Contraindications for Quetiapine (Seroquel)
Quetiapine is contraindicated in patients with hypersensitivity to quetiapine or to any excipients in the formulation, as anaphylactic reactions have been reported in patients treated with quetiapine fumarate tablets. 1
Absolute Contraindications
- Hypersensitivity to quetiapine or any components of the formulation 1
- Pregnancy or women who may become pregnant without reliable contraception 2
- Concurrent use with monoamine oxidase inhibitors (MAOIs) 2
- Personal or family history of medullary thyroid cancer (when used with GLP-1 receptor agonists) 2
Relative Contraindications/Use with Caution
Cardiovascular Conditions
Neurological/Psychiatric Conditions
- Seizure disorders (uncontrolled) 2
- Acute angle-closure glaucoma or patients at risk for increased intraocular pressure 2
- Patients younger than 24 years with depression due to increased risk of suicidal behavior/ideation 2
Other Medical Conditions
- Hepatic impairment (dose adjustment required) 3
- Renal failure (dose adjustment required) 3
- Elderly patients (require lower doses due to increased sensitivity to side effects) 3
Special Precautions
Drug Interactions
- Chronic opioid therapy (contraindicated with naltrexone/bupropion combinations) 2
- Other CNS depressants (may cause additive sedation) 3
- Medications that can prolong QT interval (monitor closely)
Monitoring Requirements
- Regular monitoring for metabolic changes (weight gain, blood glucose, lipid parameters) 2
- Monitoring for extrapyramidal symptoms, although quetiapine has a lower risk compared to typical antipsychotics 4, 5, 6
- Monitoring for orthostatic hypotension, especially when initiating therapy 3
Clinical Considerations
Quetiapine is generally well-tolerated with a favorable side effect profile compared to other antipsychotics. It has a placebo-level incidence of extrapyramidal symptoms across its entire dose range 4, 6 and does not elevate plasma prolactin levels compared to placebo 4, 6.
When prescribing quetiapine, it's important to consider the risk-benefit profile for each individual patient, particularly in vulnerable populations such as the elderly, adolescents, or patients with organic brain disorders 4, 5.
The contraindications and precautions for quetiapine highlight the importance of thorough patient screening before initiating therapy and ongoing monitoring during treatment to minimize adverse effects and optimize therapeutic outcomes.