What is the appropriate dosing of Seroquel (quetiapine) for a 95 lb female?

Appropriate Quetiapine (Seroquel) Dosing for a 95 lb Female

For a 95 lb (43 kg) female, the appropriate initial dose of quetiapine is 25 mg once or twice daily, with careful titration based on response and tolerability, generally not exceeding 300 mg daily for most indications. 1, 2

Initial Dosing and Titration

• Start with 25 mg once daily at bedtime, which is a conservative approach for a patient with lower body weight 2
• Titration should be slower than standard protocols due to the patient's lower body weight (95 lbs/43 kg) 2
• A modified titration schedule for this patient would be:
  • Day 1: 25 mg at bedtime
  • Day 2-3: 25 mg twice daily (total 50 mg/day)
  • Day 4-5: 50 mg twice daily (total 100 mg/day)
  • Further increases should be made in 50 mg increments every 3-4 days as needed and tolerated 2, 3

Dosing Considerations by Indication

• For sleep disturbances or anxiety: 25-100 mg daily is often sufficient 4
• For mood disorders: 150-300 mg daily is typically effective 4, 5
• For psychotic disorders: May require higher doses (300-400 mg daily), but should be approached with caution in a lower-weight patient 1, 4

Weight-Based Considerations

• Standard dosing is typically based on patients weighing 70 kg or more 2
• For a 95 lb (43 kg) female, doses should be approximately 40-60% of standard adult doses 2
• Maximum daily dose should generally not exceed 300 mg for this patient, even for psychotic disorders, unless benefits clearly outweigh risks 1, 6

Administration Schedule

• Twice daily dosing is generally recommended for quetiapine, though once daily (at bedtime) may be appropriate for lower doses 3
• For doses ≤150 mg/day, once-daily bedtime dosing may be sufficient and can minimize daytime sedation 3, 2
• For doses >150 mg/day, twice-daily dosing (morning and evening) is preferred for better tolerability 3

Monitoring and Safety Considerations

• Monitor for excessive sedation, orthostatic hypotension, and dizziness, which may be more pronounced in lower-weight individuals 1
• Check baseline metabolic parameters (glucose, lipids) and monitor regularly, as even low doses can cause metabolic changes 4
• Be alert for potential QTc prolongation, especially if the patient is on other medications that affect cardiac conduction 1
• Weight gain should be monitored closely, as it may be proportionally more significant in a lower-weight individual 4

Specific Precautions for Lower-Weight Patients

• Lower-weight patients may experience more pronounced side effects at standard doses 2
• Sedation and orthostatic hypotension are particularly common during initial titration 1, 2
• Consider checking drug levels if available, particularly if response is inadequate or side effects are problematic at seemingly appropriate doses 2

Adjusting Maintenance Dose

• Once target symptoms have improved, attempt to find the lowest effective maintenance dose 2
• For many indications in a 95 lb female, maintenance doses of 50-200 mg daily may be sufficient 4, 5
• Consider once-daily dosing at bedtime for maintenance therapy if tolerated, which may improve adherence 3