Can You Crush Seroquel (Quetiapine)?
No, you should not crush Seroquel extended-release (XR) formulations, but immediate-release quetiapine tablets can be crushed when necessary for patients with swallowing difficulties.
Formulation-Specific Guidance
Extended-Release (Seroquel XR)
- Crushing bictegravir/tenofovir alafenamide/emtricitabine is not recommended 1
- While this guideline specifically addresses a different medication, the same principle applies to extended-release formulations generally—crushing destroys the controlled-release mechanism and can lead to dose dumping, increased side effects, and loss of therapeutic efficacy
Immediate-Release Quetiapine
- Immediate-release quetiapine tablets can be crushed when medically necessary 1
- This is particularly relevant for patients experiencing severe mucositis from chemotherapy or those with significant dysphagia 1
- When crushing is required due to prolonged swallowing difficulty, switching to a regimen that can be crushed or delivered in liquid formulation is recommended 1
Clinical Considerations When Crushing Is Necessary
Pharmacokinetic Impact
- Quetiapine is rapidly absorbed after oral administration with median time to maximum plasma concentration of 1-2 hours 2
- The drug has a mean terminal half-life of approximately 7 hours 2
- Crushing immediate-release tablets should not significantly alter these parameters, though administration timing may need adjustment
Patient Populations Requiring Special Consideration
- Elderly patients: May require lower doses (starting at 25 mg/day with 25-50 mg daily increases) and are more vulnerable to adverse effects 3
- Hepatic impairment: Oral clearance is reduced; crushing tablets does not change this, but dose adjustments remain necessary 2
- Patients with swallowing disorders: Crushing immediate-release tablets is appropriate, but consider liquid formulations if available 1
Common Pitfalls to Avoid
- Never crush extended-release formulations as this eliminates the controlled-release mechanism
- Do not assume all antipsychotics can be crushed—verify formulation type first
- Be aware that quetiapine is associated with weight gain (approximately 2.1 kg in short-term trials) 3, somnolence, and dizziness 3—crushing does not mitigate these effects
- Remember that quetiapine should be avoided in elderly patients with dementia due to FDA boxed warning regarding increased mortality risk 1
Alternative Considerations
If crushing is frequently needed, consider:
- Switching to liquid formulations if available
- Using alternative antipsychotics with better formulation options for patients with chronic swallowing difficulties
- Quetiapine has relatively low seizure risk compared to clozapine 4, making it a reasonable choice when crushing is necessary in patients with seizure history