What percentage of patients experience weight gain with Quetiapine (Seroquel)?

From the Guidelines

Seroquel (quetiapine) is associated with significant weight gain in approximately 25-30% of users, with an average weight gain of around 7% of body weight over the first year of treatment. This weight gain is dose-dependent, with higher doses leading to greater weight increases 1. The mechanisms behind Seroquel-induced weight gain include increased appetite, carbohydrate craving, sedation leading to reduced physical activity, and metabolic changes that affect insulin sensitivity and fat storage.

Key Points to Consider

• Weight gain typically begins within the first few weeks of treatment and may continue gradually over months.
• Patients taking Seroquel should monitor their weight regularly, maintain a balanced diet, and engage in regular physical activity.
• For those with pre-existing metabolic concerns or obesity, alternative antipsychotics with lower weight gain profiles, such as lurasidone and ziprasidone, might be considered 1.
• Any medication changes should only occur under medical supervision, as the choice of agent must be guided by best practice for the individual patient’s circumstance.

Management of Weight Gain

• Regular weight monitoring is crucial for early detection of significant weight gain.
• Lifestyle modifications, including diet and exercise, can help mitigate weight gain.
• In some cases, switching to a different antipsychotic with a lower risk of weight gain may be necessary, but this decision should be made in consultation with a healthcare provider.

From the FDA Drug Label

Increases in weight have been observed in clinical trials Patients receiving quetiapine should receive regular monitoring of weight. Adults: In clinical trials with quetiapine the following increases in weight have been reported Table 6: Proportion of Patients with Weight Gain ≥ 7% of Body Weight (Adults) Weight Gain ≥7% of Body Weight Schizophrenia * Quetiapine 391 89 (23%) Placebo 206 11 (6%) Bipolar Mania (monotherapy) † Quetiapine 209 44 (21%) Placebo 198 13 (7%) Bipolar Mania (adjunct therapy) ‡ Quetiapine 196 25 (13%) Placebo 203 8 (4%) Bipolar Depression § Quetiapine 554 47 (8%) Placebo 295 7 (2%) Children and Adolescents: In two clinical trials with quetiapine, one in bipolar mania and one in schizophrenia, reported increases in weight are included in Table 7 Table 7: Proportion of Patients with Weight Gain ≥7% of Body Weight (Children and Adolescents) Weight Gain ≥7% of Body Weight Schizophrenia * Quetiapine 111 23 (21%) Placebo 44 3 (7%) Bipolar Mania † Quetiapine 157 18 (12%) Placebo 68 0 (0%)

The percentage of patients with weight gain ≥7% of body weight varies by indication and population:

• Schizophrenia: 23% of adults and 21% of children and adolescents
• Bipolar Mania (monotherapy): 21% of adults and 12% of children and adolescents
• Bipolar Mania (adjunct therapy): 13% of adults
• Bipolar Depression: 8% of adults and 15% of children and adolescents 2

From the Research

Seroquel Weight Gain Percentage

• The percentage of weight gain associated with Seroquel (quetiapine) is a significant concern in patients with schizophrenia and other psychiatric disorders 3, 4, 5, 6, 7.
• A study published in 2000 found that quetiapine had a weight-neutral or 'normalizing' effect, with a tendency towards favorable shifts in body weight in underweight patients and severely obese patients 4.
• Another study published in 2014 found that 32% of patients treated with quetiapine experienced a significant weight increase (>7% of their baseline weight) after 12 weeks of treatment 7.
• A 2018 study found that after 1 year of treatment, quetiapine was associated with significant increments in weight, BMI, total cholesterol, LDL-cholesterol, triglycerides, and the triglyceride/HDL index, although there were no significant differences in metabolic parameters between quetiapine and other antipsychotics (aripiprazole and ziprasidone) 6.
• The weight gain liability of quetiapine is considered to be moderate, with a ranking of SGAs showing clozapine and olanzapine as having the highest risk, followed by amisulpride, asenapine, iloperidone, paliperidone, quetiapine, risperidone, and sertindole in the middle, and aripiprazole, lurasidone, and ziprasidone with the lowest risk 5.

Comparison with Other Antipsychotics

• Quetiapine has been compared to other antipsychotics, such as aripiprazole and ziprasidone, in terms of weight gain liability 6, 7.
• A study published in 2014 found that patients treated with aripiprazole gained significantly more weight than those treated with ziprasidone, while quetiapine-treated patients showed a significant increase in total cholesterol and LDL-cholesterol plasma levels 7.
• Another study published in 2018 found that there were no significant differences in metabolic parameters between quetiapine, aripiprazole, and ziprasidone after 1 year of treatment 6.