Quetiapine
SEROQUEL
Pronunciation: kwe-TYE-a-peen (SER-oe-kwel)
“Sera, Quit typing!”
Spooky mascot → antipsychotic
Crown → antihistamine
Polka dots on pink → α1 blocker → syncope if titrated too quickly (hit the floor)
QT prolongation
For mania (typing all night)
What it isD2 and 5-HT2A antagonist with strong H1 and alpha-1 blockade; schizophrenia and bipolar disorder. Adjunctive depression is approved for SEROQUEL XR.
Why this oneIts bipolar-depression indication, and adjunctive depression as SEROQUEL XR, give it unusually broad mood utility for an antipsychotic.
What limits itSedation, orthostasis and metabolic burden occur even at insomnia doses. Strong CYP3A4 modifiers markedly change exposure.
Pearls
- Off-label for Parkinson psychosis; minimal EPS, no agranulocytosis.
- XR works off-label for anxiety, second- or third-line.
Quetiapine prescription history
Animated chart of estimated U.S. prescriptions per year, Antipsychotics (1954–2026). Quetiapine enters in 1997 (estimated).
FDA-approved for
- schizophrenia (1997)
- bipolar mania (2004)
- bipolar depression (2006)
- adjunct for depression, as SEROQUEL XR (2009)
Off-label
- insomnia
- anxiety
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Schizophrenia | Adults | 25 mg BID | 150-750 mg/day | 750 mg/day |
| Schizophrenia | Adolescents 13-17 y | 25 mg BID | 400-800 mg/day | 800 mg/day |
| Bipolar mania (monotherapy or adjunct to lithium/divalproex) | Adults | 50 mg BID | 400-800 mg/day | 800 mg/day |
| Bipolar mania (monotherapy) | Children/Adolescents 10-17 y | 25 mg BID | 400-600 mg/day | 600 mg/day |
| Bipolar depression | Adults | 50 mg QHS | 300 mg/day | 300 mg/day |
Titration Schizophrenia adults: after Day 4, further adjustments in 25-50 mg BID increments at intervals of not less than 2 days.
Renal Undefined
Hepatic Lower starting dose (25 mg/day) and slower titration may be needed
Instructions
- May be taken with or without food
- Elderly: consider lower starting dose (50 mg/day), slower titration, careful monitoring
Available strengths
- tab 25, 50, 100, 150, 200, 300, 400 mg
- ER tab 50, 150, 200, 300, 400 mg
Cautions
- Neuroleptic malignant syndrome
- Metabolic changes: hyperglycemia/diabetes, dyslipidemia, weight gain
- Tardive dyskinesia
- Orthostatic hypotension; falls
- Cerebrovascular events in elderly with dementia
- Increased blood pressure in children/adolescents
- Leukopenia/neutropenia/agranulocytosis
- QT prolongation
- Seizures
- Hypothyroidism, hyperprolactinemia
- Cataracts
- Anticholinergic effects; discontinuation syndrome
Adverse reactions
- Adults: somnolence, dizziness, dry mouth, constipation, asthenia, abdominal pain, postural hypotension, weight gain, ALT increased, dyspepsia
- Children/adolescents: somnolence, dizziness, fatigue, increased appetite, nausea, vomiting, dry mouth, tachycardia, weight increased
Pregnancy No established drug-associated risk of birth defects; third-trimester exposure risks neonatal extrapyramidal and/or withdrawal symptoms.
Lactation Undefined
Cost
Generic entry2012
Active metabolites
Open Quetiapine in the interactive console ↗
Memory aids: interaction avatars
Open Quetiapine in the interactive console ↗
Self-check
- Quetiapine: Are metabolic effects absent at insomnia doses?
No; metabolic burden still occurs. - Quetiapine: Which enzyme modifiers markedly change exposure?
Strong CYP3A4 modifiers.