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Quetiapine Dosage

Applies to the following strength(s): 25 mg ; 100 mg ; 200 mg ; 300 mg ; 50 mg ; 400 mg ; 150 mg

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Schizophrenia

Immediate-release tablets:
-Day 1: 25 mg orally twice a day
-Days 2 and 3: Increase in 25 to 50 mg increments divided 2 or 3 times with the goal of achieving a total daily dose of 300 to 400 mg by day 4
-Further dose adjustments should be made in 25 to 50 mg increments twice a day in intervals of not less than 2 days
Recommended dose: 150 to 750 mg orally per day in divided doses
Maximum dose: 750 mg/day

Extended-release (XR) tablets:
-Day 1: 300 mg orally once a day
-Increase in increments of up to 300 mg/day
Recommended dose: 400 to 800 mg orally once a day
Maximum dose: 800 mg/day

Comments:
-After initial dose titration, adjustments can be made upwards or downwards depending on clinical response and tolerability.
-When restarting this drug in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed; for patients who have been off this drug for less than 1 week, the maintenance dose may be reinitiated.
-Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Use: For the treatment of schizophrenia.

Usual Adult Dose for Bipolar Disorder

MANIA Associated with Bipolar Disorder:

-Immediate-release (IR) tablets:
Day 1: Twice daily dosing totaling 100 mg/day orally
Day 2: Twice daily dosing totaling 200 mg/day orally
Day 3: Twice daily dosing totaling 300 mg/day orally
Day 4: Twice daily dosing totaling 400 mg/day orally
-Further dose adjustments should be in increments of no greater than 200 mg/day
Recommended dose: 400 to 800 mg per day in divided doses
Maximum dose: 800 mg/day

-Extended-release (XR) tablets:
Day 1: 300 mg orally once a day
Day 2: 600 mg orally once a day
Recommended dose: 400 to 800 mg/day
Maximum dose: 800 mg/day

DEPRESSIVE Episodes Associated with Bipolar Disorder:

-Immediate-release (IR) tablets:
Day 1: 50 mg orally once a day at bedtime
Day 2: 100 mg orally once a day at bedtime
Day 3: 200 mg orally once a day at bedtime
Day 4: 300 mg orally once a day at bedtime
Recommended dose: 300 mg/day
Maximum dose: 300 mg/day

-Extended-release (XR) tablets:
Day 1: 50 mg orally once a day
Day 2: 100 mg orally once a day
Day 3: 200 mg orally once a day
Day 4: 300 mg orally once a day
Recommended dose: 300 mg/day
Maximum dose: 300 mg/day

MAINTENANCE TREATMENT:
-As adjunct to lithium or divalproex: 400 to 800 mg orally/day (IR should be dosed twice a day; XR once a day)
-Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Comments:
-After initial dose titration, adjustments can be made upwards or downwards depending on clinical response and tolerability.
-When restarting this drug in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed; for patients who have been off this drug for less than 1 week, the maintenance dose may be reinitiated.

Uses:
-For the acute treatment of manic or mixed episodes associated with bipolar I disorder, both as monotherapy and as an adjunct to lithium or divalproex;
-For the acute treatment of depressive episodes associated with bipolar disorder;
-For the maintenance treatment of bipolar 1 disorder as an adjunct to lithium or divalproex.

Usual Adult Dose for Depression

Extended-release (XR) tablets:
-Day 1: 50 mg orally once a day
-Day 2: 50 mg orally once a day
-Day 3: 150 mg orally once a day
Recommended dose: 150 mg to 300 mg orally once a day
Maximum dose: 300 mg/day

Comments:
-After initial dose titration, adjustments can be made upwards or downwards depending on clinical response and tolerability.
-When restarting this drug in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed; for patients who have been off this drug for less than 1 week, the maintenance dose may be reinitiated.
-Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Use: As adjunctive therapy to antidepressants for the treatment of major depressive disorder.

Usual Geriatric Dose for Schizophrenia

Immediate-release tablets:
-Initial dose: 25 mg orally twice a day
-Dose increases should be made in increments of 50 mg/day depending on clinical response and tolerability
Recommended dose: 150 to 750 mg orally per day in divided doses
Maximum dose: 750 mg/day

Extended-release (XR) tablets:
-Initial dose: 50 mg orally once a day
-Dose increases should be made in increments of 50 mg/day depending on clinical response and tolerability
Recommended dose: 400 to 800 mg orally once a day
Maximum dose: 800 mg/day

Comments:
-Consider slower dose titration and careful monitoring during the initial dosing period; lower target doses may be appropriate in elderly patients, especially those who are debilitated or have a predisposition to hypotensive reactions.
-When restarting this drug in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed.
-Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Use: For the treatment of schizophrenia.

Usual Geriatric Dose for Bipolar Disorder

MANIA Associated with Bipolar Disorder (as monotherapy or as adjunct therapy to lithium or divalproex):
Immediate-release (IR) tablets:
-Initial dose: 25 mg orally twice a day
-Dose increases should be made in increments of 50 mg/day depending on clinical response and tolerability
Recommended dose: 400 to 800 mg orally per day in divided doses
Maximum dose: 800 mg/day

Extended-release (XR) tablets:
-Initial dose: 50 mg orally once a day
-Dose increases should be made in increments of 50 mg/day depending on clinical response and tolerability
Recommended dose: 400 to 800 mg/day
Maximum dose: 800 mg/day

DEPRESSIVE Episodes Associated with Bipolar Disorder
Immediate-release (IR) tablets:
-Initial dose: 25 mg orally twice a day
-Dose increases should be made in increments of 50 mg/day depending on clinical response and tolerability
Recommended dose: 300 mg/day
Maximum dose: 300 mg/day

Extended-release (XR) tablets:
-Initial dose: 50 mg orally once a day
-Dose increases should be made in increments of 50 mg/day depending on clinical response and tolerability
Recommended dose: 300 mg/day
Maximum dose: 300 mg/day

MAINTENANCE TREATMENT:
-As adjunct to lithium or divalproex: (IR or XR): 400 to 800 mg/day
-Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Comments:
-Consider slower dose titration and careful monitoring during the initial dosing period; lower target doses may be appropriate in elderly patients, especially those who are debilitated or have a predisposition to hypotensive reactions.
-When restarting this drug in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed.

Uses:
-For the acute treatment of manic or mixed episodes associated with bipolar I disorder, both as monotherapy and as an adjunct to lithium or divalproex;
-For the acute treatment of depressive episodes associated with bipolar disorder;
-For the maintenance treatment of bipolar 1 disorder as an adjunct to lithium or divalproex.

Usual Geriatric Dose for Depression

Extended-release (XR) tablets:
-Initial dose: 50 mg orally once a day
-Dose increases should be made in increments of 50 mg/day depending on clinical response and tolerability
Recommended dose: 150 mg to 300 mg orally once a day
Maximum dose: 300 mg/day

Comments:
-Consider slower dose titration and careful monitoring during the initial dosing period; lower target doses may be appropriate in elderly patients, especially those who are debilitated or have a predisposition to hypotensive reactions.
-When restarting this drug in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed.
-Patients should be periodically reassessed to determine the need for maintenance treatment and the appropriate dose for such treatment.

Use: As adjunctive therapy to antidepressants for the treatment of major depressive disorder.

Usual Pediatric Dose for Schizophrenia

Age: 13 to 17 years:
Special Considerations in Treating Pediatric Schizophrenia
-Prior to initiating medication therapy, a thorough diagnostic evaluation carefully considering the risks associated with medication treatment should be performed.
-Medication treatment should be a part of a total treatment program that often includes psychological, educational, and social interventions.

Immediate-release tablets:
-Day 1: 25 mg orally twice a day
-Day 2: Twice daily dosing totaling 100 mg/day orally
-Day 3: Twice daily dosing totaling 200 mg/day orally
-Day 4: Twice daily dosing totaling 300 mg/day orally
-Day 5: Twice daily dosing totaling 400 mg/day orally
-Further dose adjustments should be in increments no greater than 100 mg/day
Recommended dose: 400 to 800 mg/per day in 2 or 3 divided doses
Maximum dose: 800 mg/day

Extended-release (XR) tablets:
-Day 1: 50 mg orally once a day
-Day 2: 100 mg orally once a day
-Day 3: 200 mg orally once a day
-Day 4: 300 mg orally once a day
-Day 5: 400 mg orally once a day
Recommended dose: 400 to 800 mg once a day
Maximum dose: 800 mg/day

Comments:
-After initial dose titration, adjustments can be made upwards or downwards depending on clinical response and tolerability.
-When restarting this drug in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed; for patients who have been off this drug for less than 1 week, the maintenance dose may be reinitiated.

Use: For the treatment of schizophrenia.

Usual Pediatric Dose for Bipolar Disorder

Age: 10 to 17 years:
Special Considerations in Treating Pediatric Bipolar 1 Disorder:
-Prior to initiating medication therapy, a thorough diagnostic evaluation carefully considering the risks associated with medication treatment should be performed.
-Medication treatment should be a part of a total treatment program that often includes psychological, educational, and social interventions.

MANIA Associated with Bipolar Disorder:

Immediate-release (IR) tablets:
-Day 1: 25 mg orally twice a day
-Day 2: Twice daily dosing totaling 100 mg/day orally
-Day 3: Twice daily dosing totaling 200 mg/day orally
-Day 4: Twice daily dosing totaling 300 mg/day orally
-Day 5: Twice daily dosing totaling 400 mg/day orally
-Further dose adjustments in increments of no greater than 100 mg/day
Recommended dose: 400 to 600 mg per day in 2 or 3 divided doses
Maximum dose: 600 mg/day

Extended-release (XR) tablets:
-Day 1: 50 orally once a day
-Day 2: 100 mg orally once a day
-Day 3: 200 mg orally once a day
-Day 4: 300 mg orally once a day
-Day 5: 400 mg orally once a day
Recommended dose: 400 to 600 mg/day
Maximum dose: 600 mg/day

Comments:
-After initial dose titration, adjustments can be made upwards or downwards depending on clinical response and tolerability.
-Safety and efficacy has been demonstrated in the treatment of bipolar mania in children and adolescents ages 10 to 17 years; safety and efficacy have not been established in patients with bipolar depression or for maintenance treatment of bipolar disorder.

Use:
-For the acute treatment of manic or mixed episodes associated with bipolar I disorder.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

Initial dose: 25 mg orally once a day
-Dose increases should be in increments of 25 to 50 mg/day to an effective dose based on clinical response and tolerability

Extended-release (XR) tablets:
Initial dose: 50 mg orally once a day
-Dose increases should be in increments of 50 mg/day to an effective dose based on clinical response and tolerability

Dose Adjustments

Consider slower dose titration and lower target doses in elderly patients, debilitated patients, and/or those patients who have a predisposition to hypotensive reactions.

IMMEDIATE-RELEASE (IR) to EXTENDED-RELEASE (XR) Tablets:
-Switch to XR tablets once a day at the equivalent total daily dose of the IR tablets; individual dosage adjustments may be necessary.

Concomitant Use with potent CYP450 3A4 Inhibitors:
-Quetiapine (IR and XR) dose should be reduced to one-sixth of original dose.
-When CYP450 3A4 inhibitor is discontinued, the quetiapine dose should be increased by 6-fold.

Concomitant Use with potent CYP450 3A4 Inducers:
-Quetiapine (IR and XR) dose should be increased up to 5-fold of the original dose when patients are concurrently receiving chronic treatment (greater than 7 to 14 days) with a potent CYP450 3A4 inducer; titrate dose based on clinical response and tolerability.
-When CYP450 3A4 inducer is discontinued, the quetiapine dose should be reduced to the original level within 7 to 14 days.

Reinitiation in Patients Previously Stopping Therapy:
-Although not systematically studied, it is recommended that when restarting quetiapine in patients who have been off therapy for more than 1 week, the initial dosing schedule should be followed.
-For patients who have been off this drug for less than 1 week, gradual dose titration may not be needed and the maintenance dose may be reinitiated.

-Discontinuation Syndrome:
-Acute withdrawal symptoms have been reported with abrupt cessation (e.g., insomnia, nausea, vomiting).
-Gradual dose reduction is recommended.

Switching from Other Antipsychotics:
-Although not systematically studied, it is recommended the period of overlapping antipsychotic administration should be minimized.
-When switching from depot antipsychotics, consider initiating quetiapine therapy in place of the next scheduled injection.

Precautions

US BOXED WARNINGS: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS:
-Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.
-This drug is not approved for use in patients with dementia-related psychosis.
SUICIDAL THOUGHTS AND BEHAVIORS:
-Antidepressants may increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. There was no increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24 and there was a reduction in risk with antidepressant use in patients aged 65 and older.
-Patients of all ages who are started on antidepressant therapy should be monitored for suicidal thoughts and behaviors; families and caregivers should be advised of the need for vigilance.

Safety and efficacy for the treatment of schizophrenia have not been established in patients younger than 13 years; safety and efficacy in the maintenance treatment of schizophrenia has not been established in patients less than 18 years.

Safety and efficacy for the treatment of bipolar mania have not been established in patients younger than 10 years; safety and effectiveness in patients with bipolar depression or for the maintenance treatment of bipolar disorder has not been established in patients less than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
Immediate-release tablets:
-Take orally with or without food
Extended-release tablets:
-Swallow whole; do not split, chew, or crush
-Take orally without food or with a light meal (approximately 300 calories)
-Take once daily, preferably in the evening

General:
-Pediatric schizophrenia and bipolar I disorder present diagnostic challenges due to variable symptom profiles and variable patterns of periodicity of manic or mixed symptoms. Therefore, a thorough diagnostic evaluation should be performed and medication treatment should only be used as part of a total treatment program.
-Patients who require chronic therapy should be maintained on the smallest dose that produces a satisfactory response.
-Patients with depression may experience worsening of their depressive symptoms and/or emergence of suicidal ideation and behavior; improvement may not occur during the first few weeks or more of treatment.
-Controlled clinical trials assessing long-term use are not available; the physician who prescribes this drug should periodically re-evaluate the long-term risks and benefits for the individual patient.

Monitoring:
-Children and adolescents should have their blood pressure measured at baseline and periodically during treatment.
-CBC should be obtained frequently during the first few months in patients with preexisting low WBC and/or a prior history of drug-induced leukopenia or neutropenia; patients with neutropenia should be carefully monitored for fever or other symptoms or signs of infection.
-Blood glucose levels should be checked at baseline and periodically during treatment
-Monitor for increases in weight and lipids.
-Slit lamp examinations or other sensitive methods to detect cataract formation are recommended at initiation and at 6-month intervals during chronic treatment.
-Patients receiving antidepressants should be monitored for clinical worsening, suicidality, and unusual changes in behavior.
-Consider measuring TSH and free T4 at baseline and periodically if clinically indicated.

Patient advice:
-Patients, families, and caregivers should be educated on the risks of suicidal thoughts and behaviors, as well as the risk of mania and hypomania; what to watch for and when to seek medical advice.
-This drug may impair judgment, thinking, or motor skills; have patient avoid driving or operating machinery until adverse effects are determined.
-Advise patient to speak to physician or health care professional if pregnant, intend to become pregnant, or are breastfeeding.
-Advise patient that this drug may cause metabolic changes such as increases in blood sugar, body weight and lipids.
-Patients should avoid overheating and dehydration.
-Patients should speak with their healthcare provider if they are taking, or plan to take any new prescription or over the counter medications because there is a potential for drug interactions; patients should be advised to avoid alcohol as it may make some side effects worse.

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