Quetiapine (Seroquel) Dose Titration
For schizophrenia in adults, start quetiapine at 25 mg twice daily on Day 1, increase to 50-100 mg twice daily on Day 2,100-200 mg twice daily on Day 3, and reach 300-400 mg/day by Day 4, with further adjustments in 25-50 mg increments at intervals of at least 2 days to a target range of 150-750 mg/day. 1
Standard Titration by Indication
Schizophrenia - Adults
- Day 1: 25 mg twice daily 1
- Day 2: Increase by 25-50 mg to divided doses 2-3 times daily 1
- Day 3: Continue incremental increases of 25-50 mg 1
- Day 4: Target range of 300-400 mg/day 1
- Maintenance: 150-750 mg/day (maximum 750 mg/day) 1
- Further adjustments should be made in increments of 25-50 mg twice daily at intervals of not less than 2 days 1
Schizophrenia - Adolescents (13-17 years)
- Day 1: 25 mg twice daily 1
- Day 2: 100 mg/day in divided doses 1
- Day 3: 200 mg/day in divided doses 1
- Day 4: 300 mg/day in divided doses 1
- Day 5: 400 mg/day in divided doses 1
- Target range: 400-800 mg/day (maximum 800 mg/day) 1
- Further adjustments should be in increments no greater than 100 mg/day 1
Bipolar Mania - Adults
- Day 1: 100 mg/day in divided doses 1
- Day 2: 200 mg/day in divided doses 1
- Day 3: 300 mg/day in divided doses 1
- Day 4: 400 mg/day in divided doses 1
- Further dosage adjustments up to 800 mg/day by Day 6 should be in increments of no greater than 200 mg/day 1
- Target range: 400-800 mg/day (maximum 800 mg/day) 1
Bipolar Mania - Children and Adolescents (10-17 years)
- Day 1: 25 mg twice daily 1
- Day 2: 100 mg/day in divided doses 1
- Day 3: 200 mg/day in divided doses 1
- Day 4: 300 mg/day in divided doses 1
- Day 5: 400 mg/day in divided doses 1
- Target range: 400-600 mg/day (maximum 600 mg/day) 1
- Further adjustments should be in increments no greater than 100 mg/day 1
Bipolar Depression - Adults
- Administer once daily at bedtime 1
- Day 1: 50 mg 1
- Day 2: 100 mg 1
- Day 3: 200 mg 1
- Day 4: 300 mg 1
- Target dose: 300 mg/day (maximum 300 mg/day) 1
Special Population Modifications
Elderly Patients
Elderly patients require substantially slower titration with lower starting doses. 2, 1
- Starting dose: 12.5 mg twice daily for psychiatric conditions or delirium 2, or 50 mg/day per FDA labeling 1
- Titration: Increase in increments of 50 mg/day depending on clinical response and tolerability 1
- Maximum dose: 200 mg twice daily 2
- Critical monitoring: Elderly patients are at higher risk for transient orthostatic hypotension and sedating effects, requiring careful dose escalation 2
Hepatic Impairment
- Starting dose: 25 mg/day 1
- Titration: Increase daily in increments of 25-50 mg/day to an effective dose 1
- Caution: Inter-subject variability in clearance requires cautious dose escalation in patients with hepatic impairment, particularly alcoholic cirrhosis 3
Renal Impairment
- No dosage adjustment is necessary for patients with renal impairment 3
- Standard titration schedules can be followed 3
Critical Monitoring During Titration
Monitor patients closely for orthostatic hypotension, sedation/somnolence, dizziness, and dry mouth during the titration phase, as these side effects can significantly impact patient adherence and safety. 4
- Orthostatic hypotension is particularly problematic during initial titration 4
- Sedation and somnolence are common dose-dependent effects 4
- These adverse effects are most prominent during the titration phase and often improve with continued treatment 4
Dosing Frequency Considerations
Quetiapine can be effectively administered twice daily rather than three times daily, despite its relatively short 7-hour plasma elimination half-life. 5
- A study comparing 225 mg twice daily versus 150 mg three times daily (both totaling 450 mg/day) found no significant differences in efficacy between dosing regimens 5
- Twice-daily dosing may improve patient compliance while maintaining therapeutic efficacy 5
- The lack of correlation between plasma concentrations and dopamine D2 receptor occupancy supports less frequent dosing 5