What is the maximum recommended dose of Seroquel (quetiapine) per day?

Maximum Recommended Dose of Quetiapine (Seroquel)

The maximum recommended dose of quetiapine (Seroquel) is 800 mg per day for schizophrenia and bipolar mania, while for bipolar depression the maximum dose is 300 mg per day. 1

FDA-Approved Maximum Dosages by Indication

• Schizophrenia

  • Adults: Maximum 750-800 mg/day 1
  • Adolescents (13-17 years): Maximum 800 mg/day 1
  • Maintenance therapy: Maximum 800 mg/day 1

• Bipolar Disorder

  • Bipolar Mania (Adults): Maximum 800 mg/day 1
  • Bipolar Mania (Children/Adolescents 10-17 years): Maximum 600 mg/day 1
  • Bipolar Depression (Adults): Maximum 300 mg/day 1
  • Bipolar I Maintenance (Adults): Maximum 800 mg/day 1

Dosing Considerations for Special Populations

• Elderly patients: Should start at lower doses (50 mg/day) with more gradual titration due to increased risk of hypotensive reactions 1

• Hepatically impaired patients: Should start at 25 mg/day with gradual titration in increments of 25-50 mg/day based on clinical response and tolerability 1

Clinical Evidence Supporting Dosing Recommendations

• Fixed-dose efficacy studies of immediate-release quetiapine suggest dosages of 150-450 mg/day are as effective as higher doses of 600-750 mg/day for schizophrenia 2

• For extended-release quetiapine, doses of 600 and 800 mg/day showed equal efficacy and were numerically superior to 400 mg/day 2

• In clinical practice, some case reports suggest use of higher doses (>800 mg/day), but robust controlled data strongly support that the standard dosage range is appropriate for clinical use 2

• For borderline personality disorder with psychosis, doses ranging from 300-750 mg/day (mean 537.5 mg/day) have shown efficacy 3

Administration Considerations

• Quetiapine can be taken with or without food 1

• Depending on the indication, quetiapine may be administered:

  • Once daily (typically for bipolar depression) 1
  • Twice daily (most common regimen) 1, 4
  • Three times daily (in some cases) 1, 4

• A comparison study of twice-daily versus three-times-daily dosing found no significant differences in efficacy between 225 mg twice daily and 150 mg three times daily (both totaling 450 mg/day) 4

Metabolic Monitoring Considerations

• Even at low doses, quetiapine may lead to increases in weight and triglycerides across psychiatric disorders 5

• Quetiapine-induced elevations in LDL and total cholesterol appear to be more common in schizophrenia patients 5

Common Pitfalls to Avoid

• Exceeding the FDA-approved maximum dose without clear clinical justification
• Failing to adjust doses for elderly or hepatically impaired patients
• Not monitoring for metabolic side effects, even at lower doses
• Rapid dose escalation leading to increased side effects
• Using higher than necessary doses when lower doses may be equally effective with fewer side effects 2