What are the indications and dosages for Seroquel (quetiapine)?

Quetiapine (Seroquel) Indications and Dosages

Quetiapine is FDA-approved for schizophrenia, bipolar disorder (mania, depression, and maintenance), and as adjunctive therapy for major depressive disorder, with specific dosing regimens for each indication. 1

Approved Indications and Dosing

Schizophrenia

• Adults:

  • Initial: Day 1: 25 mg twice daily
  • Titration: Increase by 25-50 mg divided 2-3 times daily on Days 2-3
  • Target: 300-400 mg/day by Day 4
  • Recommended range: 150-750 mg/day
  • Maximum: 750 mg/day 1

• Adolescents (13-17 years):

  • Initial: Day 1: 25 mg twice daily
  • Titration: Increase to 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4), 400 mg (Day 5)
  • Recommended range: 400-800 mg/day
  • Maximum: 800 mg/day 1

Bipolar Disorder

Bipolar Mania

• Adults:

  • Initial: Day 1: 100 mg total (divided twice daily)
  • 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 (max 200 mg/day increments)
  • Recommended range: 400-800 mg/day
  • Maximum: 800 mg/day 1

• Children/Adolescents (10-17 years):

  • Initial: Day 1: 25 mg twice daily
  • Titration: Increase to 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4), 400 mg (Day 5)
  • Recommended range: 400-600 mg/day
  • Maximum: 600 mg/day 1

Bipolar Depression

• Adults:
  • Initial: Day 1: 50 mg once daily at bedtime
  • Titration: Increase to 100 mg (Day 2), 200 mg (Day 3), 300 mg (Day 4)
  • Recommended dose: 300 mg/day
  • Maximum: 300 mg/day 1, 2

Bipolar I Disorder Maintenance

• Adults:
  • Dose: 400-800 mg/day (divided twice daily) as adjunct to lithium or divalproex
  • Maximum: 800 mg/day 1

Special Populations

Elderly Patients

• Start at 50 mg/day
• Titrate slowly in 50 mg increments
• Lower target doses recommended 1

Hepatic Impairment

• Start at 25 mg/day
• Titrate in 25-50 mg/day increments to effective dose 1

Off-Label Uses

While not FDA-approved for these indications, evidence suggests quetiapine may be used in:

1. Delirium in cancer patients:
   • Starting dose: 25 mg orally once daily
   • Titration: Increase as needed up to 200 mg/day
   • Note: Less likely to cause extrapyramidal symptoms than typical antipsychotics 3

Administration Considerations

• Can be taken with or without food 1
• For most indications, divided dosing (twice daily) is recommended
• For bipolar depression, once-daily dosing at bedtime is recommended 1, 2

Monitoring Requirements

• Regular assessment of clinical response and tolerability
• Monitor for metabolic effects (weight, blood glucose, lipids)
• No routine blood monitoring required (unlike clozapine) 4, 5

Clinical Pearls

• Quetiapine has a placebo-level incidence of extrapyramidal symptoms across its entire dosage range 4, 5
• Unlike some antipsychotics, quetiapine does not elevate prolactin levels compared to placebo 5
• Common side effects include dry mouth, sedation, somnolence, dizziness, and constipation 2
• Quetiapine has shown efficacy against both positive and negative symptoms in schizophrenia 4, 5
• For bipolar depression, the 300 mg dose is as effective as 600 mg with potentially fewer side effects 2

Always consider the risk-benefit profile for each patient, particularly regarding metabolic effects, sedation, and cardiovascular risks when prescribing quetiapine.