Quetiapine XR

SEROQUEL XR

Open Quetiapine XR in the interactive console ↗

What it isExtended-release D2 and 5-HT2A antagonist with strong H1 and alpha-1 blockade; schizophrenia and adjunctive depression.

Why this oneIt offers once-daily evening dosing; the XR label carries the MDD-adjunct indication (2009).

What limits itTake without food or with a light meal (<300 kcal). Sedation, orthostasis, and metabolic disease limit use; strong CYP3A4 modifiers alter exposure.

FDA-approved for

schizophrenia (2007)
depression (adjunct) (2009)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Increased mortality in elderly patients with dementia-related psychosis treated with antipsychotics (not approved for this use). Increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults taking antidepressants; monitor closely. Not approved for pediatric patients under 10 years of age.

FDA dosing	Population	Start	Target	Max
Schizophrenia	Adults	300 mg/day (Day 1)	400-800 mg/day	800 mg/day
Schizophrenia	Adolescents 13-17 y	50 mg/day, titrate 100/200/300/400 over Days 2-5	400-800 mg/day	800 mg/day
Bipolar I disorder, manic or mixed (monotherapy or adjunct to lithium/divalproex)	Adults	300 mg/day Day 1, 600 mg/day Day 2	400-800 mg/day	800 mg/day
Bipolar I disorder, manic (acute monotherapy)	Children/adolescents 10-17 y	50 mg/day, titrate 100/200/300/400 over Days 2-5	400-600 mg/day	600 mg/day
Bipolar disorder, depressive episodes	Adults	50 mg/day, titrate 100/200/300 over Days 2-4	300 mg/day	300 mg/day
Bipolar I disorder maintenance (adjunct to lithium/divalproex)	Adults	Continue effective dose	400-800 mg/day	800 mg/day
Major depressive disorder (adjunct to antidepressants)	Adults	50 mg/day Days 1-2, 150 mg/day Day 3	150-300 mg/day	300 mg/day

Titration Schizophrenia (adults): dose increases at intervals as short as 1 day (increments up to 300 mg/day)

Renal Undefined (clinical experience limited)

Hepatic Start 50 mg/day, increase in 50 mg/day increments (higher plasma levels expected)

When restarting after >1 week off, follow initial dosing schedule

Instructions

Swallow whole; do not split, chew, or crush
Take without food or with a light meal (~300 calories)
Administer once daily, preferably in the evening
Reduce dose to one-sixth with strong CYP3A4 inhibitors; increase up to 5-fold with chronic strong CYP3A4 inducers
Elderly: start 50 mg/day with slower titration

Cautions

Cerebrovascular adverse reactions in elderly with dementia-related psychosis
Neuroleptic malignant syndrome
Metabolic changes (hyperglycemia/diabetes, dyslipidemia, weight gain)
Tardive dyskinesia
Orthostatic hypotension
Increased blood pressure in children and adolescents
Leukopenia, neutropenia, agranulocytosis
Cataracts (lens changes)
Anticholinergic (antimuscarinic) effects

Adverse reactions

Somnolence
Dry mouth
Dizziness
Constipation
Dyspepsia
Weight gain
Increased appetite
Fatigue

Pregnancy Third-trimester exposure risks extrapyramidal and/or withdrawal symptoms in neonates; epidemiologic data have not established increased risk of major birth defects

Lactation Present in human milk (relative infant dose <1%); consider benefits vs risk

⚠ BOXED WARNING