From the Research
Quetiapine (Seroquel) can be used in patients with End-Stage Renal Disease (ESRD), typically without dose adjustment, as it is primarily metabolized by the liver, with less than 5% excreted unchanged in the urine, making it generally safe for ESRD patients. However, clinicians should start with lower doses (25-50mg daily) and titrate slowly while monitoring for side effects, as the overall frailty and comorbidity burden of ESRD patients may increase sensitivity to side effects, necessitating careful monitoring and individualized dosing 1. Patients on dialysis do not require supplemental doses after dialysis sessions since quetiapine is not significantly removed during hemodialysis. Common side effects to monitor include sedation, orthostatic hypotension, and metabolic changes (weight gain, hyperglycemia). Caution is warranted in ESRD patients with cardiovascular comorbidities due to potential QT prolongation.
Some key considerations when prescribing quetiapine to ESRD patients include:
- Starting with lower doses and titrating slowly to minimize the risk of side effects
- Monitoring for signs of orthostatic hypotension, sedation, and metabolic changes
- Being aware of the potential for QT prolongation, particularly in patients with cardiovascular comorbidities
- Considering the overall frailty and comorbidity burden of the patient when determining the optimal dose and monitoring plan
- Recognizing that quetiapine is not significantly removed during hemodialysis, and therefore does not require supplemental doses after dialysis sessions 1.
It's also important to note that while quetiapine may be safe for use in ESRD patients, its use has been associated with an increased risk of acute kidney injury and other adverse outcomes in older adults, highlighting the need for careful monitoring and individualized care 1.