Quetiapine (Seroquel): Uses, Dose, and Side Effects

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Quetiapine (Seroquel) is an atypical antipsychotic that is mainly used in the treatment of schizophrenia and bipolar disorder. Atypical means that quetiapine is less likely than older antipsychotics to cause side effects, and more likely to be effective in the treatment of symptoms such as lack of motivation and social withdrawal. It works by increasing the levels of certain neurotransmitters (chemicals) in the brain, such as dopamine and serotonin. Quetiapine can decrease hallucinations, help you to think more clearly and positively, feel at ease, and be active. Mood, sleep, appetite, and energy level are also improved by quetiapine. It can prevent severe mood swings or decrease how often they occur. Its uses, dose, and side effects are discussed below.

A pack of 30 quetiapine (Seroquel) tablets.
Quetiapine (Seroquel) (Picture Credit: https://thedrugclassroom.com/)

Uses of Quetiapine

(Cunha, 2017) (WebMD, n.d.) (Multum, 2019)

Quetiapine is used to treat:

  • Schizophrenia in adults and children who are at least 13 years old
  • Bipolar disorder in adults and children who are at least 10 years old, particularly mania and associated depression
  • Major depression in adults, together with antidepressant medications

Quetiapine may also be used for purposes not listed here. Quetiapine is not approved for use in children younger than 10 years, and in older adults with dementia-related conditions because it increases the risk of death. Do not use quetiapine if you are allergic to it.

Quetiapine calms and sedates, and reduces the incidence of psychotic thoughts in people with schizophrenia. It also helps to calm acute manic episodes in people with bipolar disorder. It may be used as the sole therapy or in addition to lithium or divalproex. When used as maintenance therapy for manic episodes in bipolar disorder, it is best used in addition to lithium or divalproex. It may be used as sole therapy for the treatment of depressive episodes in people with bipolar disorder. It may also be used off-label for other conditions such as generalized anxiety disorder.

Dose of Quetiapine

(Cunha, 2017) (WebMD, n.d.) (Multum, 2019)

The dose is based on your medical condition, how you respond to treatment, and other medications you may be taking. To reduce your risk of side effects, quetiapine may be started at a low dose and the dose increased gradually.

It is usually prescribed to be taken 2 or 3 times daily. Seroquel may be taken with or without food, but Seroquel XR should be taken without food or with a light meal. The doses of quetiapine will typically be lower in children and elderly than those listed below.

In an attempt to improve faster, if you increase the dose on your own, or try taking the medication more often or for longer than prescribed, you will only be increasing the risk of serious side effects, and will not improve any faster.

Beneficial effects on mood may be seen within two weeks. Do not stop taking quetiapine on your own without consulting your doctor, even if you are feeling better. Otherwise, it may result in a relapse or worsening of symptoms.

Quetiapine dose should be tapered off gradually. Stopping it abruptly may cause a discontinuation syndrome; symptoms include nausea, insomnia, headache, diarrhea, vomiting, irritability, and dizziness.

Dose for Schizophrenia

To begin with, started off on 25 mg orally 2 times a day, followed by increase in 25 to 50 mg increments, given in divided doses 2 or 3 times daily, on days 2 and 3, reaching up to 300 to 400 mg orally per day, given in divided doses, on day 4.

Depending on the response to treatment, further dose adjustments should be made in 25 to 50 mg increments twice a day in intervals of not less than 2 days. The maintenance dose is 150 to 750 mg orally per day in divided doses. The maximum dose is 750 mg/day.

Dose for Bipolar Disorder

Mania treatment: Started off with 50 mg orally 2 times a day on day 1, and increased by 50 mg per day till day 4. Depending on the response to treatment, further dose adjustments should be made in increments of no greater than 200 mg/day. The maintenance dose is 400 to 800 mg per day in divided doses, with the maximum dose allowed being 800 mg/day.

Bipolar depression treatment: Started off on Day 1 with 50 mg orally once a day at bedtime, increased by 50 mg on Day 2, and by 100 mg on days 3 and 4. The maintenance dose is 300 mg orally once a day at bedtime. The maximum dose is 300 mg/day.

Dose for Major Depression

In this, Seroquel XR tablets are used. Start off on Day 1 with 50 mg orally once a day, continue the same on Day 2, and increase to 150 mg orally once a day on day 3. The maintenance dose is 150 mg to 300 mg orally once a day. The maximum dose is 300 mg/day.

In Case of Missed Dose

Take the missed dose as soon as you remember, provided the time is not close to the next scheduled dose. Do not take two doses at one time.

In Case of Overdose

If someone has overdosed and has serious symptoms such as severe drowsiness, loss of consciousness or trouble breathing, call emergency services.

Things to Avoid While Taking Quetiapine

You should avoid drinking alcohol. Otherwise, dangerous side effects could occur.

Avoid driving or hazardous activity until you know that quetiapine is not causing dizziness or drowsiness in you. If you do not follow this precaution, it can cause falls, accidents, or severe injuries.

Avoid getting up too fast from a sitting or lying down position, because it can cause a sudden drop in blood pressure, leading to dizziness.

Stay hydrated and cool during exercise and in hot weather. Otherwise, you risk having a heat stroke.

Quetiapine Side Effects

(Cunha, 2017) (WebMD, n.d.) (Multum, 2019)

Common side effects of quetiapine include:

  • Dizziness, drowsiness, tiredness
  • Confusion
  • Lack of energy
  • Headache
  • Fast heartbeats
  • Stuffy or runny nose
  • Increased appetite and weight gain
  • Indigestion, vomiting, constipation
  • Dry mouth
  • Speech problems like slurring
  • Increased blood sugar and cholesterol
  • Sudden fall in blood pressure if standing up too quickly from a lying down or sitting position
  • Abnormal liver function tests

Less common side effects include:

  • Mood or behavior changes
  • Muscle rigidity
  • Black, tarry stools
  • Blurred vision
  • Chest pain
  • Cough
  • Restlessness
  • Lip smacking or puckering
  • Mask-like face
  • Shakiness in the legs, arms, hands, or feet
  • Shuffling walk and slowed movements
  • Sweating
  • Uncontrolled chewing movements
  • Uncontrolled movements of the arms and legs
  • Uncontrolled twisting movements of the neck, trunk, arms, or legs
  • Dry, puffy skin
  • Unusual secretion of milk (in females)
  • Allergic reaction: Symptoms include skin rash, difficulty in breathing, swelling in your face or throat. Get emergency medical help.
  • A severe skin reaction, characterized by red or purple skin rash with blistering and peeling, skin pain, fever, sore throat, and burning eyes. Get emergency medical help.
  • Tardive dyskinesia: Manifests as unusual/uncontrolled movements of the face, lips, mouth, tongue, arms or legs.
  • Neuroleptic malignant syndrome (NMS): Get emergency medical help if you have some of the following symptoms: muscle stiffness/pain/tenderness/weakness, severe tiredness, severe confusion, fever, sweating, fast/irregular heartbeat, dark urine, and change in the amount of urine.
  • Some people have thoughts about suicide while taking quetiapine. Stay alert to changes in your mood or symptoms and report them immediately to your doctor.
  • Quetiapine use in older adults with dementia-related conditions may prove fatal.

Quetiapine Use during Pregnancy and Breastfeeding

This drug is only recommended for use during pregnancy when there are no alternatives and benefit outweighs risk. Neonates exposed to antipsychotic drugs during the third trimester of pregnancy are at risk for extrapyramidal and/or withdrawal symptoms following delivery such as agitation, changes in muscle tone, tremor, drowsiness, respiratory distress and feeding disorder.

Quetiapine passes into milk, so its use is not recommended during breastfeeding. A decision should be made to discontinue breastfeeding or discontinue the drug, depending on the importance of the drug to the mother. Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.

Interactions

More than 600 drugs are known to interact with quetiapine. Out of these, more than 100 are major drug interactions.

The risk of a heart problem with quetiapine may be higher if you also use certain other medicines for infections, asthma, heart problems, high BP, depression, cancer, malaria, or HIV.

Other medications that affect the removal of quetiapine from your body, which may affect how quetiapine works, are certain antifungals, anti-TB drug rifampicin, and drugs used to treat seizures, such as phenytoin.

Other interactions are with opioid pain or cough relievers, alcohol, marijuana, drugs used for sleep or anxiety, muscle relaxants, or antihistamines.

References and Bibliography

Brunton, L., 2018. Goodman & Gilman’s The Pharmacological Basis of Therapeutics. 13 ed. New York: McGraw Hill.

Cunha, J., 2017. Quetiapine. [Online]
Available at: https://www.rxlist.com/consumer_quetiapine_seroquel_seroquel_xr/drugs-condition.htm
[Accessed 29 Aug 2019].

Cunha, J., 2017. Seroquel. [Online]
Available at: https://www.rxlist.com/seroquel-side-effects-drug-center.htm
[Accessed 29 Aug 2019].

Multum, C., 2019. Quetiapine. [Online]
Available at: https://www.drugs.com/mtm/quetiapine.html
[Accessed 29 Aug 2019].

Ritter, J. et al., 2020. Rang and Dale’s Pharmacology. 9 ed. Edinburgh: Elsevier.

WebMD, n.d. Quetiapine Fumarate. [Online]
Available at: http://www.webmd.com/drugs/2/drug-4689-8274/quetiapine-oral/quetiapine-oral/details
[Accessed 29 Aug 2019].

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Quetiapine (Seroquel): Uses, Dose, and Side Effects
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Quetiapine (Seroquel): Uses, Dose, and Side Effects
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Quetiapine (Seroquel) is an atypical antipsychotic that is used in the treatment of schizophrenia, and mania and depression of bipolar disorder.
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DepressionPedia.org

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