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Quetiapine
Aka: Quetiapine, Seroquel
- See Also
- Quetiapine Overdose
- Antipsychotic Medication
- Psychosis
- Class
- Atypical Antipsychotic (Second Generation Antipsychotic)
- Neuroleptic
- Dibenzothiazepine Antipsychotic
- Mechanism
- Dopamine, Serotonin, histamine and adrenergic antagonist
- Potent alpha-1 Adrenergic Receptor antagonist (risk of Hypotension)
- Weak antagonist at Dopamine (D2), muscarinic (M1) and Serotonin (5HT-1A) with risk of sedation
- Indications
- Schizophrenia
- Psychosis in Dementia
- Bipolar Disorder
- Mania
- Major Depression (adjunct)
- Autism (not FDA approved)
- Insomnia (not FDA approved)
- Dosing
- Available in both immediate release and sustained release formulations
- Adults
- Initial: 25 mg PO bid-tid
- Increase in 25-50 mg/day increments
- Target: 300-400 mg/day divided bid-tid
- Maximum dose: 750 mg/day
- Elderly
- Initial dose: 12.5 mg PO qhs
- Titrate up every few days (caution due to sedation)
- Pharmacokinetics
- Lipophilic
- Large volume of distribution (10 L/kg +/-4 L/kg)
- Plasma protein binding: 83%
- Not dialyzable
- Half-Life: 6 hours
- Peak Levels: 2-3 hours
- Metabolism: CYP 3A4
- Adverse Effects: General
- Sedation
- Headache
- Orthostatic Hypotension
- Cataract formation
- Dry Mouth
- Weight gain
- Neuroleptic Malignant Syndrome
- QTc Prolongation
- Adverse Effects: Overdose
- See Quetiapine Overdose
- Somnolence
- Tachycardia
- Hypotension
-
Drug Interactions
- Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
- Clarithromycin
- Erythromycin
- Grapefruit juice
- Fluconazole
- Itraconazole
- Ketoconazole
- Quinidine
- Decrease Antipsychotic levels (lower efficacy)
- Barbiturates
- Carbamazepine
- Phenytoin
- Rifampin
- Theophylline
- Other effects
- Avoid concurrent use of other medications prolonging QT Interval
- See Prolonged QT Interval due to Medication
- Monitoring
- See Quetiapine Overdose
- See Antipsychotic
- Screen for Cataract formation every 6 months
- Consider EKG, Electrolyte and Magnesium monitoring due to QT Interval prolongation risk
- Pharmacokinetics
- Metabolized by Cytochrome P450 3A4
- References
- Otter and Tomaszewski (2018) Crit Dec Emerg Med 32(8): 32