Can Quetiapine (quetiapine) be given to a patient with a history of seizures?

From the Guidelines

Quetiapine can be given to patients with seizures, but with caution and careful monitoring, as it has a relatively lower seizure risk compared to other antipsychotics. When prescribing quetiapine to these patients, it is essential to start with a low dose (typically 25 mg daily) and increase gradually while monitoring for seizure activity, as indicated in the study by 1. The recommended maintenance dose ranges from 150-800 mg daily depending on the indication, with lower doses for elderly patients or those with hepatic impairment. Quetiapine works by blocking multiple neurotransmitter receptors, including dopamine D2 and serotonin 5-HT2A, which contributes to its relatively lower seizure threshold impact compared to medications like clozapine or chlorpromazine.

Some key points to consider when prescribing quetiapine to patients with seizures include:

• Starting with a low dose and gradually increasing as needed and tolerated
• Monitoring for breakthrough seizures, especially during dose adjustments
• Considering dose reduction or switching to another medication with even lower seizure risk, such as aripiprazole or risperidone, if seizures occur or worsen while on quetiapine
• Being aware of the potential for quetiapine to cause orthostatic hypotension, dizziness, and sedation, as noted in the study by 1

It is also important to note that the management of seizures in patients with epilepsy or seizure disorders requires a comprehensive approach, including the use of antiepileptic medications, as discussed in the study by 1. However, quetiapine is not typically used as a first-line treatment for seizures, and its use in this context should be carefully considered and monitored.

In terms of the evidence, the study by 1 provides guidance on the use of quetiapine in patients with delirium, including those with seizures, and highlights the importance of careful dosing and monitoring. The study by 1 discusses the management of seizures in the emergency department, including the use of antiepileptic medications, and provides context for the use of quetiapine in this setting. Overall, the use of quetiapine in patients with seizures requires careful consideration and monitoring, and should be guided by the latest evidence and clinical guidelines.

From the FDA Drug Label

5.13 Seizures During clinical trials, seizures occurred in 0.5% (20/3490) of patients treated with quetiapine compared to 0.2% (2/954) on placebo and 0. 7% (4/527) on active control drugs. As with other antipsychotics, quetiapine should be used cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold, e.g., Alzheimer’s dementia.

Quetiapine use in patients with seizure history: Quetiapine can be given to patients with a history of seizures, but it should be used cautiously. The drug label recommends careful consideration in patients with conditions that potentially lower the seizure threshold. 2

From the Research

Quetiapine Administration in Patients with Seizure

• Quetiapine can be associated with an increased risk of seizures, particularly in patients with conditions that lower the seizure threshold, such as Alzheimer's disease 3.
• The risk of seizures may be higher with relatively high doses of quetiapine, and caution should be exercised when using this medication in elderly patients with such conditions 3.
• Other antipsychotic drugs, such as clozapine, also carry a risk of seizure induction, while quetiapine, risperidone, amisulpride, and aripiprazole seem to pose a lower risk 4.
• To minimize the risk of seizures, it is recommended to start with a small dose of antipsychotic drug, titrate slowly, monitor serum levels, and keep the drug at the minimal effective dose 4.

Antiepileptic Drugs and Seizure Control

• Valproate, lamotrigine, and topiramate have been shown to be effective in treating generalized tonic-clonic, tonic, and clonic seizures, with lamotrigine having the highest probability of presenting the outcome "Seizure free" 5.
• Valproate and ethosuximide are considered the best options for the treatment of absence seizures, promoting better control of seizures 5.
• Levetiracetam, lamotrigine, oxcarbazepine, topiramate, and valproate have demonstrated favorable efficacy in ameliorating the severity of post-seizure condition 6.
• The choice of antiepileptic drug and dosage should be individualized based on the patient's specific condition and medical history, and regular monitoring is necessary to adjust the treatment plan as needed 7.