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 1.
From the Research
Yes, Seroquel (quetiapine) can lower the seizure threshold, though the risk is relatively low compared to some other antipsychotic medications. The seizure risk with quetiapine is dose-dependent, with higher doses (typically above 600mg daily) associated with greater risk 2. Patients with pre-existing seizure disorders, brain injuries, or those taking other medications that lower the seizure threshold should be monitored more carefully when using quetiapine.
Key Considerations
- The mechanism behind this effect involves quetiapine's impact on various neurotransmitter systems, particularly dopamine and serotonin pathways, which can alter neuronal excitability 3.
- Healthcare providers typically start with lower doses and gradually increase to minimize this risk.
- If a patient has a history of seizures, alternative medications might be considered, or quetiapine might be used with concurrent anticonvulsant therapy.
- Patients should be educated about potential warning signs of seizure activity and advised to report any unusual symptoms promptly to their healthcare provider.
Relevant Evidence
- A study from 2003 reviewed the literature concerning the seizure-lowering effects of first- and second-generation antipsychotic medication, noting that while rigorously controlled studies are infrequent, case reports suggest that these medications can lower the seizure threshold 2.
- Another study from 2002 discussed the effects of psychotropic drugs on seizure threshold, highlighting that the risk is dose-dependent and that certain medications, like maprotiline and clomipramine among antidepressants, and chlorpromazine and clozapine among antipsychotics, have a relatively high seizurogenic potential 3.
- However, the most recent and highest quality study directly addressing the question of quetiapine's effect on seizure threshold was not found among the provided references, suggesting the need for consultation of more current literature for the most accurate and evidence-based guidance.