Quetiapine

Aka: Quetiapine, Seroquel

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II. Class

  1. Atypical Antipsychotic (Second Generation Antipsychotic)
  2. Neuroleptic
  3. Dibenzothiazepine Antipsychotic

III. Mechanism

  1. Dopamine, Serotonin, histamine and adrenergic antagonist
  2. Potent alpha-1 Adrenergic Receptor antagonist (risk of Hypotension)
  3. Weak antagonist at Dopamine (D2), muscarinic (M1) and Serotonin (5HT-1A) with risk of sedation

IV. Indications

  1. Schizophrenia
  2. Psychosis in Dementia
  3. Bipolar Disorder
  4. Mania
  5. Major Depression (adjunct)
  6. Autism (not FDA approved)
  7. Insomnia (not FDA approved)

V. Dosing

  1. Available in both immediate release and sustained release formulations
  2. Adults
    1. Initial: 25 mg PO bid-tid
    2. Increase in 25-50 mg/day increments
    3. Target: 300-400 mg/day divided bid-tid
    4. Maximum dose: 750 mg/day
  3. Elderly
    1. Initial dose: 12.5 mg PO qhs
    2. Titrate up every few days (caution due to sedation)

VI. Pharmacokinetics

  1. Lipophilic
  2. Large volume of distribution (10 L/kg +/-4 L/kg)
  3. Plasma protein binding: 83%
  4. Not dialyzable
  5. Half-Life: 6 hours
  6. Peak Levels: 2-3 hours
  7. Metabolism: CYP 3A4

VII. Adverse Effects: General

  1. Sedation
  2. Headache
  3. Orthostatic Hypotension
  4. Cataract formation
  5. Dry Mouth
  6. Weight gain
  7. Neuroleptic Malignant Syndrome
  8. QTc Prolongation

VIII. Adverse Effects: Overdose

  1. See Quetiapine Overdose
  2. Somnolence
  3. Tachycardia
  4. Hypotension

IX. Drug Interactions

  1. Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
    1. Clarithromycin
    2. Erythromycin
    3. Grapefruit juice
    4. Fluconazole
    5. Itraconazole
    6. Ketoconazole
    7. Quinidine
  2. Decrease Antipsychotic levels (lower efficacy)
    1. Barbiturates
    2. Carbamazepine
    3. Phenytoin
    4. Rifampin
    5. Theophylline
  3. Other effects
    1. Avoid concurrent use of other medications prolonging QT Interval
      1. See Prolonged QT Interval due to Medication

X. Monitoring

  1. See Quetiapine Overdose
  2. See Antipsychotic
  3. Screen for Cataract formation every 6 months
  4. Consider EKG, Electrolyte and Magnesium monitoring due to QT Interval prolongation risk

XI. Pharmacokinetics

  1. Metabolized by Cytochrome P450 3A4

XII. References

  1. Otter and Tomaszewski (2018) Crit Dec Emerg Med 32(8): 32

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Related Studies

Cost: Medications

quetiapine (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
QUETIAPINE ER 150 MG TABLET Generic $10.87 each
QUETIAPINE ER 200 MG TABLET Generic $11.65 each
QUETIAPINE ER 300 MG TABLET Generic $15.35 each
QUETIAPINE ER 400 MG TABLET Generic $17.19 each
QUETIAPINE ER 50 MG TABLET Generic $6.02 each
QUETIAPINE FUMARATE 100 MG TAB Generic $0.10 each
QUETIAPINE FUMARATE 200 MG TAB Generic $0.19 each
QUETIAPINE FUMARATE 25 MG TAB Generic $0.07 each
QUETIAPINE FUMARATE 300 MG TAB Generic $0.27 each
QUETIAPINE FUMARATE 400 MG TAB Generic $0.26 each
QUETIAPINE FUMARATE 50 MG TAB Generic $0.08 each
seroquel (on 6/22/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
SEROQUEL 100 MG TABLET Generic $0.10 each
SEROQUEL 200 MG TABLET Generic $0.19 each
SEROQUEL XR 150 MG TABLET Generic $10.87 each
SEROQUEL XR 200 MG TABLET Generic $11.65 each
SEROQUEL XR 300 MG TABLET Generic $15.35 each
SEROQUEL XR 400 MG TABLET Generic $17.19 each
SEROQUEL XR 50 MG TABLET Generic $6.02 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

Ontology: quetiapine (C0123091)

Definition (NCI) A dibenzothiazepine derivative with antipsychotic property. Quetiapine fumarate antagonizes serotonin activity mediated by 5-HT 1A and 5-HT2 receptors. With a lower affinity, this agent also reversibly binds to dopamine D1 and D2 receptors in the mesolimbic and mesocortical areas of the brain leading to decreased psychotic effects, such as hallucinations and delusions. In addition, quetiapine also binds to other alpha-1, alpha-2 adrenergic and histamine H1 receptors.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C069541
SnomedCT 108443001, 386850001
LNC LP21161-2, MTHU012935
English 2-(2-(4-dibenzo(b,f)(1,4)thiazepine-11-yl-1-piperazinyl)ethoxy)ethanol, quetiapine, quetiapine (medication), quetiapine [Chemical/Ingredient], QUEtiapine, QUETIAPINE, Quetiapine, Quetiapine (product), Quetiapine (substance)
Spanish quetiapina (producto), quetiapina (sustancia), quetiapina
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Seroquel (C0287163)

Definition (CHV) brand name of quetiapine, a drug used to treat schizophrenia and bipolar disorder
Definition (CHV) brand name of quetiapine, a drug used to treat schizophrenia and bipolar disorder
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C069541
English quetiapine (Seroquel), seroquel, seroquel [brand name], SEROquel, AstraZeneca Brand of Quetiapine Fumarate, Zeneca Brand of Quetiapine Fumarate, Seroquel
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Pharmacology

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