Seroquel: Atypical Antipsychotic for Schizophrenia and Bipolar Disorder Management
Seroquel
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| Product dosage: 200mg | |||
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| Product dosage: 300mg | |||
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Synonyms | |||
Seroquel (quetiapine) is an atypical antipsychotic medication indicated for the treatment of schizophrenia, bipolar disorder, and as adjunctive therapy in major depressive disorder. It functions primarily as an antagonist at multiple neurotransmitter receptors, including serotonin and dopamine receptors, which contributes to its efficacy in managing both positive and negative symptoms of psychiatric conditions. Its well-established pharmacokinetic profile and extensive clinical trial data support its position as a foundational psychopharmacological agent. This medication requires precise dosing and medical supervision to optimize therapeutic outcomes while minimizing potential adverse effects.
Features
- Active Ingredient: Quetiapine fumarate
- Pharmacological Class: Dibenzothiazepine derivative, atypical antipsychotic
- Available Formulations: Immediate-release (IR) tablets: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg; Extended-release (XR) tablets: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg
- Receptor Binding Profile: Antagonist activity at serotonin 5-HT2A, dopamine D2, histamine H1, and adrenergic α1 and α2 receptors
- Bioavailability: Approximately 100% for immediate-release formulation
- Half-life: IR: ~6 hours; XR: ~7 hours
- Metabolism: Primarily hepatic via cytochrome P450 3A4 isoenzyme
- Excretion: Primarily renal (73%) and fecal (20%)
Benefits
- Effectively reduces positive symptoms of schizophrenia, including hallucinations and delusions
- Demonstrates significant efficacy in managing acute manic and depressive episodes associated with bipolar I disorder
- Improves negative symptoms of schizophrenia, such as social withdrawal and affective flattening
- Provides rapid onset of sedative effects beneficial for agitation and sleep disturbances
- Lower incidence of extrapyramidal symptoms compared to conventional antipsychotics
- Established long-term maintenance therapy supporting relapse prevention
Common use
Seroquel is primarily prescribed for the treatment of schizophrenia in adults and adolescents aged 13 years and older. It is also approved for acute manic episodes associated with bipolar I disorder, both as monotherapy and adjunctive therapy, and for bipolar depression. Additionally, it is used as adjunctive treatment in major depressive disorder when response to antidepressant monotherapy is inadequate. Off-label uses may include anxiety disorders, insomnia, and dementia-related behavioral disturbances, though these applications require careful risk-benefit assessment.
Dosage and direction
Schizophrenia:
- Adults: Initial dose 25 mg twice daily, increase by 25-50 mg divided two to three times daily to target range of 300-400 mg daily by day 4
- Maintenance: 300-800 mg daily
- Adolescents (13-17 years): Initial dose 25 mg twice daily, titrate to target dose of 400-800 mg/day
Bipolar Mania:
- Initial: 50 mg twice daily, increase to 200 mg twice daily by day 4, then further increases of up to 200 mg daily to maximum 800 mg/day
Bipolar Depression:
- Initial: 50 mg once daily at bedtime, increase to 300 mg/day by day 4
Major Depressive Disorder (adjunct):
- Initial: 50 mg once daily, increase to 150 mg daily
Extended-release formulation should be taken once daily, preferably in the evening without food or with a light meal. Tablets should be swallowed whole and not crushed, chewed, or divided.
Precautions
- Requires regular monitoring of metabolic parameters including weight, blood glucose, and lipid profile
- Orthostatic hypotension may occur, particularly during initial dose titration
- Cataract formation has been reported in animal studies; regular ophthalmological examinations recommended
- May impair cognitive and motor performance; caution when operating machinery
- Temperature regulation dysfunction may occur; advise patients about heat exposure and dehydration
- Use with caution in patients with cardiovascular disease, cerebrovascular disease, or conditions that would predispose to hypotension
- Regular assessment for emergence of suicidal ideation and behavior is recommended
Contraindications
- Hypersensitivity to quetiapine or any component of the formulation
- Concomitant use with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, indinavir, ritonavir, clarithromycin
- History of neuroleptic malignant syndrome
- Severe hepatic impairment
- Dementia-related psychosis (increased mortality risk in elderly patients with dementia-related psychosis)
Possible side effect
Very common (>10%):
- Somnolence (dose-related)
- Dry mouth
- Dizziness
- Constipation
- Weight gain
- Dyspepsia
Common (1-10%):
- Orthostatic hypotension
- Tachycardia
- Increased appetite
- Fatigue
- Elevated liver enzymes
- Extrapyramidal symptoms
- Hyperprolactinemia
Uncommon (0.1-1%):
- Syncope
- Leukopenia
- Neutropenia
- Seizures
- Priapism
- Neuroleptic malignant syndrome
Rare (<0.1%):
- Pancreatitis
- Stevens-Johnson syndrome
- Tardive dyskinesia
- Diabetic ketoacidosis
Drug interaction
- Strong CYP3A4 inhibitors (ketoconazole, itraconazole, HIV protease inhibitors, macrolide antibiotics): Increase quetiapine exposure; dose reduction required
- Strong CYP3A4 inducers (phenytoin, carbamazepine, rifampin, St. John’s wort): Decrease quetiapine exposure; dose adjustment may be necessary
- Antihypertensive agents: Enhanced hypotensive effects
- CNS depressants (alcohol, benzodiazepines, opioids): Additive sedative effects
- Dopamine agonists: May diminish effectiveness
- Drugs that prolong QTc interval: Additive effects on cardiac repolarization
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take double or extra doses to make up for a missed dose. For extended-release formulations, the tablet should not be divided or crushed if attempting to make up a partial dose.
Overdose
Seroquel overdose may present with drowsiness, sedation, tachycardia, hypotension, and anticholinergic effects. QTc prolongation and coma may occur in large overdoses. Management includes supportive care with continuous cardiac monitoring, maintaining airway patency, and ensuring adequate oxygenation. Gastric lavage may be considered if presented early. There is no specific antidote; activated charcoal may be administered if the patient presents within 1-2 hours of ingestion. Hemodialysis is unlikely to be beneficial due to high protein binding.
Storage
Store at controlled room temperature 20-25°C (68-77°F). Keep in original container, tightly closed, and protect from moisture and light. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Do not store in bathroom cabinets where moisture levels may fluctuate.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Seroquel is a prescription medication that should only be used under the supervision of a qualified healthcare professional. Individual response to medication may vary, and proper diagnosis and treatment planning require comprehensive medical evaluation. Patients should not initiate, discontinue, or change dosage without consulting their prescribing physician.
Reviews
Clinical studies demonstrate Seroquel’s efficacy across multiple psychiatric indications. In 6-week controlled trials for schizophrenia, quetiapine showed significant improvement in PANSS scores compared to placebo (p<0.001). Bipolar depression studies revealed significant improvement in MADRS scores at week 8 (p<0.001). Long-term maintenance studies support its role in relapse prevention, though metabolic side effects require ongoing monitoring. Real-world evidence confirms its utility in clinical practice, particularly for patients who cannot tolerate other antipsychotic medications.