What is the appropriate Seroquel (quetiapine) dosing for an 8-year-old?

Quetiapine (Seroquel) Dosing for an 8-Year-Old

For an 8-year-old child, quetiapine should be initiated at 25 mg twice daily on day 1, then increased to 100 mg total on day 2,200 mg total on day 3,300 mg total on day 4, and up to 400 mg total on day 5, with a maximum recommended dose of 600 mg/day. 1

Dosing Guidelines for Pediatric Patients

The FDA-approved dosing for quetiapine in children and adolescents follows a specific titration schedule:

• Day 1: 25 mg twice daily
• Day 2: Increase to twice daily dosing totaling 100 mg
• Day 3: Twice daily dosing totaling 200 mg
• Day 4: Twice daily dosing totaling 300 mg
• Day 5: Twice daily dosing totaling 400 mg

Further adjustments should be in increments no greater than 100 mg/day within the recommended dose range of 400 to 600 mg/day. Based on response and tolerability, quetiapine may be administered three times daily. 1

Indications and Considerations

For pediatric patients, quetiapine is FDA-approved for:

• Bipolar mania in children and adolescents (10-17 years): 400-600 mg/day with a maximum of 600 mg/day
• Schizophrenia in adolescents (13-17 years): 400-800 mg/day with a maximum of 800 mg/day

Important Considerations for 8-Year-Old Patients

1. Off-label use: Quetiapine is not FDA-approved for children under 10 years of age. Use in an 8-year-old would be off-label.

2. Dosage adjustments:

   • Start with lower doses than those recommended for adolescents
   • Titrate more slowly to minimize side effects
   • Monitor closely for adverse effects

3. Administration:

   • Can be taken with or without food
   • Divided doses (twice or three times daily) are recommended for children

Monitoring and Safety

When prescribing quetiapine to an 8-year-old, careful monitoring is essential:

• Metabolic parameters: Weight, blood glucose, lipid profile
• Cardiovascular effects: Blood pressure, heart rate
• Neurological effects: Extrapyramidal symptoms, sedation
• Endocrine function: Though quetiapine has a placebo-level effect on prolactin at all doses 2, 3

Potential Side Effects in Children

Common side effects to monitor in pediatric patients include:

• Sedation and somnolence
• Increased appetite and weight gain
• Dizziness
• Dry mouth
• Potential metabolic changes

Clinical Pearls

1. Divided dosing: Studies have shown that twice-daily dosing of quetiapine is as effective as three-times-daily dosing, which may improve adherence 4

2. Hepatic impairment: For patients with hepatic impairment, start at 25 mg/day and increase in increments of 25-50 mg/day 1

3. Drug interactions: Quetiapine dose should be reduced to one-sixth of the original dose when co-administered with potent CYP3A4 inhibitors 1

4. Titration: Slow titration is key to minimizing side effects, especially in younger patients

Conclusion

While quetiapine can be used in an 8-year-old child, it represents off-label use and requires careful consideration of risks and benefits. The dosing should follow the titration schedule outlined above, starting at the lowest possible dose and increasing gradually while monitoring for efficacy and adverse effects.