Quetiapine
SEROQUEL
What it isD2 and 5-HT2A antagonist with strong H1 and alpha-1 blockade; schizophrenia, bipolar disorder and adjunctive depression.
Why this oneIts bipolar-depression and adjunctive-depression indications 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.
FDA-approved for
- schizophrenia (1997)
- bipolar mania (2004)
- bipolar depression (2006)
- adjunct for depression (2009)
Off-label
- insomnia
- anxiety
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
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
⚠ BOXED WARNING
- Increased mortality in elderly patients with dementia-related psychosis
Cost, est. cash$4–$80/month
Generic entry2012
Classes and tags
Clinical profile
Legacy pregnancy categoryC
Defining liabilityMetabolic effects, extrapyramidal symptoms/tardive dyskinesia and agent-specific QT or orthostatic risk.
Active metabolites
Mechanism of action: Quetiapine ballicule
Open Quetiapine in the interactive console ↗
Memory aids: mascots and interaction avatars
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)
