Quetiapine (Seroquel) Indications and Dosages
Quetiapine is FDA-approved for schizophrenia, bipolar disorder (including mania and depression), and as adjunctive therapy for major depressive disorder, with specific dosing regimens for each indication. 1
Approved Indications and Dosing Regimens
1. Schizophrenia
Adults:
- Initial dose: 25 mg twice daily on Day 1
- Titration: Increase by 25-50 mg twice daily over 2-3 days
- Target dose: 300-400 mg/day by Day 4, divided into 2-3 doses
- Maintenance dose: 150-750 mg/day
- Maximum dose: 750 mg/day 1
Adolescents (13-17 years):
- Initial dose: 25 mg twice daily on Day 1
- Titration: Increase to 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4), 400 mg (Day 5)
- Recommended dose: 400-800 mg/day
- Maximum dose: 800 mg/day 1
2. Bipolar Disorder
Bipolar Mania
Adults (monotherapy or adjunct to lithium/divalproex):
- Initial dose: 50 mg twice daily (100 mg/day) on Day 1
- Titration: Increase to 200 mg (Day 2), 300 mg (Day 3), 400 mg (Day 4)
- Further adjustments: Up to 800 mg/day by Day 6
- Recommended dose: 400-800 mg/day
- Maximum dose: 800 mg/day 1
Children and Adolescents (10-17 years):
- Initial dose: 25 mg twice daily on Day 1
- Titration: Increase to 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4), 400 mg (Day 5)
- Recommended dose: 400-600 mg/day
- Maximum dose: 600 mg/day 1
Bipolar Depression
- Adults:
- Initial dose: 50 mg once daily at bedtime on Day 1
- Titration: Increase to 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4)
- Recommended dose: 300 mg/day
- Maximum dose: 300 mg/day 1
3. Bipolar I Disorder Maintenance
- Adults (adjunct to lithium or divalproex):
- Dose: 400-800 mg/day divided twice daily
- Maximum dose: 800 mg/day 1
Special Population Considerations
Elderly Patients
- Start at lower doses: 50 mg/day
- Titrate more slowly: Increase in increments of 50 mg/day
- Monitor closely for hypotensive reactions 1
Hepatic Impairment
- Starting dose: 25 mg/day
- Titration: Increase daily in increments of 25-50 mg/day
- Adjust based on clinical response and tolerability 1
Administration Guidelines
- Can be taken with or without food
- For maintenance treatment, periodically reassess to determine continued need 1
Efficacy Profile
Quetiapine has demonstrated efficacy in:
- Positive and negative symptoms of schizophrenia 2, 3
- Acute and maintenance treatment of bipolar mania 1
- Bipolar depression, with significant improvements in depressive symptoms 4
- Cognitive function improvement compared to conventional antipsychotics 3
Tolerability and Safety
Common adverse effects include:
Notable safety advantages:
- Placebo-level incidence of extrapyramidal symptoms (EPS) across all doses 2, 3
- No significant elevation in prolactin levels compared to placebo 2, 3
- Generally well-tolerated with minimal effects on weight in short-term use 2
Clinical Pearls
- For schizophrenia, doses of 400 mg/day or higher are recommended for patients who don't fully respond to lower doses 2
- For bipolar depression, the recommended dose is 300 mg/day, with no additional benefit at higher doses 4
- Quetiapine has been shown to be particularly useful in patients susceptible to EPS, including elderly patients and those with pre-existing dopaminergic pathology 2
- In delirium management for cancer patients, quetiapine starting dose is 25 mg orally, which can be given every 12 hours if scheduled dosing is required 5
Monitoring Recommendations
- No requirement for routine ECG or blood monitoring 2
- Monitor for metabolic changes (weight, blood glucose, lipids) during treatment 4
- Assess periodically for continued need of maintenance treatment 1
Quetiapine's favorable tolerability profile, particularly regarding EPS and prolactin levels, makes it a suitable first-line option for its approved indications, with dosing tailored to the specific condition being treated.