What are the dose recommendations for Seroquel (quetiapine)?

Quetiapine (Seroquel) Dosage Recommendations

For quetiapine (Seroquel), the recommended initial dosage is 12.5 mg twice daily, with a maximum dosage of 200 mg twice daily for most indications. 1

Dosing by Indication

Schizophrenia

• Adults:

  • Initial: Day 1: 25 mg twice daily
  • Titration: Increase in increments of 25-50 mg divided two or three times daily on Days 2 and 3
  • Target: 300-400 mg by Day 4
  • Recommended dose: 150-750 mg/day
  • Maximum dose: 750 mg/day 2

• Adolescents (13-17 years):

  • Initial: Day 1: 25 mg twice daily
  • Titration: Day 2: 100 mg/day, Day 3: 200 mg/day, Day 4: 300 mg/day, Day 5: 400 mg/day
  • Recommended dose: 400-800 mg/day
  • Maximum dose: 800 mg/day 2

Bipolar Disorder

• Bipolar Mania (Adults):

  • Initial: Day 1: 100 mg/day (divided twice daily)
  • Titration: Day 2: 200 mg/day, Day 3: 300 mg/day, Day 4: 400 mg/day
  • Further adjustments up to 800 mg/day by Day 6 in increments ≤200 mg/day
  • Recommended dose: 400-800 mg/day
  • Maximum dose: 800 mg/day 2

• Bipolar Mania (Children/Adolescents 10-17 years):

  • Initial: Day 1: 25 mg twice daily
  • Titration: Day 2: 100 mg/day, Day 3: 200 mg/day, Day 4: 300 mg/day, Day 5: 400 mg/day
  • Recommended dose: 400-600 mg/day
  • Maximum dose: 600 mg/day 2

• Bipolar Depression (Adults):

  • Initial: Day 1: 50 mg once daily at bedtime
  • Titration: Day 2: 100 mg, Day 3: 200 mg, Day 4: 300 mg
  • Recommended dose: 300 mg/day
  • Maximum dose: 300 mg/day 2

Dementia-Related Psychosis

• Initial dose: 12.5 mg twice daily
• Maximum dose: 200 mg twice daily
• Note: More sedating; beware of transient orthostasis 1

Special Populations

Elderly Patients

• Start at 50 mg/day
• Increase in increments of 50 mg/day depending on clinical response and tolerability 2
• Consider slower titration and lower target doses 2

Hepatically Impaired Patients

• Start at 25 mg/day
• Increase daily in increments of 25-50 mg/day to effective dose 2

Administration Guidelines

• Can be taken with or without food 2
• For most indications, administer in divided doses (typically twice daily) 2, 3
• For bipolar depression, administer once daily at bedtime 2

Practical Dosing Considerations

• Standard titration to 400 mg/day is recommended using: day 1: 50 mg; day 2: 100 mg; day 3: 200 mg; day 4: 300 mg; day 5: 400 mg 4
• Faster titration may be possible in hospitalized patients - studies show similar safety when escalating to 400 mg/day in as little as 2 days versus the standard 5-day schedule 5
• In patients who respond, continue at optimal dose that maintains remission (range 150-750 mg/day) 4
• Twice daily administration is as effective as three times daily dosing 3

Monitoring

• No need for routine ECG or blood pressure monitoring 6
• No need for hematological monitoring (unlike clozapine) 6
• Monitor for sedation, the most common adverse effect 6
• Monitor for orthostatic hypotension, especially during initial dose titration 1

Switching Strategies

• When switching from other antipsychotics to quetiapine, individualize the approach to minimize risk of psychotic relapse 4
• Quetiapine can be initiated while gradually tapering the previous antipsychotic 4

Remember that quetiapine is generally well tolerated with extrapyramidal symptoms comparable to placebo across the full dosage range, making it a valuable option for patients who cannot tolerate other antipsychotic medications 6.