Does Seroquel (quetiapine) come in a 12.5mg tablet?

Availability of Quetiapine 12.5mg Tablets

Yes, quetiapine (Seroquel) is available in a 12.5mg tablet form, which is commonly used as an initial dose for elderly patients or those with hepatic impairment when treating delirium or other psychiatric conditions. 1

Dosage Forms and Strengths

Quetiapine fumarate tablets are available in multiple strengths:

• 12.5mg (initial dose for elderly patients) 1
• 25mg (round, pink tablets) 2
• 50mg (round, white to off-white tablets) 2
• 100mg (round, yellow tablets) 2
• 200mg (round, white to off-white tablets) 2
• 300mg (capsule-shaped, white tablets) 2
• 400mg (capsule-shaped, yellow tablets) 2

Clinical Applications of Low-Dose Quetiapine

The 12.5mg dose is particularly important in several clinical scenarios:

Elderly Patients

• Initial dosing: Start with 12.5mg twice daily for elderly patients with delirium or psychiatric conditions 1
• Titration: Can be gradually increased based on response and tolerability 1
• Reduced side effects: Lower starting doses help minimize orthostatic hypotension and excessive sedation in older adults 1

Delirium Management

• Starting dose: 12.5mg is recommended as the initial dose for delirium in medically ill or elderly patients 1
• Administration: Can be given twice daily (q12h) if scheduled dosing is required 1
• Advantages: Less likely to cause extrapyramidal symptoms compared to other antipsychotics 1

Hepatic Impairment

• Dose adjustment: Patients with hepatic impairment should start with lower doses like 12.5mg 1
• Metabolism: Quetiapine is primarily metabolized through the liver via CYP3A4 enzymes, making dose reduction necessary in hepatic dysfunction 3

Pharmacological Properties

Quetiapine has several properties that make it suitable for use at lower doses:

• Receptor profile: Antagonist at both serotonin 5-HT2 and dopamine D2 receptors 4
• Sedative effects: Even at low doses like 12.5mg, can provide sedative effects beneficial in agitation 5
• Low EPS risk: Maintains placebo-level incidence of extrapyramidal symptoms across its entire dose range 3, 6
• Prolactin effects: Does not elevate plasma prolactin levels compared to placebo 3

Practical Considerations

• Titration schedule: When starting with 12.5mg, dose can be gradually increased based on response and tolerability 1
• Formulation: The 12.5mg tablet is specifically designed for initial dosing in vulnerable populations 1
• Administration: Oral route only for the tablet formulation 1
• Monitoring: Regular assessment of response and side effects is important, particularly when starting with low doses 1

Common Pitfalls and Caveats

• Sedation: Even at 12.5mg, quetiapine can cause significant sedation in some patients 1
• Orthostatic hypotension: Monitor for dizziness and falls, especially in elderly patients 1
• Drug interactions: Quetiapine interacts with medications that affect CYP3A4 enzymes 7
• QTc prolongation: Although less common at lower doses, ECG monitoring may be warranted in patients with cardiac risk factors 1
• Weight gain: While less pronounced at lower doses, weight monitoring is still recommended 3

The availability of the 12.5mg tablet strength allows for appropriate dosing in vulnerable populations, helping to minimize side effects while still providing therapeutic benefit.