What is the top dose of Seroquel (quetiapine)?

Maximum Dose of Quetiapine (Seroquel)

The maximum FDA-approved dose of quetiapine (Seroquel) is 800 mg per day, although in clinical practice the maximum dose should not exceed 750-800 mg daily depending on the indication. 1

Dosing Information by Indication

Schizophrenia

• Initial dose: Start low (25-50 mg twice daily)
• Titration: Increase by 25-50 mg 2-3 times daily
• Target dose: 300-400 mg/day in divided doses
• Maximum dose: 750-800 mg/day
• Most patients respond at 400-800 mg/day 2

Bipolar Disorder

• Bipolar mania: 400-800 mg/day (maximum 800 mg/day)
• Bipolar depression: 300-600 mg/day
• Maintenance: 400-800 mg/day 3

Other Off-Label Uses

• Generalized anxiety disorder: ~150 mg/day
• Unipolar depression (adjunctive): 150-300 mg/day 3

Dosing Considerations

Administration Schedule

• Can be administered twice daily (BID) or three times daily (TID)
• Studies have shown comparable efficacy between 225 mg BID and 150 mg TID regimens 4
• Extended-release formulation allows for once-daily dosing

Special Populations

Elderly Patients

• Lower starting doses recommended
• Slower titration required
• Plasma clearance reduced by 30-50% in elderly patients 1
• Maximum dose should be lower than in younger adults

Hepatic Impairment

• Start with 25 mg/day
• Increase in increments of 25-50 mg/day
• Lower maximum dose recommended due to decreased metabolism 1

Renal Impairment

• Clinical experience is limited
• Dose adjustment may be necessary based on individual response 1

Important Monitoring Considerations

• Metabolic parameters: Weight, lipids, blood glucose
• Even low doses may lead to increases in weight and triglycerides 3
• Cardiovascular: Blood pressure, heart rate
• Neurological: Extrapyramidal symptoms (rare with quetiapine)
• Sedation: Common side effect, especially at initiation

Clinical Pearls

• Quetiapine has a relatively short half-life (~7 hours), which influences dosing frequency 4
• Higher doses (≥400 mg/day) should be considered in patients who do not fully respond to lower doses 5
• Despite some clinical practice trends toward using doses above 800 mg/day, robust evidence does not support exceeding the FDA-approved maximum dose 2
• Quetiapine has a unique advantage of placebo-level incidence of extrapyramidal symptoms across its dosing range 5

Common Pitfalls to Avoid

• Exceeding the maximum recommended dose without clear evidence of benefit
• Inadequate dose titration (too rapid or too slow)
• Failure to adjust dosing in elderly patients or those with hepatic impairment
• Not accounting for drug interactions that may affect quetiapine metabolism (particularly CYP3A4 inducers or inhibitors)

Remember that while some clinicians may use higher doses in certain treatment-resistant cases, the evidence base strongly supports that the standard dosage range (up to 800 mg/day) is appropriate for most clinical situations 2.