Quetiapine Starting Dose
For most adults with schizophrenia, start quetiapine at 50 mg/day on day 1, then titrate rapidly to 400 mg/day by day 5 using twice-daily divided dosing. 1, 2
Standard Titration Schedule for Adults
The recommended dose escalation follows this specific protocol, administered in two divided doses per day 1, 2:
- Day 1: 50 mg/day
- Day 2: 100 mg/day
- Day 3: 200 mg/day
- Day 4: 300 mg/day
- Day 5: 400 mg/day (target dose)
This schedule can be accelerated to reach 400 mg/day in as little as 2-3 days in acutely ill hospitalized patients, as rapid escalation has demonstrated similar safety and tolerability to the 5-day schedule 3.
Therapeutic Dosing Range
- The effective dose range is 150-750 mg/day, with maximum effects typically occurring at ≥250 mg/day 4, 1
- Target maintenance dosing is 300-450 mg/day for most patients 1
- Fixed-dose studies demonstrate that 150-450 mg/day is as effective as higher doses of 600-750 mg/day 5
Special Population Adjustments
Dementia patients require substantially lower starting doses 6:
- Start at 12.5 mg twice daily (25 mg/day total)
- Maximum dose: 200 mg twice daily
- Titrate gradually due to risk of orthostatic hypotension, particularly during initial titration 6
Elderly, frail, or hepatically/renally impaired patients 1:
- Start at 25 mg/day
- Increase by 25-50 mg increments daily
- Effective doses are typically lower than in younger adults 1
Important Clinical Considerations
Common pitfalls to avoid:
- Quetiapine is more sedating than other atypical antipsychotics, so warn patients about somnolence (17.5% incidence) 6, 1
- Monitor for orthostatic hypotension, particularly during titration 1
- Headache (19.4%) and dizziness (9.6%) are common early adverse events 1
Dosing frequency: Twice-daily administration is as effective as three-times-daily dosing and improves adherence 1.
No routine monitoring required: Unlike some antipsychotics, quetiapine does not require routine ECG or blood monitoring, causes placebo-level extrapyramidal symptoms, and does not elevate prolactin 4, 1.