Recommended Use and Dosage of Quetiapine (Seroquel) in Psychiatric Disorders
Quetiapine is recommended as a second-generation antipsychotic for schizophrenia, bipolar disorder (both mania and depression), with specific dosing regimens based on indication, age, and clinical presentation. 1
Schizophrenia Treatment
- Initial dosing for adults with schizophrenia should begin with 25 mg twice daily on day 1, with increases in increments of 25-50 mg divided two or three times daily on days 2 and 3, reaching 300-400 mg by day 4 1
- Maintenance dosage range for adults with schizophrenia is 150-750 mg/day, with a maximum dose of 750 mg/day 1
- For adolescents (13-17 years) with schizophrenia, start with 25 mg twice daily on day 1, increase to 100 mg total on day 2,200 mg on day 3,300 mg on day 4, and 400 mg on day 5, with a recommended dose range of 400-800 mg/day 1
- Antipsychotic treatment should be continued for at least 12 months after the beginning of remission 2
Bipolar Disorder Treatment
Bipolar Mania
- For adults with bipolar mania (monotherapy or as adjunct to lithium/divalproex), begin with 100 mg total on day 1,200 mg on day 2,300 mg on day 3,400 mg on day 4, with further adjustments up to 800 mg/day by day 6 1
- Recommended dose range for adults with bipolar mania is 400-800 mg/day 1
- For children and adolescents (10-17 years) with bipolar mania, start with 25 mg twice daily on day 1, increasing to 100 mg total on day 2,200 mg on day 3,300 mg on day 4, and 400 mg on day 5, with a recommended dose range of 400-600 mg/day 1
- Quetiapine is effective as both monotherapy and in combination with mood stabilizers for treating acute bipolar mania 3, 4
Bipolar Depression
- For adults with bipolar depression, administer once daily at bedtime: 50 mg on day 1,100 mg on day 2,200 mg on day 3, and 300 mg on day 4 1
- Recommended and maximum dose for bipolar depression is 300 mg/day 1
- Quetiapine is the only atypical antipsychotic approved for use as monotherapy in both bipolar mania and depression, which offers potential compliance advantages 5
Bipolar Maintenance
- For maintenance treatment of bipolar I disorder in 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 of bipolar disorder 2
- Decision to continue maintenance treatment after 2 years should preferably be made by a mental health specialist 2
Special Populations and Considerations
- Elderly patients should start on 50 mg/day with careful titration in increments of 50 mg/day based on clinical response and tolerability 1
- Patients with hepatic impairment should start on 25 mg/day with increases in increments of 25-50 mg/day 1
- Quetiapine can be taken with or without food 1
- For individuals stable for several years on antipsychotic treatment, withdrawal may be considered while keeping in mind the increased risk of relapse 2
- Routinely, one antipsychotic should be prescribed at a time; combination treatment may be considered for non-responders under supervision of mental health professionals 2
Side Effects and Monitoring
- Common side effects include sedation, dizziness, orthostatic hypotension, and weight gain 2, 6
- Quetiapine has a low incidence of extrapyramidal symptoms compared to typical antipsychotics 3, 4
- Monitor for metabolic effects including weight gain, which is a significant clinical concern, especially in youth 2
- Baseline and periodic monitoring of liver function tests may be prudent 2
- For patients on quetiapine for bipolar disorder, monitor for treatment-emergent mania, though the risk appears low 5
Clinical Pearls and Caveats
- Psychoeducation should be routinely offered alongside medication to individuals with psychotic and bipolar disorders and their family members 2
- There have been reports of quetiapine abuse and dependence, particularly among prisoners and patients with substance use disorders, due to its anxiolytic and sedative effects 7
- When treating comorbid conditions in patients with bipolar disorder, address mood symptoms first before treating ADHD or other comorbidities 2
- Quetiapine may be helpful in patients whose psychotic manifestations did not adequately respond to other atypical antipsychotics 6
- In individuals with bipolar depression, quetiapine monotherapy should be considered a first-line option for acute treatment 5