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Quetiapine fumarate
Quetiapine fumarate (Seroquel)
Quetiapine fumarate
(kweh-TYE-ah-peen)
Pregnancy Category: C Seroquel (Rx)

Classification: Antipsychotic drug

Action/Kinetics: Mechanism unknown but may act as an antagonist at dopamine D₂ and serotonin 5HT₂ receptors. Side effects may be due to antagonism of other receptors (e.g., histamine H₁, dopamine D₁, adrenergic alpha-1 and alpha-2, serotonin 5HT_1A). Rapidly absorbed. Peak plasma levels: 1.5 hr. Metabolized by liver and excreted through urine and feces. t1/2, terminal: About 6 hr.

Uses: Management of psychoses.

Contraindications: Lactation.

Special Concerns: Use with caution in liver disease, in those at risk for aspiration pneumonia, and in those with history of seizures or conditions that lower seizure threshold (e.g., Alzheimer's). Safety and efficacy have not been determined in children.

Side Effects: Side effects with incidence of 1% or more are listed. Body as a whole: Asthenia, rash, fever, weight gain, back pain, flu syndrome. CNS: Headache, somnolence, dizziness, hypertonia, dysarthria. GI: Constipation, dry mouth, dyspepsia, anorexia, abdominal pain. CV: Orthostatic hypotension, syncope, tachycardia, palpitation. Respiratory: Pharyngitis, rhinitis, increased cough, dyspnea. Miscellaneous: Peripheral edema, hyperprolactinemia, sweating, leukopenia, ear pain. NOTE: Neuroleptic malignant syndrome and seizures although rare, may occur.

Laboratory Test Alterations: ALT during initial therapy, AST, total cholesterol, triglycerides.

Overdose Management: Symptoms: Drowsiness, sedation, tachycardia, hypotension, dystonic reaction of the head and neck, seizures, obtundation. Treatment: Cardiovascular monitoring for arrhythmias. If antiarrhythmic therapy is used, disopyramide, procainamide, and quinidine increase risk of prolongation of QT. Treat hypotension and circulatory shock with IV fluids or sympathomimetic drugs (do not use epinephrine or dopamine as they may worsen hypotension). Use anticholinergic drugs to treat severe extrapyramidal symptoms.

Drug Interactions: Barbiturates / Effect of quetiapine due to breakdown by liver Carbamazepine / Effect of quetiapine due to breakdown by liver Dopamine agonists / Quetiapine antagonizes effect Glucocorticoids / Effect of quetiapine due to breakdown by liver Levodopa / Quetiapine antagonizes effect Phenytoin / Effect of quetiapine due to breakdown by liver Rifampin / Effect of quetiapine due to breakdown by liver Thioridazine / Clearance of quetiapine

How Supplied: Tablets: 25 mg, 100 mg, 200 mg

Dosage
•Tablets Psychoses.
Initial: 25 mg b.i.d., with increases of 25 to 50 mg b.i.d. or t.i.d. on second and third day, as tolerated. Target dose range, by fourth day, is 300 to 400 mg daily. Further dosage adjustments can occur at intervals of two or more days. The antipsychotic dose range is 150 to 750 mg/day.