Does Quetiapone (Seroquel) cause Extrapyramidal Symptoms (EPS)?

From the Guidelines

Yes, Seroquel (quetiapine) can cause extrapyramidal symptoms (EPS), but it has a significantly lower risk compared to typical antipsychotics and some other atypical antipsychotics. EPS includes movement disorders like akathisia (restlessness), dystonia (muscle spasms), parkinsonism (tremor, rigidity), and tardive dyskinesia (involuntary movements). The risk of EPS with Seroquel is dose-dependent and generally occurs at higher doses, typically above 300mg daily. At lower doses (25-200mg), which are commonly used for sleep or as adjunctive therapy for depression, the risk is minimal. Seroquel causes fewer EPS because of its relatively weak dopamine D2 receptor blockade and strong serotonin 5-HT2A receptor antagonism. It has a rapid dissociation from D2 receptors, which allows normal dopamine neurotransmission while still providing antipsychotic effects. If EPS symptoms develop while taking Seroquel, they should be reported to a healthcare provider immediately, as dosage adjustment or medication change may be necessary. According to the most recent study 1, Quetiapine is less likely to cause EPSEs than other atypical antipsychotics, and its suggested starting dose is 25 mg (immediate release) p.o. stat.

Some key points to consider:

• The risk of EPS with Seroquel is lower compared to typical antipsychotics and some other atypical antipsychotics
• The risk of EPS is dose-dependent and generally occurs at higher doses
• Seroquel causes fewer EPS due to its relatively weak dopamine D2 receptor blockade and strong serotonin 5-HT2A receptor antagonism
• If EPS symptoms develop, they should be reported to a healthcare provider immediately
• Quetiapine is less likely to cause EPSEs than other atypical antipsychotics, according to the most recent study 1.

It's also important to note that the evidence from the studies 1 suggests that atypical antipsychotics, including Seroquel, have a lower risk of EPS compared to typical antipsychotics. However, the most recent and highest quality study 1 provides the most up-to-date information on the risk of EPS with Seroquel.

From the FDA Drug Label

Extrapyramidal Symptoms:(EPS) Dystonia Class Effect: Symptoms of dystonia, prolonged abnormal contractions of muscle groups, may occur in susceptible individuals during the first few days of treatment Dystonic symptoms include: spasm of the neck muscles, sometimes progressing to tightness of the throat, swallowing difficulty, difficulty breathing, and/or protrusion of the tongue. Four methods were used to measure EPS: (1) Simpson-Angus total score (mean change from baseline) which evaluates Parkinsonism and akathisia, (2) Barnes Akathisia Rating Scale (BARS) Global Assessment Score, (3) incidence of spontaneous complaints of EPS (akathisia, akinesia, cogwheel rigidity, extrapyramidal syndrome, hypertonia, hypokinesia, neck rigidity, and tremor), and (4) use of anticholinergic medications to treat emergent EPS. In two placebo-controlled clinical trials for the treatment of bipolar depression using 300 mg and 600 mg of quetiapine, the incidence of adverse reactions potentially related to EPS was 12% in both dose groups and 6% in the placebo group In these studies, the incidence of the individual adverse reactions (akathisia, extrapyramidal disorder, tremor, dyskinesia, dystonia, restlessness, muscle contractions involuntary, psychomotor hyperactivity and muscle rigidity) were generally low and did not exceed 4% in any treatment group

Yes, Quetiapine (Seroquel) can cause Extrapyramidal Symptoms (EPS), including dystonia, parkinsonism, akathisia, and dyskinetic events. The incidence of EPS varies depending on the dose and population being treated, but it is generally higher in patients treated with quetiapine compared to placebo. The individual adverse reactions related to EPS are typically low, but can occur in up to 12% of patients treated with quetiapine 2.

From the Research

Extrapyramidal Symptoms (EPS) and Quetiapone (Seroquel)

• Quetiapone (Seroquel) has been studied in relation to its potential to cause Extrapyramidal Symptoms (EPS) in several research studies 3, 4, 5, 6, 7.
• The majority of the studies suggest that Quetiapone is associated with a low incidence of EPS, including parkinsonism and akathisia 3, 4, 5, 7.
• A study published in the International Journal of Psychiatry in Clinical Practice found that Quetiapone was well tolerated and associated with significant improvements in EPS in patients with schizophrenia switched from other antipsychotics 3.
• Another study published in the Journal of Clinical Psychopharmacology found that patients with preexisting EPS who were switched to Quetiapone showed significant reduction in parkinsonism, akathisia, and dyskinesia 5.
• A review of Quetiapone and its clinical applications in schizophrenia published in Expert Opinion on Pharmacotherapy noted that Quetiapone is associated with a placebo-level incidence of EPS and has minimal effects on weight and plasma prolactin levels 7.
• However, it is also noted that while Quetiapone has a lower EPS liability compared to other antipsychotics, it is not entirely free of EPS, and the incidence of EPS can vary depending on the dose, patient population, and other factors 6.