quetiapine SEROQUEL

Class: Second Generation Antipsychotic/​Dibenzothiazepine
FDA Indications: Bipolar Depression, Bipolar Mania, Schizophrenia, MDD (adjunct)
Off-Label Use: Anxiety, Insomnia, GAD, OCD, Dementia, Parkinsons Disease Psychosis, Lewy Body Dementia
Prescribing
Forms: 25, 100, 200, 300, 400mg tablet; 50, 150, 200, 300, 400mg extended-release tablet
Dose Range: 25-800 mg/day
Starting: Start at 25-50 mg BID or TID, increasing to 400-800mg qd for bipolar disorder and schizophrenia, 150-300 mg qd for MDD
Stopping: Taper 6-8 weeks, rapid d/c can lead to rebound psychosis
Monitoring:

NAMI drug fact sheet

Precautions
Serious Side Effects: , , , , Cataracts
Conditional Risk of TdP, Drugs to Avoid in Congenital Long QT
Side Effects: sedation/somnolence, weakness/asthenia, constipation, weight gain, xerostomia, orthostatic hypotension, transaminitis, EPS, abdominal pain
Pharmacodynamics
1° MOA: 5HT2A–D2 Antagonist
Target: Antagonism at: norquetiapine is an antagonist at: norquetiapine is a partial agonist at:
Pharmacokinetics
t½: TMAX:
Substrate of: 3A4; 2D6
Inhibits: ∅ ; Induces:
Active Metabolites: norquetiapine (t½ = 12°)
DDIs
Misc
  • - EPS is virtually non-existent, even at high doses
  • - Weight gain: Moderate, less than Zyprexa, more than Geodon or Abilify
  • - No prolactin elevation
  • - along with clozapine, preferred over other atypical antipsychotics in treatment of noncognitive symptoms of Dementia with Lewy bodies (usually in low doses, i.e. 6.25-50mg qd)
Special Populations

Category C—No structural malformations attributable to quetiapine have been reported, the number of exposures is too low to fully assess embryo-fetal risk. There is a risk of EPS and/or withdrawal sx in the newborn if used in the 3rd trimester. Nevertheless, quetiapine is indicated for severe debilitating mental disease and the benefits to the mother appear to outweigh the potential embryo-fetal risks.

RID 0.09-0.1%; Limited Human Data—Potential Toxicity


All atypicals may increase mortality in elderly patients by 1.7 times greater than placebo. A slower rate of titration and lower target dose may be needed in elderly patients

No dosage adjustment necessary for renal insufficiency


A slower rate of titration and lower target dose may be needed in patients with hepatic impairment

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Last updated July 08 2018 15:58:23. Disclaimer: This website does not provide medical advice, nor is it a substitute for clinical judgment.