Quetiapine Fumarate

Indications
Oral
Schizophrenia
Adult: Initially, 25 mg bid on day 1, increased to 50 mg bid on day 2, 100 mg bid on day 3 and 150 mg bid on day 4. Usual dose range: 300-450 mg daily. Max: 750 mg/day.
Elderly: Initially, 25 mg daily, increased in steps of 25-50 mg daily according to response.
Renal impairment: Initially, 25 mg daily, may increase in steps of 25-50 mg daily according to response.
Hepatic impairment: Dose adjustment may be required.
Oral
Bipolar disorder
Adult: Manic phase: 50 mg bid on day 1, 100 mg bid on day 2, 150 mg bid on day 3 and 200 mg bid on day 4. Usual range: 400-800 mg/day; adjust dose according to response. Dosage increments should be ≤200 mg/day. Depressive phase: Initially, 50 mg at bedtime on day 1; 100 mg on day 2, 200 mg on day 3, and 300 mg on day 4. May increase to 400 mg on day 5 and 600 mg on day 8, if needed.
Elderly: Initially, 25 mg daily, increased in steps of 25-50 mg daily according to response.
Renal impairment: Initially, 25 mg daily, may increase in steps of 25-50 mg daily according to response.
Hepatic impairment: Dose adjustment may be required.

Special Populations: Recommended dose for patients with hepatic or renal impairment: Initially, 25 mg daily increased in increments of 25-50 mg daily according to response.
Contraindications
Severe CNS depression, bone marrow suppression, coma.
Warnings / Precautions
CV disease, cerebrovascular disease or conditions that predispose to hypotension. History of seizures; neuroleptic malignant syndrome; tardive dyskinesia. Monitor glycaemic control, especially in diabetics. Hepatic or renal impairment. Gradual withdrawal is recommended. Monitor for signs of clinical worsening, suicidality or unusual changes in behaviour. Pregnancy and lactation.
Adverse Reactions
Headache, asthenia, abdominal pain, back pain, fever, chest pain, postural and orthostatic hypotension, hypertension, constipation, dry mouth, dyspepsia, diarrhoea, leucopenia, elevations in serum transaminase level, weight gain, myalgia, somnolence, dizziness, anxiety, rhinitis, rash, dry skin, ear pain, UTI, syncope, neuroleptic malignant syndrome, variations in WBC count, neutropenia, eosinophilia, elevations in nonfasting serum triglyceride level and total cholesterol, decrease in thyroid hormone levels, prolongation of the QTc interval.
Overdose Reactions
Symptoms include drowsiness and sedation, tachycardia and hypotension.
Drug Interactions
Increased risk of drowsiness and postural hypotension when used with alcohol. CYP3A4 inducers eg. phenytoin and carbamazepine may decrease plasma levels of quetiapine while CYP3A4 inhibitors eg. ketoconazole and erythromycin may increase its plasma levels.
See Below for More quetiapine Drug Interactions
Mechanism of Actions
Quetiapine is an antagonist at multiple neurotransmitter receptors in the brain: Serotonin 5-HT1A and 5-HT2, dopamine D1 and D2, histamine H1 and adrenergic a1 and a2 receptors. It is used in the treatment of schizophrenia and bipolar disorder.
Absorption: Well absorbed after oral doses.
Distribution: Widely distributed throughout the body. 83% bound to plasma proteins.
Metabolism: Extensively metabolised in the liver by sulfoxidation and oxidation.
Excretion: Excreted mainly as inactive metabolites. Elimination half-life: about 6-7 hr.
Administration
May be taken with or without food.
Extended-release: Should be taken on an empty stomach. (Take w/o food or w/ a light meal. Swallow whole, do not chew/crush. )
Storage Conditions
Oral: Store at 25°C.
ATC Classification
N05AH04 - quetiapine ; Belongs to the class of diazepines, oxazepines and thiazepines antipsychotics.
Storage
Oral: Store at 25°C.
Available As
  • Quetiapine Fumarate 100 mg
  • Quetiapine Fumarate 200 mg
  • Quetiapine Fumarate 25 mg
  • Quetiapine Fumarate 300 mg
  • Quetiapine Fumarate 400 mg
  • Quetiapine Fumarate 50 mg
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