Seroquel (Quetiapine) Dosing
For most adult patients, start quetiapine at 12.5 mg twice daily and titrate to a maximum of 200 mg twice daily, with careful monitoring for orthostatic hypotension during initial dose escalation. 1
Standard Adult Dosing
- Initial dose: 12.5 mg twice daily 1
- Maximum dose: 200 mg twice daily (400 mg/day total) for most indications 1
- Monitor closely for orthostatic hypotension, especially during the initial titration phase 1
- Sedation and orthostatic hypotension are common during dose escalation, requiring cautious administration 1
Special Population: Elderly Patients
- Start at 12.5 mg twice daily in elderly patients with psychiatric conditions or delirium 2
- Maximum dose remains 200 mg twice daily 2
- Elderly patients face higher risk of transient orthostatic hypotension and increased sedating effects 2
- Require more careful dose escalation and closer monitoring compared to younger adults 2
Alternative Titration Schedule for Schizophrenia
While the American Academy of Family Physicians recommends the conservative approach above, research in schizophrenia populations suggests a more aggressive titration schedule may be appropriate in specific psychiatric settings:
- Day 1: 50 mg/day 3
- Day 2: 100 mg/day 3
- Day 3: 200 mg/day 3
- Day 4: 300 mg/day 3
- Day 5: 400 mg/day (target dose) 3
- Therapeutic range: 150-750 mg/day administered twice daily 3
However, the guideline-recommended conservative approach should take precedence in general practice settings to minimize adverse effects, particularly orthostatic hypotension and sedation 1.
Key Clinical Considerations
- Dose-response relationship: Clinical efficacy in schizophrenia is dose-related, with maximum effects occurring at dosages ≥250 mg/day 4
- Fixed-dose studies demonstrate that 150-450 mg/day is effective and no less effective than higher doses of 600-750 mg/day 5
- Twice-daily administration is appropriate; no significant efficacy difference exists between twice and three times daily dosing 4
Common Pitfalls to Avoid
- Do not escalate too rapidly in elderly patients or those at risk for falls, as orthostatic hypotension is most problematic during initial titration 1, 2
- Avoid unnecessary high-dose prescribing: robust evidence does not support routine use above 750-800 mg/day despite some case reports suggesting benefit 5
- Monitor for sedation: patients reporting mild initial sedation may actually show better antipsychotic response 6