Seroquel: Atypical Antipsychotic for Schizophrenia and Bipolar Disorder
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Synonyms | |||
Seroquel (quetiapine) is an atypical antipsychotic medication indicated for the treatment of schizophrenia, bipolar disorder, and as adjunctive therapy in major depressive disorder. It functions primarily as an antagonist at multiple neurotransmitter receptors, including serotonin and dopamine receptors, which contributes to its efficacy in managing both positive and negative symptoms of psychiatric conditions. This medication is available in immediate-release and extended-release formulations, allowing for tailored treatment approaches based on individual patient needs and clinical presentation.
Features
- Active ingredient: Quetiapine fumarate
- Available formulations: Immediate-release (Seroquel) and extended-release (Seroquel XR) tablets
- Receptor activity: Antagonist at serotonin (5-HT2A), dopamine (D2), histamine (H1), and adrenergic (α1 and α2) receptors
- FDA-approved indications: Schizophrenia, bipolar disorder (mania and depression), adjunctive treatment for major depressive disorder
- Multiple dosage strengths available: 25mg, 50mg, 100mg, 200mg, 300mg, 400mg tablets
- Bioavailability: Approximately 100% for immediate-release formulation
- Half-life: Approximately 6 hours (immediate-release) and 7 hours (extended-release)
- Metabolism: Primarily hepatic via CYP3A4 isoenzyme
Benefits
- Effective reduction of positive symptoms in schizophrenia, including hallucinations and delusions
- Improvement of negative symptoms such as social withdrawal and affective flattening
- Mood stabilization in bipolar disorder, addressing both manic and depressive episodes
- Adjunctive efficacy in treatment-resistant major depressive disorder
- Flexible dosing regimens with both immediate and extended-release formulations
- Generally favorable metabolic profile compared to some other atypical antipsychotics
Common use
Seroquel is primarily prescribed for the management of schizophrenia in adults and adolescents aged 13 years and older. In bipolar disorder, it is used for the treatment of acute manic episodes, depressive episodes, and as maintenance therapy. The extended-release formulation (Seroquel XR) is particularly useful for once-daily dosing, improving medication adherence. Off-label uses may include anxiety disorders, insomnia, and dementia-related psychosis, though these applications require careful risk-benefit assessment by treating physicians.
Dosage and direction
Dosage must be individualized based on clinical condition, patient response, and tolerability. For schizophrenia: Initial dose is 25mg twice daily, with increases of 25-50mg divided into two or three doses on days 2 and 3, up to a target range of 300-400mg daily by day 4. Maintenance dose typically ranges from 300-800mg daily. For bipolar mania: Similar titration with target dose of 400-800mg daily. For bipolar depression: 50mg at bedtime on day 1, 100mg on day 2, 200mg on day 3, and 300mg on day 4. Extended-release formulation should be taken once daily, preferably in the evening without food or with a light meal. Tablets should be swallowed whole and not crushed, chewed, or divided.
Precautions
Patients should be monitored regularly for metabolic changes including weight gain, hyperglycemia, and dyslipidemia. Regular assessment of blood glucose, lipid profile, and weight is recommended. Orthostatic hypotension may occur, particularly during initial dose titration. Sedation is common, especially during initial treatment; patients should exercise caution when operating machinery or driving. Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of mortality. Neuroleptic malignant syndrome and tardive dyskinesia are potential serious adverse effects requiring immediate medical attention.
Contraindications
Seroquel is contraindicated in patients with known hypersensitivity to quetiapine or any component of the formulation. Concomitant use with strong CYP3A4 inhibitors such as ketoconazole, itraconazole, indinavir, ritonavir, and clarithromycin is contraindicated due to significantly increased quetiapine exposure. Use in combination with other drugs that prolong the QT interval is generally avoided. The extended-release formulation should not be used in children under 18 years.
Possible side effect
Common adverse reactions (≥10%) include somnolence, dry mouth, dizziness, constipation, asthenia, abdominal pain, postural hypotension, and weight gain. Moderate frequency effects (1-10%) include tachycardia, elevated liver enzymes, dyspepsia, and increased appetite. Serious but rare side effects (<1%) include neuroleptic malignant syndrome, tardive dyskinesia, seizures, leukopenia, neutropenia, priapism, and QT prolongation. Metabolic effects including hyperglycemia, diabetes mellitus, and hypertriglyceridemia may occur. Cataract formation has been observed in animal studies; periodic eye examinations are recommended.
Drug interaction
Strong CYP3A4 inhibitors (ketoconazole, itraconazole, HIV protease inhibitors, macrolide antibiotics) increase quetiapine exposure and require dose reduction. CYP3A4 inducers (phenytoin, carbamazepine, rifampin, St. John’s wort) decrease quetiapine exposure and may require dose adjustment. Concomitant use with other central nervous system depressants (alcohol, benzodiazepines, opioids) may enhance sedative effects. Antihypertensive agents may potentiate orthostatic hypotension. Drugs that prolong QT interval (antiarrhythmics, certain antibiotics) should be used with caution. Lithium and valproate coadministration requires monitoring for enhanced adverse effects.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next scheduled dose. In that case, the missed dose should be skipped and the regular dosing schedule resumed. Patients should not take a double dose to make up for a missed dose. For the extended-release formulation, if remembered within 6 hours of the scheduled time, the dose should be taken immediately. If remembered more than 6 hours late, the dose should be skipped and the next dose taken at the regular time.
Overdose
Seroquel overdose may manifest as sedation, tachycardia, hypotension, and QT prolongation. Anticholinergic effects including dry mouth and ileus may occur. In severe cases, coma, respiratory depression, and seizures have been reported. Management involves supportive care with continuous cardiac monitoring for at least 12-18 hours. Activated charcoal may be administered if presentation is early. Hypotension should be treated with intravenous fluids and vasopressors if necessary. There is no specific antidote for quetiapine overdose. Dialysis is unlikely to be effective due to high protein binding.
Storage
Store at room temperature (15-30°C or 59-86°F) in a dry place protected from light. Keep in the original container with the lid tightly closed. Do not store in bathroom cabinets where moisture may accumulate. Keep out of reach of children and pets. Do not use after the expiration date printed on the packaging. Properly dispose of any unused medication through medication take-back programs or according to local regulations.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Individual treatment decisions must be made by qualified healthcare professionals based on comprehensive patient assessment. Dosage and administration should follow approved prescribing information. Patients should not alter their medication regimen without consulting their prescribing physician. The full prescribing information contains complete details regarding warnings, precautions, and adverse reactions.
Reviews
Clinical studies demonstrate Seroquel’s efficacy in reducing PANSS scores in schizophrenia by approximately 30-40% compared to placebo. In bipolar depression, response rates of 58% have been reported versus 36% for placebo. Maintenance studies show significant delay in time to recurrence of mood episodes. Real-world evidence supports its effectiveness, though weight gain and metabolic effects remain concerns requiring ongoing management. Patient-reported outcomes indicate improved quality of life and functional capacity when metabolic parameters are properly monitored and managed.