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quetiapine

Pronunciation

Generic Name: quetiapine (kwe TYE a peen)
Brand Name: SEROquel, SEROquel XR

What is quetiapine?

Quetiapine is an antipsychotic medicine. It works by changing the actions of chemicals in the brain.

Quetiapine is used to treat schizophrenia in adults and children who are at least 13 years old.

Quetiapine is used to treat bipolar disorder (manic depression) in adults and children who are at least 10 years old.

Quetiapine is also used together with antidepressant medications to treat major depressive disorder in adults.

Extended-release quetiapine (Seroquel XR) is for use only in adults and should not be given to anyone younger than 18 years old.

Quetiapine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about quetiapine?

Some young people have thoughts about suicide when first taking quetiapine. Stay alert to changes in your mood or symptoms. Report any new or worsening symptoms to your doctor.

Quetiapine is not approved for use in psychotic conditions related to dementia. Quetiapine may increase the risk of death in older adults with dementia-related conditions.

What should I discuss with my healthcare provider before taking quetiapine?

You should not use quetiapine if you are allergic to it.

Quetiapine is not approved for use in psychotic conditions related to dementia. Quetiapine may increase the risk of death in older adults with dementia-related conditions.

To make sure quetiapine is safe for you, tell your doctor if you have:

  • liver or kidney disease;

  • heart disease, heart rhythm problems, a history of heart attack or stroke;

  • high or low blood pressure;

  • a history of low white blood cell (WBC) counts;

  • abnormal thyroid tests or prolactin levels;

  • seizures or epilepsy;

  • cataracts;

  • high cholesterol or triglycerides;

  • a personal or family history of diabetes; or

  • trouble swallowing.

Some young people have thoughts about suicide when first taking quetiapine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. However, you may have withdrawal symptoms or other problems if you stop taking your medicine during pregnancy. If you become pregnant while taking quetiapine, do not stop taking it without your doctor's advice.

Quetiapine can pass into breast milk and may harm a nursing baby. You should not breast-feed while you are using quetiapine.

Do not give quetiapine to a child without a doctor's advice. Extended-release quetiapine (Seroquel XR) is for use only in adults and should not be given to anyone younger than 18 years old.

How should I take quetiapine?

Follow all directions on your prescription label. Never take quetiapine in larger amounts, or for longer than recommended by your doctor. High doses or long-term use of quetiapine can cause a serious movement disorder that may not be reversible. Symptoms of this disorder include tremors or other uncontrollable muscle movements.

Take this medicine with a full glass of water. You may take quetiapine with or without food.

Do not crush, chew, or break an extended-release tablet. Swallow it whole.

Quetiapine may cause you to have high blood sugar (hyperglycemia). If you are diabetic, check your blood sugar levels on a regular basis while you are taking quetiapine.

You should not stop using quetiapine suddenly. Stopping suddenly may make your condition worse.

Blood pressure may need to be checked often in a child or teenager taking quetiapine.

Quetiapine can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking quetiapine.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. An overdose of quetiapine can be fatal.

What should I avoid while taking quetiapine?

Avoid drinking alcohol. It can worsen the side effects of quetiapine.

Quetiapine may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert. Avoid getting up too fast from a sitting or lying position, or you may feel dizzy. Get up slowly and steady yourself to prevent a fall.

Avoid becoming overheated or dehydrated during exercise and in hot weather. You may be more prone to heat stroke.

Quetiapine side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, anxiety, panic attacks, trouble sleeping, or if you feel impulsive, irritable, agitated, hostile, aggressive, restless, hyperactive (mentally or physically), more depressed, or have thoughts about suicide or hurting yourself.

Call your doctor at once if you have:

  • twitching or uncontrollable movements of your eyes, lips, tongue, face, arms, or legs;

  • mask-like appearance of the face, trouble swallowing, problems with speech;

  • a light-headed feeling, like you might pass out;

  • blurred vision, tunnel vision, eye pain, or seeing halos around lights;

  • severe nervous system reaction--very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, fainting;

  • high blood sugar--increased thirst, increased urination, hunger, dry mouth, fruity breath odor, drowsiness, dry skin, blurred vision, weight loss; or

  • low blood cell counts--sudden weakness or ill feeling, fever, chills, cold or flu symptoms, cough, sore throat, red or swollen gums, painful mouth sores, skin sores, trouble breathing.

Common side effects may include:

  • trouble with movement;

  • dizziness, weakness;

  • increased appetite, weight gain;

  • sore throat;

  • dry mouth; or

  • nausea, vomiting, stomach pain, constipation.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Quetiapine dosing 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 daily 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 have 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.

What other drugs will affect quetiapine?

Quetiapine can cause a serious heart problem if you use certain medicines at the same time, including antibiotics, antidepressants, heart rhythm medicine, antipsychotic medicines, and medicines to treat cancer, malaria, HIV or AIDS. Tell your doctor about all medicines you use, and those you start or stop using during your treatment with quetiapine.

Taking quetiapine with other drugs that make you sleepy or slow your breathing can worsen these effects. Ask your doctor before taking quetiapine with a sleeping pill, narcotic pain medicine, muscle relaxer, or medicine for anxiety, depression, or seizures.

Many drugs can interact with quetiapine. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

  • antibiotic or antifungal medicine;

  • antiviral medicine to treat hepatitis or HIV/AIDS;

  • heart or blood pressure medicine;

  • medicine to treat mental illness;

  • St. John's wort;

  • seizure medicine; or

  • tuberculosis medicine.

This list is not complete and many other drugs can interact with quetiapine. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about quetiapine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 14.03. Revision Date: 2015-12-08, 3:13:11 PM.

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