What is the recommended dosage of Seroquel (quetiapine) for agitation?

Quetiapine (Seroquel) Dosage for Agitation

For acute agitation, quetiapine should be started at 50-100 mg with flexible dosing up to 300 mg/day, though non-pharmacological interventions should be attempted first whenever possible. 1

First-Line Approach: Non-Pharmacological Management

Before initiating pharmacological treatment for agitation, attempt these evidence-based approaches:

• Create a calm, structured environment
• Use verbal de-escalation techniques
• Identify and address underlying causes of agitation
• Implement behavioral interventions appropriate to cognitive level

Pharmacological Management with Quetiapine

Dosing Recommendations

For acute agitation:

• Initial dose: 50-100 mg 2, 3
• Titration: Can be escalated to 100 mg/day by day 4 4
• Flexible dosing: 50-300 mg/day based on clinical response 4
• Mean effective dose: Approximately 143 mg/day for elderly patients with dementia-related agitation 4
• Administration: Typically given in divided doses (twice daily) 5, 3

Special Considerations

1. Elderly patients and those with dementia:

   • Start at lower doses (25 mg/day for immediate-release formulation) 4
   • Titrate more slowly
   • Monitor closely for orthostatic hypotension

2. Rapid dose escalation (for severe agitation):

   • Day 1: 50 mg
   • Day 2: 100 mg
   • Day 3: 200 mg
   • Day 4: 300 mg
   • Day 5: 400 mg 3, 6

Monitoring and Safety

• Orthostatic hypotension: Common side effect (40% of patients may experience this), particularly concerning in potentially volume-depleted patients 2
• Regular monitoring: Assess for sedation, QT prolongation, and metabolic side effects
• Follow-up: Within 1-2 weeks after starting medication or changing doses 1

Important Caveats

• Quetiapine has shown some efficacy as a sedative agent in emergency settings, but no clear dose-response pattern has emerged in studies 2
• Orthostasis is common and does not correlate with dosing 2
• Extended-release quetiapine (XR) has a similar safety profile to immediate-release (IR) formulation and may be dosed once daily 4
• Small studies have not supported quetiapine use for acute agitation in potentially volume-depleted patients 2

Alternative Medications for Agitation

If quetiapine is not appropriate, consider these alternatives with their recommended dosing:

• Haloperidol: 0.5-1 mg orally at night (max 5 mg/day)
• Risperidone: 0.25 mg/day (max 2 mg/day)
• Olanzapine: 2.5 mg/day (max 10 mg/day) 1

Reassessment

The need for continued medication should be reassessed within 3-6 months, with attempts to taper and discontinue to determine the lowest effective maintenance dose 1.