From the Guidelines
Quetiapine dosage does not require adjustment for patients with renal impairment, but caution and close monitoring for adverse effects are advised, especially in severe renal impairment. According to the british thoracic society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (ntm-pd) 1, no dose adjustment is required for patients with renal impairment. However, it is noted that two primary metabolites may accumulate in severe renal impairment, and the clinical significance of this is unknown. Some key points to consider when prescribing quetiapine to patients with renal impairment include:
- No initial dose adjustment is necessary for patients with mild to moderate kidney dysfunction.
- For patients with severe renal impairment, caution is advised, and close monitoring for adverse effects is recommended.
- Quetiapine is primarily metabolized by the liver, which explains why renal function has minimal impact on the drug's clearance.
- Healthcare providers should monitor patients with severe renal impairment more closely for side effects such as sedation, orthostatic hypotension, and anticholinergic effects, as drug accumulation could theoretically occur in severe renal failure, as noted in the guidelines 1.
From the Research
Quetiapine Dosage Adjustment for Renal Function
- The dosage adjustment of quetiapine for patients with impaired renal function is not necessary, as indicated by a study published in 2000 2.
- This study found no clinically significant differences in the pharmacokinetic parameters of quetiapine in subjects with renal impairment compared to healthy control subjects.
- Another study published in 2001 3 also suggests that the pharmacokinetics of quetiapine are not altered by renal impairment.
- However, it is essential to note that quetiapine is primarily eliminated through hepatic metabolism, and its clearance may be affected by hepatic impairment rather than renal impairment 3.
- A study published in 2007 4 emphasizes the importance of drug dosing adjustments in patients with chronic kidney disease, but this is more relevant to drugs that are cleared renally.
- In the case of quetiapine, the available evidence suggests that dosage adjustment for renal function may not be necessary, but it is crucial to consider the individual patient's overall health and potential interactions with other medications 2, 3.
- A review of drug information sources published in 2014 5 highlights the inconsistency in dosing recommendations for patients with renal impairment, emphasizing the need for an evidence-based approach to drug dosage adjustment.
- A systematic review published in 2021 6 focuses on the use of antipsychotics in patients undergoing hemodialysis, but it does not provide specific guidance on quetiapine dosage adjustment for renal function.