What is the maximum recommended dose of Seroquel (quetiapine) XR?

Maximum Dose of Seroquel XR (Quetiapine Extended-Release)

The maximum recommended dose of Seroquel XR is 800 mg once daily for schizophrenia and bipolar mania, and 300 mg once daily for bipolar depression. 1

Dosing by Indication

Schizophrenia

• Maximum dose: 800 mg/day 1
• Recommended therapeutic range: 400-800 mg/day once daily 1
• Initial dosing starts at 300 mg on Day 1, increases to 600 mg on Day 2, and can reach 800 mg by Day 3 if tolerated 1, 2
• The FDA label specifies that doses above 800 mg/day have not been systematically evaluated 1

Bipolar Mania

• Maximum dose: 800 mg/day 1
• Recommended therapeutic range: 400-800 mg/day 1
• Same rapid titration schedule as schizophrenia applies 1

Bipolar Depression

• Maximum dose: 300 mg/day 1
• This is substantially lower than for other indications and should not be exceeded 1
• Administered once daily at bedtime 1

Critical Dosing Distinctions for Special Populations

Elderly Patients

• Do NOT use the standard maximum doses 3
• For dementia-related behavioral disturbances: maximum 400 mg/day total (200 mg twice daily) 3
• Start at 50 mg/day with 50 mg/day increments 1
• The American Academy of Family Physicians emphasizes slower titration and lower target doses in elderly patients 3

Hepatic Impairment

• Start at 25 mg/day with 25-50 mg/day increments 1
• Maximum dose should be lower than standard dosing, though specific upper limit not defined in FDA labeling 1

Important Safety Considerations

Dose-Related Effects

• Efficacy is dose-dependent, with maximum therapeutic effects occurring at ≥250 mg/day for immediate-release formulations 4
• For XR formulations, the therapeutic range of 400-800 mg/day has been established in clinical trials 2
• Low doses (<250 mg/day) may paradoxically worsen mania due to preferential 5HT2A receptor blockade over D2 antagonism, increasing dopamine concentrations 5

Common Pitfalls to Avoid

• Never use schizophrenia maximum doses (800 mg/day) in elderly patients with dementia—the ceiling is 400 mg/day for this population 3
• Do not underdose acute mania: the recommended therapeutic dose is 600-800 mg/day, not the lower doses sometimes used off-label 5
• Quetiapine XR is more sedating than other atypical antipsychotics, which may limit tolerability at higher doses 3

Monitoring Requirements

• Monitor for orthostatic hypotension, especially during initial titration 6, 3
• Six-monthly slit lamp eye examinations are recommended in some countries due to potential lenticular changes with long-term use 4
• Avoid abrupt discontinuation; taper gradually over 10-14 days when stopping treatment 3