Recommended Use and Dosage of Quetiapine (Seroquel) in Psychiatric Disorders
Quetiapine is indicated for schizophrenia, bipolar disorder (mania, depression, and maintenance), and as an adjunctive treatment for delirium, with specific dosing regimens for each condition based on patient age, condition severity, and hepatic function.
Schizophrenia
Adults
- Initial dose: Start with 25 mg twice daily on Day 1, then increase in increments of 25-50 mg divided two or three times daily on Days 2 and 3 to reach 300-400 mg by Day 4 1
- Recommended maintenance dose: 150-750 mg/day 1
- Maximum dose: 750 mg/day 1
- Duration: Continue treatment for at least 12 months after remission begins 2
Adolescents (13-17 years)
- Initial dose: 25 mg twice daily on Day 1, increasing to total daily doses of 100 mg on Day 2,200 mg on Day 3,300 mg on Day 4, and 400 mg on Day 5 1
- Recommended dose: 400-800 mg/day 1
- Maximum dose: 800 mg/day 1
- May be administered three times daily based on response and tolerability 1
Bipolar Disorder
Bipolar Mania - Adults
- Initial dose: 100 mg total on Day 1,200 mg on Day 2,300 mg on Day 3,400 mg on Day 4 1
- Further adjustments up to 800 mg/day by Day 6 in increments of no more than 200 mg/day 1
- Recommended dose: 400-800 mg/day 1
- Maximum dose: 800 mg/day 1
Bipolar Mania - Children and Adolescents (10-17 years)
- Initial dose: 25 mg twice daily on Day 1, increasing to total daily doses of 100 mg on Day 2,200 mg on Day 3,300 mg on Day 4, and 400 mg on Day 5 1
- Recommended dose: 400-600 mg/day 1
- Maximum dose: 600 mg/day 1
- May be administered three times daily based on response and tolerability 1
Bipolar Depression - Adults
- Administer once daily at bedtime 1
- Initial dose: 50 mg on Day 1,100 mg on Day 2,200 mg on Day 3,300 mg on Day 4 1
- Recommended dose: 300 mg/day 1
- Maximum dose: 300 mg/day 1
Bipolar Maintenance - Adults
- Administer twice daily totaling 400-800 mg/day as adjunct to lithium or divalproex 1
- Maintenance treatment should continue for at least 2 years after the last episode 2
Special Populations
Elderly Patients
- Start with lower doses: 50 mg/day 1
- Increase in increments of 50 mg/day based on clinical response and tolerability 1
- Use slower titration and lower target doses due to risk of hypotensive reactions 1
Hepatically Impaired Patients
- Start with 25 mg/day 1
- Increase daily in increments of 25-50 mg/day to effective dose 1
- Adjust based on clinical response and tolerability 1
Use in Delirium
- Initial dose: 25 mg (immediate release) orally 2
- Dosing schedule: Every 12 hours if scheduled dosing required 2
- Reduce dose in older patients and those with hepatic impairment 2
- Oral route only 2
- Note: Quetiapine is sedating and less likely to cause extrapyramidal symptoms than other antipsychotics 2
Administration Guidelines
- Can be taken with or without food 1
- For most conditions, twice daily dosing is recommended 1
- For bipolar depression, once-daily dosing at bedtime is recommended 1
Monitoring and Precautions
- Monitor for extrapyramidal symptoms, though quetiapine has lower risk compared to typical antipsychotics 2
- Watch for sedation, dizziness, and orthostatic hypotension, particularly in elderly patients 2, 1
- Monitor weight, blood glucose, and lipid parameters during treatment 2
- Avoid abrupt discontinuation; taper gradually when stopping treatment 2
- Periodically reassess the need for maintenance treatment 1
Common Side Effects
- Dry mouth, sedation, somnolence, and dizziness 2
- Constipation and increased appetite 2
- Weight gain (though less than some other atypical antipsychotics) 3
- Minimal impact on prolactin levels compared to other antipsychotics 3
Important Considerations
- Routinely prescribe one antipsychotic at a time; combination therapy should be considered only under specialist supervision for non-responders 2
- Quetiapine is effective for both positive and negative symptoms of schizophrenia 3
- May improve cognitive function, depressive symptoms, and reduce hostility/aggression 3
- In bipolar disorder, quetiapine can be used as monotherapy or as an adjunct to mood stabilizers like lithium or valproate 1
- For patients with comorbid substance use disorders, monitor closely as there have been reports of quetiapine abuse and dependence 4