What is the recommended dosing frequency for quetiapine (Seroquel)?

From the Guidelines

Quetiapine should be dosed twice daily, with a starting dose of 25 mg and gradual titration to minimize side effects, as recommended in the most recent guidelines 1. The dosing frequency of quetiapine depends on the formulation and condition being treated.

• For immediate-release quetiapine, twice-daily dosing is common, with doses ranging from 25-400 mg per dose based on the indication.
• Extended-release quetiapine (Seroquel XR) is designed for once-daily dosing, usually taken in the evening. Starting doses are generally low (25-50 mg for immediate-release, 50-300 mg for extended-release) with gradual titration to minimize side effects like sedation, dizziness, and orthostatic hypotension.
• For schizophrenia, maintenance doses typically range from 400-800 mg daily, while bipolar disorder may require 400-800 mg daily for acute mania and 300-600 mg daily for bipolar depression.
• Lower doses (25-200 mg daily) are often used for adjunctive treatment of depression or anxiety. The sedating properties of quetiapine make evening dosing preferable, especially for the extended-release formulation. Dosing should be individualized based on patient response and tolerability, with regular monitoring for metabolic side effects including weight gain, hyperglycemia, and dyslipidemia, as suggested by 1. According to the guidelines, quetiapine can be started at a dose of 25 mg, with a dosing frequency of twice daily, as stated in 1. It's essential to follow the most recent guidelines, such as those provided in 1, to ensure the best possible outcomes for patients taking quetiapine. In terms of specific dosing recommendations, the guidelines suggest that quetiapine can be dosed at 25 mg, twice daily, with adjustments made as needed to minimize side effects and optimize efficacy, as recommended in 1.

From the FDA Drug Label

DOSAGE & ADMINISTRATION SECTION 2.1 Important Administration Instructions Quetiapine fumarate tablets can be taken with or without food. 2. 2 Recommended Dosing The recommended initial dose, titration, dose range and maximum quetiapine fumarate tablets dose for each approved indication is displayed in Table 1. Table 1: Recommended Dosing for Quetiapine Fumarate Tablets IndicationInitial Dose and TitrationRecommended DoseMaximum Dose Schizophrenia-Adults Day 1: 25 mg twice daily. Increase in increments of 25 mg to 50 mg divided two or three times on Days 2 and 3 to range of 300 to 400 mg by Day 4 Further adjustments can be made in increments of 25 to 50 mg twice a day, in intervals of not less than 2 days. 150 to 750 mg/day 750 mg/day

The recommended dosing frequency for quetiapine (Seroquel) varies by indication, but common frequencies include:

• Twice daily for schizophrenia in adults and adolescents
• Three times daily for schizophrenia in adolescents, if necessary
• Once daily at bedtime for bipolar depression in adults
• Twice daily for bipolar I disorder maintenance therapy in adults 2

From the Research

Recommended Dosing Frequency for Quetiapine

The recommended dosing frequency for quetiapine (Seroquel) can vary depending on the specific formulation and the individual patient's needs.

• Quetiapine can be administered in a twice-daily or three-times-daily regimen, with a total daily dose ranging from 150-450 mg/day 3.
• A study comparing twice-daily and three-times-daily dosing regimens of quetiapine found that both regimens were effective and well-tolerated, with no significant differences in efficacy between the two groups 3.
• Extended-release quetiapine (quetiapine XR) can be administered once-daily, with a dose range of 400-800 mg/day 4.
• A study evaluating the efficacy and safety of once-daily administration of quetiapine fumarate found that it was effective and well-tolerated, with no significant differences in response between once-daily and twice-daily administration 5.

Dose Escalation

• The original dosing recommendations for quetiapine suggested a gradual dose escalation over 5 days, with a target dose of 400 mg/day 6.
• However, a pilot study found that rapid dose escalation to 400 mg/day over 2-3 days was well-tolerated and effective in patients with acute schizophrenia 6.
• Another study found that quetiapine XR can be rapidly escalated to a dose of 600-800 mg/day over 2-3 days, with a therapeutically effective dose reached by day 2 4.

Clinical Considerations

• The choice of dosing frequency and regimen should be individualized based on the patient's clinical response and tolerability 7, 4, 3, 5.
• Patients with schizophrenia or schizoaffective disorder may require flexible dosing regimens to achieve optimal therapeutic effects 5.
• Quetiapine has a relatively short plasma elimination half-life, but dopamine D2 receptor occupancies correlate poorly with plasma concentrations, suggesting that dosing frequency may not be strictly determined by pharmacokinetics 3.