From the Guidelines
Quetiapine (Seroquel) is not directly associated with impaired renal function as a common adverse effect, but it may contribute to kidney problems in rare cases, particularly in patients with pre-existing kidney disease or those taking other medications that affect kidney function 1.
Mechanism and Risks
The primary concern with quetiapine and kidney function is not the drug itself but rather its potential to cause dehydration or rhabdomyolysis, a condition that can lead to kidney damage. Additionally, quetiapine may cause urinary retention, which could theoretically contribute to kidney problems if not managed properly. However, these risks are relatively rare and more commonly associated with other factors or medications.
Monitoring and Precautions
Given the potential, albeit rare, for quetiapine to contribute to kidney issues, it is crucial for patients taking this medication to stay well-hydrated and attend regular follow-up appointments for monitoring of kidney function through blood tests 1. Patients with existing kidney disease may require dose adjustments of quetiapine or other medications to minimize the risk of kidney damage. Any symptoms suggestive of kidney problems, such as decreased urination, swelling in the legs or feet, or unusual fatigue, should be reported to a healthcare provider immediately.
Clinical Considerations
In clinical practice, the decision to prescribe quetiapine should be based on a thorough assessment of the patient's overall health, including their kidney function and the presence of any other conditions that could increase the risk of kidney damage. While the risk of quetiapine causing impaired renal function is not a common adverse effect, the benefits and risks of using quetiapine should be carefully weighed by the healthcare provider, especially in patients with pre-existing kidney disease or those taking other medications that could affect kidney function 1.
From the Research
Impaired Renal Function and Quetiapine
- The study 2 found that quetiapine had no effect on the endogenous creatinine clearance of renally impaired or healthy control subjects, suggesting that dosage adjustment of quetiapine may be unnecessary in psychotic patients with decreased renal function.
- However, a case report 3 described a patient with renal failure caused by lithium who developed neuroleptic malignant syndrome after being treated with lamotrigine, aripiprazole, and quetiapine, highlighting the potential risks of using multiple antipsychotic drugs in combination with mood stabilizers in patients with organic disorders.
- A population-based cohort study 4 found that atypical antipsychotic drug use, including quetiapine, was associated with a higher risk for hospitalization with acute kidney injury (AKI) in older adults, with a relative risk of 1.73.
- A systematic review 5 on the use of antipsychotics in hemodialysis patients found that there is limited literature on the pharmacokinetics of antipsychotics in such patients, but suggested that some antipsychotics, including risperidone and aripiprazole, may be safe and effective in patients undergoing hemodialysis.
Key Findings
- Quetiapine may not require dosage adjustment in patients with decreased renal function 2.
- The use of multiple antipsychotic drugs in combination with mood stabilizers may increase the risk of neuroleptic malignant syndrome in patients with organic disorders 3.
- Atypical antipsychotic drug use, including quetiapine, is associated with an increased risk of AKI in older adults 4.
- Some antipsychotics, including risperidone and aripiprazole, may be safe and effective in patients undergoing hemodialysis 5.