From the FDA Drug Label
Table 1: Recommended Dosing for Quetiapine Fumarate Tablets IndicationInitial Dose and TitrationRecommended DoseMaximum Dose ... Bipolar Mania- Adults Monotherapy or as an adjunct to lithium or divalproex Day 1: Twice daily dosing totaling 100 mg. Day 2: Twice daily dosing totaling 200 mg. Day 3: Twice daily dosing totaling 300 mg. Day 4: Twice daily dosing totaling 400 mg Further dosage adjustments up to 800 mg/day by Day 6 should be in increments of no greater than 200 mg/day. 400 to 800 mg/day 800 mg/day ... Bipolar I Disorder Maintenance Therapy- Adults Administer twice daily totaling 400 to 800 mg/day as adjunct to lithium or divalproex. Generally, in the maintenance phase, patients continued on the same dose on which they were stabilized 400 to 800 mg/day 800 mg/day
The recommended dosing for Bipolar Mania in adults is 400 to 800 mg/day, with a maximum dose of 800 mg/day. For Bipolar I Disorder Maintenance Therapy in adults, the recommended dose is 400 to 800 mg/day, with a maximum dose of 800 mg/day 1.
- Initial dose: 100 mg on Day 1, increasing to 400 mg by Day 4
- Titration: Further adjustments up to 800 mg/day by Day 6 in increments of no greater than 200 mg/day
- Maintenance therapy: 400 to 800 mg/day, administered twice daily, as adjunct to lithium or divalproex.
From the Research
Seroquel (quetiapine) for bipolar disorder is typically started at 50mg twice daily, gradually increasing to an effective dose range of 300-800mg per day, as recommended by recent guidelines and studies 2, 3. The medication is commonly taken at bedtime due to its sedating effects, with extended-release formulations allowing once-daily dosing. Key points to consider when prescribing Seroquel for bipolar disorder include:
- Gradual titration to minimize side effects like sedation, dizziness, and orthostatic hypotension
- Regular monitoring for metabolic side effects, including weight gain, blood glucose, and lipid levels
- Avoiding alcohol while taking Seroquel and not abruptly discontinuing the medication to prevent worsening symptoms
- Adjusting dosing based on individual response, side effects, and other medications being taken For acute mania, doses often reach 400-800mg daily, while bipolar depression usually requires 300-600mg daily, as supported by studies such as 4. It's essential to note that Seroquel works by blocking multiple neurotransmitter receptors, including dopamine and serotonin, which helps stabilize mood, and its use should be considered in the context of overall treatment plans, including lifestyle approaches and psychotherapy, as highlighted in studies like 5 and 6. In terms of specific dosing, the most recent and highest quality study 2 suggests that the effective dose range for Seroquel in bipolar disorder is 300-800mg per day, which is consistent with other studies and guidelines. Overall, the use of Seroquel for bipolar disorder should be guided by the most recent and highest quality evidence, with a focus on minimizing side effects and maximizing efficacy, as recommended by studies like 2 and 3.