Weight Gain with Low-Dose Quetiapine (Seroquel)
Yes, quetiapine (Seroquel) can cause weight gain even at low doses, though the risk appears to be dose-dependent with greater weight gain typically occurring at higher doses.
Evidence for Weight Gain with Quetiapine
Weight gain is explicitly listed as a common side effect in the FDA drug label for quetiapine, which states: "Weight gain is common in people who take quetiapine fumarate tablets so you and your healthcare provider should check your weight regularly" 1
Clinical trials showed significant weight gain with quetiapine across various psychiatric conditions:
- 23% of schizophrenia patients gained ≥7% of body weight (vs. 6% with placebo)
- 21% of bipolar mania patients gained ≥7% of body weight (vs. 7% with placebo)
- 8% of bipolar depression patients gained ≥7% of body weight (vs. 2% with placebo) 1
Dose-Relationship and Pattern of Weight Gain
A comprehensive study of patients with schizophrenia found that weight gain with quetiapine is dose-dependent:
- Patients on <200 mg/day: mean weight gain of 1.54 kg
- Patients on 200-399 mg/day: mean weight gain of 4.08 kg
- Patients on 400-599 mg/day: mean weight gain of 1.89 kg
- Patients on ≥600 mg/day: mean weight gain of 3.57 kg 2
Most weight gain (>60%) occurs within the first 12 weeks of treatment, with more modest changes after 6 months 2
A 2021 study confirmed the dose-dependent nature of quetiapine's metabolic effects, finding that daily dose influences weight gain and increases the risk of clinically relevant weight gain (≥7% from baseline) 3
Low-Dose Considerations
Even at low doses used for insomnia (25-200 mg/day), quetiapine has been associated with significant weight gain compared to baseline in retrospective cohort studies 4
Case reports have documented serious adverse events including weight gain even with low-dose quetiapine treatment 4
The 2021 study emphasized that "the potential harm of low-dose quetiapine should not be dismissed" despite the dose-dependent relationship 3
Monitoring and Management
The FDA label recommends regular weight monitoring and implementing weight management strategies: "Talk to your healthcare provider about ways to control weight gain, such as eating a healthy, balanced diet, and exercising" 1
Weight gain with quetiapine appears to be inversely related to baseline body mass index, suggesting that patients who are underweight at baseline may experience more significant weight gain 2
Comparison with Other Medications
While quetiapine does cause weight gain, some older studies suggested it might have a more favorable long-term weight profile compared to some other atypical antipsychotics 5
However, more recent evidence indicates that the weight gain risk with quetiapine should not be minimized, particularly given its dose-dependent nature 3
In conclusion, even low doses of quetiapine can cause weight gain, though the risk increases with higher doses. Regular weight monitoring is essential regardless of the dose prescribed.