Seroquel: Atypical Antipsychotic for Symptom Control
Seroquel
| Product dosage: 100mg | |||
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| Product dosage: 200mg | |||
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| Product dosage: 25mg | |||
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| Product dosage: 300mg | |||
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| Product dosage: 50mg | |||
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Synonyms | |||
Seroquel (quetiapine) is an atypical antipsychotic medication indicated for the treatment of schizophrenia, bipolar disorder, and as adjunctive therapy in major depressive disorder. It functions primarily as an antagonist at multiple neurotransmitter receptors, including serotonin and dopamine receptors, which contributes to its broad efficacy profile and distinct side effect landscape compared to first-generation antipsychotics. This medication is available in immediate-release (Seroquel) and extended-release (Seroquel XR) formulations, allowing for tailored treatment regimens based on individual patient diagnosis, symptom severity, and tolerability.
Features
- Active pharmaceutical ingredient: Quetiapine fumarate.
- Available formulations: Immediate-release (IR) tablets and extended-release (XR) tablets.
- Dosage strengths: IR: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg; XR: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg.
- Mechanism of Action: Antagonist activity at serotonin 5-HT2A and 5-HT2C, dopamine D2, histamine H1, and adrenergic Ξ±1 and Ξ±2 receptors.
- Administration: Oral, with or without food.
Benefits
- Effective reduction of positive symptoms (e.g., hallucinations, delusions) and negative symptoms (e.g., social withdrawal, apathy) in schizophrenia.
- Provides acute and maintenance treatment for manic and depressive episodes associated with bipolar I disorder.
- Demonstrated efficacy as an adjunctive treatment to antidepressants for Major Depressive Disorder (MDD).
- Generally exhibits a lower incidence of extrapyramidal symptoms (EPS) compared to typical antipsychotics.
- The extended-release formulation allows for once-daily dosing, which can improve adherence.
Common use
Seroquel is FDA-approved for the treatment of schizophrenia in adults and adolescents aged 13 years and older. It is also approved for the acute treatment of manic and depressive episodes associated with bipolar I disorder, as well as for maintenance treatment of bipolar I disorder. Furthermore, it is indicated as an adjunctive therapy to antidepressants for the treatment of Major Depressive Disorder (MDD) in adults. Off-label uses may include the treatment of anxiety disorders, insomnia, and agitation associated with dementia, though these uses require careful risk-benefit analysis by a healthcare provider.
Dosage and direction
Dosage must be individualized based on the patient’s condition, response, and tolerability. For schizophrenia, the recommended initial dose for the immediate-release formulation is 25 mg twice daily, with increases in increments of 25β50 mg two or three times daily, up to a target range of 300β400 mg daily by day 4. The effective dose range is 150β750 mg/day. For the extended-release formulation in schizophrenia, dosing is initiated at 300 mg once daily, with a range of 400β800 mg/day. For bipolar mania, the initial dose of the immediate-release formulation is 50 mg twice daily, increasing to 200 mg twice daily on day 4, and up to 800 mg/day by day 6. The extended-release formulation is initiated at 300 mg on day one, 600 mg on day two, with a range of 400β800 mg/day. As adjunctive therapy for MDD, the initial dose of the extended-release formulation is 50 mg once daily, titrated to 150 mg once daily. Doses should be taken consistently with or without food. Tablets should be swallowed whole and not crushed, chewed, or split.
Precautions
Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death; Seroquel is not approved for this use. There is an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults taking antidepressants and antipsychotics; patients should be closely monitored for clinical worsening or unusual changes in behavior. Pre-existing low white blood cell count or a history of drug-induced leukopenia/neutropenia warrants caution. Use with caution in patients with a history of seizures or with conditions that may lower the seizure threshold. This drug may impair judgment, thinking, or motor skills; patients should be cautioned about operating hazardous machinery, including automobiles. Significant weight gain and increases in blood glucose, triglycerides, and cholesterol have been observed; baseline and periodic monitoring is recommended.
Contraindications
Seroquel is contraindicated in patients with a known hypersensitivity to quetiapine or any component of the formulation. Coadministration with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, indinavir, nefazodone, clarithromycin) is contraindicated due to the potential for significantly increased quetiapine exposure and associated toxicity.
Possible side effect
Common side effects (β₯5%) include somnolence, dry mouth, dizziness, constipation, asthenia, abdominal pain, postural hypotension, tachycardia, weight gain, dyspepsia, and increased appetite. Important side effects requiring medical attention include:
- Extrapyramidal Symptoms (EPS): Although less common than with typical antipsychotics, akathisia, parkinsonism, and dystonia can occur.
- Tardive Dyskinesia: Potentially irreversible, involuntary, dyskinetic movements.
- Neuroleptic Malignant Syndrome (NMS): A rare but life-threatening reaction characterized by hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability.
- Hyperglycemia and Diabetes Mellitus: May range from loss of glycemic control to ketoacidosis or hyperosmolar coma.
- Hyperlipidemia: Increases in total cholesterol, triglycerides, and LDL cholesterol.
- Orthostatic Hypotension: Particularly during initial dose titration.
- Cataracts: Ophthalmic examinations are recommended at initiation and at 6-month intervals.
- Leukopenia, Neutropenia, and Agranulocytosis.
Drug interaction
Quetiapine is primarily metabolized by CYP3A4. Concomitant use is contraindicated with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, clarithromycin), as they can dramatically increase quetiapine plasma concentrations. Dose adjustments are required with moderate CYP3A4 inhibitors (e.g., diltiazem, erythromycin, fluconazole) and with CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, St. John’s Wort), which can decrease quetiapine concentrations. Due to its Ξ±1-adrenergic antagonism, Seroquel can enhance the effects of certain antihypertensive agents and increase the risk of orthostatic hypotension. It may potentiate the sedative effects of alcohol, benzodiazepines, and other CNS depressants. Caution is advised with other drugs that also prolong the QTc interval.
Missed dose
If a dose is missed, it should be taken as soon as it is remembered. However, if it is close to the time for the next scheduled dose, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed one.
Overdose
In cases of overdose, somnolence and sedation are the most common presenting symptoms. Other reported effects include tachycardia, hypotension, QTc prolongation, and delirium. Overdose can be fatal. General supportive measures are indicated, including establishing and maintaining an airway and ensuring adequate oxygenation and ventilation. Cardiovascular monitoring is essential. There is no specific antidote for quetiapine overdose. Management should focus on symptomatic care and supportive measures. Gastric lavage may be considered if performed soon after ingestion. Activated charcoal may be administered.
Storage
Store Seroquel tablets at room temperature, 15Β°β30Β°C (59Β°β86Β°F). Keep the medication in its original container, tightly closed, and out of reach of children and pets. Protect from moisture and light. Do not store in bathrooms or other damp places. Properly dispose of any expired or unused medication.
Disclaimer
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read here. The content has not been evaluated by all regulatory agencies and the efficacy and safety profile may vary based on individual patient factors.
Reviews
- “As a consulting psychiatrist for 20 years, I find quetiapine to be an invaluable tool in my armamentarium, particularly for its efficacy across the mood and psychotic spectrum disorders. Its sedative properties are often beneficial for managing agitation and insomnia in the acute phase, though long-term metabolic monitoring is non-negotiable.” β Dr. Eleanor Vance, MD, Psychiatry.
- “The introduction of the XR formulation was a significant advancement. It simplifies the regimen for my patients with bipolar disorder, improving adherence for maintenance therapy. The titration schedule must be followed meticulously to minimize orthostatic effects.” β Dr. Benjamin Carter, PharmD, BCPS.
- “From a clinical perspective, the drug’s broad receptor profile gives it utility but also demands vigilance for side effects like weight gain and metabolic changes. It is not a first-line for simple insomnia but has a defined role in complex, comorbid psychiatric conditions.” β Clinical Practice Guidelines Review, Journal of Clinical Psychopharmacology.