From the Guidelines
Seroquel (quetiapine) can lower the seizure threshold, although the risk is relatively low and typically dose-dependent. The evidence suggests that antipsychotic medications, including quetiapine, can lower the seizure threshold in a dose-dependent manner, with the risk being rare (usually <1%) when therapeutic doses are used 1. It is essential to note that the risk of seizures with quetiapine is higher at doses above 600mg daily. Patients with pre-existing seizure disorders, brain injuries, or those taking other medications that lower the seizure threshold should use quetiapine with caution. Some key points to consider when prescribing quetiapine include:
- Monitoring patients starting quetiapine, especially during dose adjustments
- Using caution in patients with a history of seizures and considering alternative antipsychotics with lower seizure risk
- Ensuring patients report any unusual muscle movements, confusion, or loss of consciousness promptly to their healthcare provider
- Being aware of the potential for quetiapine to affect various neurotransmitter systems, particularly dopamine and serotonin pathways, which can alter neuronal excitability 1. Overall, while the risk of seizures with quetiapine is low, healthcare providers should be aware of this potential side effect and take necessary precautions to minimize the risk, particularly in vulnerable patient populations.
From the FDA Drug Label
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. 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.
Seroquel (quetiapine) may lower the seizure threshold in certain patients, particularly those with a history of seizures or conditions that potentially lower the seizure threshold, such as Alzheimer's dementia.
- The incidence of seizures in patients treated with quetiapine was 0.5% compared to 0.2% on placebo.
- Quetiapine should be used cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold 2.
From the Research
Seroquel and Seizure Threshold
- Seroquel, also known as quetiapine, is an antipsychotic medication that may lower the seizure threshold, increasing the chances of seizure induction 3, 4.
- Studies have shown that antipsychotic medications, including quetiapine, can reduce the seizure threshold, although the risk varies among different medications 4, 5.
- Quetiapine has been associated with a relatively low risk of seizure induction compared to other antipsychotics, such as clozapine 4, 5.
- However, there have been case reports of seizures in patients taking quetiapine, particularly at high doses or in patients with underlying conditions that can lower the seizure threshold 6, 7.
Factors Influencing Seizure Risk
- The risk of seizures associated with quetiapine is influenced by factors such as dose, individual seizure threshold, and presence of underlying conditions that can lower the seizure threshold 4, 5, 7.
- High doses of quetiapine may increase the risk of seizures, and patients with conditions such as Alzheimer's disease may be more susceptible to seizure induction 7.
- Concurrent use of other medications that lower the seizure threshold may also increase the risk of seizures in patients taking quetiapine 3, 4.
Clinical Implications
- Clinicians should use caution when prescribing quetiapine to patients with conditions that can lower the seizure threshold, and monitor them closely for signs of seizure activity 5, 7.
- Starting with a low dose and titrating slowly may help minimize the risk of seizures in patients taking quetiapine 5.