Seroquel (Quetiapine)

What Is Seroquel Used For?

Seroquel is used to treat several different psychiatric disorders in adults, including:

• Schizophrenia
• Bipolar 1 disorder, mania
• Bipolar disorder, depressive episodes
• Major depressive episodes
• Alcohol dependence (off-label)
• Insomnia (off-label)
• Psychosis, Agitation related to Alzheimer’s Dementia (off-label)

Seroquel is also used to treat schizophrenia in children 12 years of age and older as well as Bipolar 1 disorder; mania, in children 10 years of age and older.

How is Seroquel Used?

Storage

Seroquel should be stored between 59°F to 86°F (15°C to 30°C)

Instructions

Seroquel should be swallowed whole with a full glass of water. Immediate-release tablets can be taken with or without food. Extended-release tablets should be taken on an empty stomach in the evening. Do not crush, chew or split extended-release tablets.

Dosage

Seroquel is available in both immediate-release and extended-release tablets.

• Immediate-release tablets are available in 25mg, 50mg, 100mg, 200mg, 300mg and 400mg tablets.
• Extended-release tablets are available in 50mg, 150mg, 200mg, 300mg and 400mg tablets.

Dosing for Adults

Schizophrenia

• Starting dose for immediate release tablets: 25mg twice daily, the dosage can be increased by 25-50mg daily until desired response.
• Average dose range: 150-750mg daily
• Maximum daily dose: 750mg daily
• Starting dose of extended-release tablets: 300mg daily, the dosage can be increased by up to 300mg per day as needed.
• Average dose range: 400-800mg daily
• Maximum daily dose: 800mg daily

Bipolar 1 disorder, mania

Starting dose of immediate-release tablets

• • Day 1: 50mg twice daily
  • Day 2: 100mg twice daily
  • Day 3: 150mg twice daily
  • Day 4: 200mg twice daily
  • If further adjustments are needed, increments can be increased by 200mg per day until the maximum dose of 800mg per day is achieved.
• Average dose range: 400-800mg daily
• Maximum daily dose: 800mg daily

Starting dose of extended-release Tablets:

• • Day 1: 300mg once daily
  • Day 2: 600mg once daily
• Average dose range: 400-800mg daily
• Maximum daily dose: 800mg daily

 Bipolar disorder, depressive episodes

Starting dose of immediate-release or extended-release tablets:

• • Day 1: 50 mg daily at bedtime
  • Day 2: 100mg daily at bedtime
  • Day 3: 200mg daily at bedtime
  • Day 4: 300mg daily at bedtime
• Average dose range: 50-300mg daily
• Maximum daily dose: 300mg daily

Major depressive episodes

• Starting dose of immediate-release tablets:
  • Day 1 and 2: 50mg at bedtime
  • Day 3: Dose may be increased to 150mg at bedtime
• Average dose range: 150-300mg daily
• Maximum daily dose: 300mg daily

 Alcohol dependence (off label)

Starting dose: 25-50mg at bedtime, the dose can be increased to a maximum dose of 300mg per day.

Insomnia (off-label)

Starting dose: 25mg at bedtime daily.

Psychosis, Agitation related to Alzheimer’s Dementia (off label)

Starting dose: 12.5mg to 50mg daily, the dosage can be increased to a maximum of 300mg daily.

Dosing for Children

Schizophrenia

Starting dose of immediate-release tablets for children who are 12 years of age and older:

• • Day 1: 25mg twice daily
  • Day 2: 50mg twice daily
  • Day 3: 100mg twice daily
  • Day 4: 150mg twice daily
  • Day 5: 200mg twice daily, further adjustments can be made in increments of 100mg a day.
• Average dose range: 400mg-800mg daily
• Maximum daily dose: 800mg daily

Starting dose of extended-release tablets for children who are 12 years of age and older

• • Day 1: 50mg daily
  • Day 2: 100mg daily
  • Day 3: 200mg daily
  • Day 4: 300mg daily
  • Day 5: 400 mg daily, further adjustments can be made in increments of 100mg a day.
• Maximum daily dose: 800mg daily.

Bipolar 1 disorder, mania

Starting dose of immediate-release tablets for children who are 10 years of age and older

• • Day 1: 25mg twice daily
  • Day 2: 50mg twice daily
  • Day 3: 100mg twice daily
  • Day 4: 150mg twice daily
  • Day 5: 200mg twice daily, if further adjustments are needed, increments can be increased by 100mg per day until the maximum dose of 800mg per day is achieved.
• Average dose range: 400-600mg daily
• Maximum daily dose: 600mg daily

Starting dose of extended-release tablets for children who are 10 years of age and older

• • Day 1: 50mg once daily
  • Day 2: 100mg once daily
  • Day 3: 200mg once daily
  • Day 4: 300mg once daily
  • Day 5: 400mg once daily, further adjustments can be made in increments of 100mg per day.
• Average dose range: 400-600mg daily
• Maximum daily dose: 600mg daily

Missed Dose

If you miss a dose of Seroquel, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not take two doses at the same time.

Overdose

If you overdose on Seroquel, serious side effects can develop. Symptoms of an overdose include drowsiness, dizziness, fainting, or a fast heartbeat. If you suspect an overdose, call the poison control helpline at 1-800-222-1222.

Side Effects

The most common side effects of Seroquel include:

• Speech problems
• Dizziness, drowsiness, or tiredness
• Fatigue
• Fast heart rate
• Congestion
• Increased appetite or weight gain
• Nausea, vomiting, or constipation
• Dry mouth
• Muscle pain or weakness
• Chills or cold sweats

Some serious side effects can also occur, check with your doctor if any of the following symptoms persist or become bothersome.

• Vision changes
• Decreased appetite
• Decreased energy or strength
• Burping
• Heartburn
• Increased muscle ton
• Sweating
• Sneezing
• Stomach upset
• Congestion or runny nose

Warnings and Precautions

Seroquel is contraindicated in those who have a known allergy or sensitivity to Seroquel or any of its ingredients.

Children

Seroquel is not approved for children younger than the age of 10.

Pregnancy

Seroquel may be used in pregnancy if the benefit outweighs the risk. There is a risk to the mother if psychiatric disorders are left untreated. The overall available data regarding Seroquel in pregnancy does not show an increase in major birth defects, miscarriage, or adverse maternal or fetal miscarriage. Seroquel may be used in pregnancy if the benefit outweighs the risk. Neonates exposed to antipsychotics during the third trimester have exhibited agitation, muscle rigidity, tremors respiratory distress, and feeding difficulties.

Lactation

Seroquel is not recommended while breastfeeding.

Dementia-Related Psychosis

Seroquel is not recommended in elderly patients with dementia-related psychosis. These patients exhibited a higher incidence of death and increased incidence of cerebrovascular events such as stroke and TIA.

Neuroleptic Malignant Syndrome

Some patients who have taken Seroquel have developed Neuroleptic Malignant Syndrome (NMS). NMS is associated with hyperreflexia, muscle rigidity, altered mental status, autonomic instability (irregular or fast heart rate and blood pressure, sweating, and cardiac arrhythmias), elevated creatine phosphokinase, rhabdomyolysis, and acute renal failure. If you experience any of these symptoms, the use of Seroquel should be discontinued.

Metabolic Changes

Atypical antipsychotic medications such as Seroquel have been associated with metabolic changes such as hyperglycemia, dyslipidemia, and weight gain.

Hyperglycemia and Diabetes Mellitus

Patients taking Seroquel should be monitored for hyperglycemia and should have a fasting blood glucose test before starting Seroquel and periodically throughout treatment.

Dyslipidemia

Some patients taking Seroquel have had an increase in lipid levels while receiving patients. Lipids should be monitored before and periodically while receiving treatment with Seroquel.

Weight Gain

There is a potential for weight gain while taking Seroquel. Patients should have their weight monitored while receiving treatment.

Tardive Dyskinesia

Some patients who have taken Seroquel have developed potentially irreversible, involuntary, and uncontrollable movements. The likelihood of developing tardive dyskinesia in patients who take Seroquel is unknown. Patients taking Seroquel should be monitored for facial grimacing, fish-like mouth movements, and involuntary tongue movements.

Orthostatic Hypotension/Syncope

Seroquel can cause orthostatic hypotension and syncope in some patients. Patients should be instructed about non-pharmacologic interventions to reduce the occurrence of syncopal episodes such as sitting on the edge of the bed for several minutes before attempting to stand. Caution should be used in patients with known cardiovascular disease and cerebrovascular disease.

Hypertension in Children and Adolescents

Hypertension has been reported in children and adolescents taking Seroquel. Blood pressure should be monitored prior to starting treatment and intermittently while receiving treatment.

Leukopenia, Neutropenia, and Agranulocytosis

Blood dyscrasias have been reported in some patients taking Seroquel. Patients with preexisting low white blood cell counts, low neutrophil counts, or a history of drug-induced leukopenia/neutropenia should be monitored routinely while taking Seroquel. Seroquel should be discontinued if severe neutropenia occurs.

Cataracts

Patients taking Seroquel have been observed to have lens changes with long-term use of Seroquel. Routine eye exams should occur every 6 months while receiving treatment.

Drug Interactions

This is not a complete list of potential drug interactions. Before taking Seroquel, tell your doctor if you take any medications, herbal supplements, or vitamins.

Medications that Cause Sedation

Many medications can increase the risk of side effects associated with Seroquel. Medications such as opioids, alcohol, marijuana, sleep or anxiety medications, muscle relaxants, and antihistamines should be discussed with your doctor before taking Seroquel. Taking Seroquel with any of these medications can result in an increased risk of drowsiness.

CYP3A4 inhibitors

This class of medications is known to increase the effects of Seroquel and should be avoided. (itraconazole, indinavir, ritonavir, nefazodone, etc.)

CYP3A4 inducers

This class of medications is known to reduce the effects of Seroquel and should be avoided. (phenytoin, carbamazepine, rifampin, avasimibe, St. John’s wort etc.)

Antihypertensive Agents

Seroquel may enhance the effects of antihypertensives, caution and monitoring should be used in patients taking antihypertensive medications.

Carbidopa/Levodopa

Seroquel may increase the effects of levodopa and dopamine agonists. Caution should be used in these patients.

Alternative Medications

There are other drugs available to treat schizophrenia and other psychiatric disorders. Speak to your doctor to discuss other medications.

First-Generation Typical Antipsychotic Medications

Typical Antipsychotics are an older class of drugs used in the treatment of schizophrenia. They work by blocking dopamine receptors in the brain and improving motor control, focus, mood, and emotions.

• Chlorpromazine (Thorazine), Fluphenazine (Prolixin), Haloperidol (Haldol), Perphenazine (Trilafon), Thioridazine (Mellaril), Thiothixene (Navane), Trifluoperazine (Stelazine)

Second Generation Atypical Antipsychotic Medications

Atypical antipsychotics are a newer class of antipsychotic medications used in the treatment of schizophrenia and bipolar disorder. They work by blocking the excitatory activity of dopamine and serotonin. Dopamine and serotonin regulate pleasure sensation, mood, behavior, and memory.

• Aripiprazole (Abilify), Aripiprazole lauroxil (Aristada), Brexpiprazole (Rexulti), Cariprazine (Vraylar), Clozapine (Clozaril), Iloperidone (Fanapt), Lumateperonee (Caplyta), Lurasidone (Latuda), Olanzapine (Zyprexa) , Olanzapine/samidorphan (Lybalvi), Paliperidone (Invega Sustenna), Paliperidone palmitate (Invega Trinza), Quetiapine (Seroquel), Risperidone (Risperdal), Ziprasidone (Geodon).

Mood Stabilizers

Mood stabilizers are an alternative to Seroquel for the treatment of bipolar disorder but not for the treatment of schizophrenia. Mood stabilizers work by regulating mood fluctuations and neurotransmitters in the brain.

• Topamax (Topiramate), Depakote (Divalproex sodium), Eskalith (Lithium), Depakene (Valproic Acid)

Frequently Asked Questions