Name Quetiapine
Classes Central Nervous System Agent
Psychotherapeutic Agent
Atypical Antipsychotic
Diseases Bipolar Disorder
Depression
Mental Disorder
Schizophrenia

Quetiapine

Quetiapine belongs to a class of drugs called the Atypical Antipsychotics. The mechanism of action of quetiapine involves 5-HT2A/D2 antagonism and 5-HT1A partial agonism. 

 

Quetiapine is indicated for the following conditions-

  • Schizophrenia 
  • Bipolar Disorder 

 

Schizophrenia-Adults

  • Initial Dose: 25 mg twice daily 
  • Recommended Dose: 150-750 mg/day
  • Maximum  Dose: 750 mg/day 

Schizophrenia (Adolescents)

  • Initial Dose:25 mg twice daily  
  • Recommended Dose: 400-800 mg/day
  • Maximum  Dose: 800 mg/day

Bipolar Mania-Adults Monotherapy or as an adjunct to lithium or divalproex

  • Initial Dose: 50 mg twice daily
  • Recommended Dose: 400– 800 mg/day 
  • Maximum Dose: 800 mg/day 

Bipolar Mania Children and Adolescents (10 to 17 years), Monotherapy

  • Initial Dose: 25 mg twice daily  
  • Recommended Dose: 400-600 mg/day
  • Maximum  Dose: 600 mg/day 

Bipolar Depression (Adults)

  • Initial Dose: 50 mg once daily at bedtime
  • Recommended Dose: 300 mg/day
  • Maximum  Dose: 300 mg/day

Most commonly reported side effects associated with the use of Quetiapine include-

  • Dizziness
  • somnolence
  • headache
  • extrapyramidal symptoms
  • Dry mouth
  • hypertriglyceridemia
  • hypercholesterolemia
  • Weight gain
  • Leucopenia
  • decreased neutrophil count
  • eosinophilia
  • Cerebrovascular Adverse Reactions: Increased incidence of cerebrovascular adverse events (e.g., stroke, transient ischemic attack) has been seen in elderly patients with dementia-related psychoses treated with atypical antipsychotic drugs
  • Neuroleptic Malignant Syndrome (NMS): Manage with immediate discontinuation and close monitoring
  • Metabolic Changes: Atypical antipsychotics have been associated with metabolic changes. These metabolic changes include hyperglycemia, dyslipidemia, and weight gain 
  • Hyperglycemia and Diabetes Mellitus: Monitor patients for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Monitor glucose regularly in patients with diabetes or at risk for diabetes 
  • Dyslipidemia: Undesirable alterations have been observed in patients treated with atypical antipsychotics. Appropriate clinical monitoring is recommended, including fasting blood lipid testing at the beginning of, and periodically, during treatment
  • Weight Gain: Gain in body weight has been observed; clinical monitoring of weight is recommended
  • Tardive Dyskinesia: Discontinue if clinically appropriate 
  • Hypotension: Use with caution in patients with known cardiovascular or cerebrovascular disease
  • Increased Blood Pressure in Children and Adolescents: Monitor blood pressure at the beginning of, and periodically during treatment in children and adolescents
  • Leukopenia, Neutropenia and Agranulocytosis: Monitor complete blood count frequently during the first few months of treatment in patients with a pre-existing low white cell count or a history of leukopenia/neutropenia and discontinue Quetiapine at the first sign of a decline in WBC in absence of other causative factors
  • Cataracts: Lens changes have been observed in patients during long-term quetiapine treatment. Lens examination is recommended when starting treatment and at 6-month intervals during chronic treatment 

Contraindication

Contraindicated in patients hypersensitive to any component of the medication.