Adult Dosing
Schizophrenia
Immediate release
- Start 25 mg PO bid
- Titrate: Increase by 25–50 mg bid-tid over 3 days, up to 300–400 mg/day divided bid-tid by the 4th day. Max: 800 mg/day
- Usual range: 150-750 mg/day
Extended release
- Start 300 mg PO in the evening; can increase by 300 mg/day, up to 400–800 mg/day. Max: 800 mg/day
Bipolar disorder, Depressive
- Immediate–release or extended-release: 50 mg PO at bedtime on Day 1, 100 mg PO at bedtime on Day 2, then 200 mg PO at bedtime on Day 3, then 300 mg PO qd at bedtime thereafter
- Doses > 300 mg rarely more effective. Max: 600 mg/day
Bipolar disorder, manic
Immediate release
- Start 50 mg PO bid
- Titrate: Can increase by 100 mg/day up to 200 mg PO bid by day 4, then may increase by 200 mg/day PRN
- Max: 800 mg/day
Extended release
- Start 300 mg PO at bedtime on Day 1, 600 mg PO at bedtime on Day 2, then 400–800 mg PO qd starting on Day 3
- Max: 800 mg/day
Elderly or debilitated
- Start 50 mg PO qpm, then increase by 25-50 mg/day
Obsessive-compulsive disorder [Non-FDA Approved]
Pediatric Dosing
Note: Safety and effectiveness of extended release tablets have not been established in pediatric patients.
Schizophrenia
Child 13-17 yrs
- Start dose: 25 mg PO bid x 1 day, then 50 mg bid x 1 day, then increase by 100 mg/day upto 200 mg PO bid by day 5, then may increase 50-100 mg/day PRN
- Range: 400-800 mg/day divided bid-tid
- Max: 800 mg/day
Bipolar disorder, manic
Child 13-17 yrs
- Start dose: 25 mg PO bid x 1 day, then 50 mg bid x 1 day, then increase by 100 mg/day up to 200 mg PO bid by day 5, then may increase 50-100 mg/day PRN
- Range: 400-600 mg/day divided bid-tid
- Max: 600 mg/day
[Outline]
See Supplemental Patient Information
- Quetiapine is not approved for dementia-related psychosis due to increased risk of death as compared to placebo. Elderly patients with dementia related psychosis are at an increased risk of death. During a typical 10 week trial, the death rate in drug treated patients was about 4.5% compared to 2.6% in placebo group. Most deaths were due to cardiovascular or infectious events, with the extent to which mortality being due to the antipsychotic vs patient characteristics was not clear [US Black Box Warning]
- Carefully weigh risk vs benefit and observe all patients for clinical worsening, suicidality or unusual changes in behavior
- Ketoacidosis, hyperosmolar coma and death have been reported. Monitor for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Perform blood glucose testing before and during treatment in patients with DM risk factors
- Administration of therapy may cause Neuroleptic Malignant Syndrome (NMS). Manage with immediate discontinuation and close monitoring
- Dizziness, tachycardia and syncope have been reported especially during the initial dose titration period. Use with caution in patients with known cardiovascular or cerebrovascular disease
- Drug may lead to leukopenia, neutropenia and agranulocytosis. Frequently monitor CBC count during the first few months of treatment in patients with a pre-existing low WBC count or hx of leukopenia/neutropenia. Discontinue therapy at the first sign of a decline in WBC in absence of other causative factors
- Lens changes have been observed in patients during long term quetiapine treatment. Perform lens examination when starting treatment and at 6 month intervals during chronic treatment
- Monitor for symptoms of hypothyroidism
- The possibility of a suicide attempt is inherent in schizophrenia, and close supervision of high risk patients should accompany drug therapy
- Blood pressure should be measured at the beginning of, and periodically during treatment in children and adolescents
- Undesirable alterations in lipids have been observed; clinical monitoring is recommended, including fasting blood lipid testing at the beginning of, and periodically during treatment
- Patient may experience some weight gain
- Care is advised when prescribing the drug to patients who are prone to conditions contributing to an elevation in the core body temperature, e.g., exercising strenuously, exposure to extreme heat, receiving concomitant anticholinergic medication, or being subject to dehydration
Cautions: Use cautiously in
Supplemental Patient Information
- Patients are advised not to perform hazardous work or activities requiring mental alertness and should not operate motor vehicle or other machinery as the drug may cause somnolence or sedation
Pregnancy Category:C
Breastfeeding: Is secreted in breast milk in minimal amounts. Limited published experience with quetiapine during breastfeeding, hence other antipsychotic agents are preferred especially while nursing a newborn or preterm infant. An exclusively breastfed infant would receive an average 0.09% of the weight-adjusted maternal dosage. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 26 November 2010).
Pricing data from www.DrugStore.com in U.S.A.
- SEROquel XR 150 MG TB24 [Bottle] (ASTRAZENECA)
60 mg = $597.99
180 mg = $1685.97 - SEROquel 300 MG TABS [Bottle] (ASTRAZENECA)
60 mg = $969.96
180 mg = $2880.07 - QUEtiapine Fumarate 25 MG TABS [Bottle] (LUPIN PHARMACEUTICALS)
100 mg = $35.99
200 mg = $65.97 - SEROquel 400 MG TABS [Bottle] (ASTRAZENECA)
30 mg = $575.97
90 mg = $1610.03 - SEROquel XR 200 MG TB24 [Bottle] (ASTRAZENECA)
60 mg = $673.96
180 mg = $1980.98 - SEROquel XR 400 MG TB24 [Bottle] (ASTRAZENECA)
60 mg = $1022.95
180 mg = $3010.84 - SEROquel 200 MG TABS [Bottle] (ASTRAZENECA)
60 mg = $715.99
180 mg = $2089.02 - SEROquel XR 300 MG TB24 [Bottle] (ASTRAZENECA)
60 mg = $880.02
180 mg = $2589.9 - SEROquel 100 MG TABS [Bottle] (ASTRAZENECA)
60 mg = $396.98
180 mg = $1158.98 - SEROquel 50 MG TABS [Bottle] (ASTRAZENECA)
100 mg = $625
300 mg = $1832.93 - SEROquel XR 50 MG TB24 [Bottle] (ASTRAZENECA)
60 mg = $337.99
180 mg = $953.01 - SEROquel 25 MG TABS [Bottle] (ASTRAZENECA)
60 mg = $212.09
180 mg = $607.9
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
