%)

            < 1%

            Priapism

            Cardiomyopathy, myocarditis

            QTc prolongation

            Night mares

            Pancreatitis

            Rhabdomyolysis

            Palpitation

            Leukocytosis

            Epistaxis

            Exfoliative dermatitis

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            Warnings

            Black Box Warnings

            Not approved for dementia-related psychosis; elderly patients with dementia-related psychosis who are treated with antipsychotic drugs are at increased risk of death, as shown in short-term controlled trials; deaths in these trials appeared to be either cardiovascular (eg, heart failure, sudden death) or infectious (eg, pneumonia) in nature

            Increased risk of suicidal thinking and behavior in children, adolescents, and young adults taking antidepressants for major depressive disorder and other psychiatric disorders; prescriptions should be written for smallest therapeutically effective quantity, and caregivers should monitor and report to healthcare professionals incidence of suicidality and associated behaviors

            Not approved for children <10 years

            Contraindications

            Documented hypersensitivity

            Cautions

            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

            Orthostatic hypotension associated with use

            Monitor for cataract

            Increased blood pressure in children and adolescents reported; monitor blood pressure at the beginning of, and periodically during treatment

            Leukopenia, neutropenia, and agranulocytosis may occur

            Somnolence may occur (especially with extended-release product)

            Potential for withdrawal symptoms after abrupt discontinuance

            False-positive urine drug screens reported when immunoassays for methadone or tricyclic antidepressants used

            FDA warning regarding off-label use for dementia in elderly (see Black Box Warnings)

            QT interval prolongation

            • Not associated with persistent increase in QT interval in trials, but QT effect was not systematically evaluated in thorough study
            • QT prolongation reported with acute overdose during postmarketing experience
            • Avoid using in combination with other drugs known to prolong QTc or in patients with increased risk of QT prolongation
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            Pregnancy & Lactation

            Pregnancy category: C

            Neonates exposed to antipsychotic drugs during 3rd trimester of pregnancy are at risk for extrapyramidal symptoms (EPS) or withdrawal symptoms after delivery; these complications vary in severity, with some being self-limited and others requiring ICU support and prolonged hospitalization 

            Lactation: Drug excreted in breast milk; breastfeeding not recommended

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

            more...
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            Pharmacology

            Mechanism of Action

            Atypical antipsychotic related to clozapine; reduces positive and negative symptoms of psychotic disorders via antagonism of multiple neurotransmitter receptors in brain, including dopamine D1 and D2, histamine H1, alpha1- and alpha2-adrenergic, and serotonin types 1 and 2 (5-HT1A, 5-HT2); has no affinity for benzodiazepine and cholinergic muscarinic receptors

            Absorption

            Bioavailability: 100%

            Peak plasma time: Immediate release, 1.5 hr; extended release, 6 hr

            Distribution

            Protein bound: 83%

            Vd: 6-14 L/kg

            Metabolism

            Metabolized in liver by CYP3A4

            Elimination

            Half-life: Immediate release, 6 hr; extended release, 7 hr

            Excretion: Urine (73%), feces (20%)

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            Images

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            Formulary

            FormularyPatient Discounts

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

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            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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