How long does Seroquel (quetiapine) 400mg Extended Release (ER) release medication over a 24-hour period in a patient with Oppositional Defiant Disorder (ODD), Autism Spectrum Disorder (ASD), and a history of in utero cocaine exposure?

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Seroquel XR 400mg Release Duration

Seroquel XR (quetiapine extended-release) 400mg releases medication over approximately 24 hours, designed for once-daily dosing. However, the provided evidence does not contain specific pharmacokinetic data about the exact release profile or duration for this formulation.

Key Pharmacological Considerations

Extended-Release Mechanism

  • Crushing or altering Seroquel XR tablets destroys the controlled-release mechanism, leading to dose dumping, increased side effects, and loss of therapeutic efficacy 1
  • Only immediate-release quetiapine formulations can be crushed when medically necessary 1
  • The extended-release formulation is specifically engineered to maintain therapeutic drug levels throughout a 24-hour period

Clinical Context for This Patient Population

For patients with ODD, ASD, and history of in utero cocaine exposure:

  • Quetiapine shows promise for treating irritability and aggression in these populations, though only risperidone and aripiprazole have FDA approval for irritability associated with ASD in children and adolescents 2
  • Patients with ODD and severe aggression may respond well to risperidone, with or without psychostimulants 3
  • Quetiapine has minimal extrapyramidal side effects compared to typical antipsychotics, making it better tolerated 4

Dosing Schedule Implications

  • The 400mg dose represents a substantial dose that should be given once daily for the XR formulation
  • Metabolic side effects are concerning with atypical antipsychotics, requiring monitoring 2
  • The extended-release formulation avoids the need for twice-daily dosing required with immediate-release quetiapine 5

Important Caveats

In utero cocaine exposure considerations:

  • Neurobehavioral abnormalities from cocaine exposure (irritability, hyperactivity, tremors) typically manifest on postnatal days 2-3 and may persist 5
  • These baseline behavioral issues may complicate assessment of medication efficacy and side effects 5

The XR formulation must remain intact to maintain the 24-hour therapeutic window—any crushing or splitting negates the extended-release properties 1

References

1
Guideline

Crushing Seroquel Formulations

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

2
Research

An update on pharmacotherapy of autism spectrum disorder in children and adolescents.

International review of psychiatry (Abingdon, England), 2018

4
Research

Quetiapine fumarate (Seroquel): a new atypical antipsychotic.

Drugs of today (Barcelona, Spain : 1998), 1999

5
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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