Seroquel: Advanced Atypical Antipsychotic for Symptom Control
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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 broad efficacy in managing both positive and negative symptoms of psychiatric conditions. This agent is available in immediate-release and extended-release formulations, allowing for tailored therapeutic strategies based on individual patient profiles and clinical requirements. Its established pharmacokinetic profile supports predictable absorption and metabolism, facilitating consistent dosing regimens.
Features
- Contains quetiapine fumarate as the active pharmaceutical ingredient
- Available in immediate-release (Seroquel) and extended-release (Seroquel XR) formulations
- Tablet strengths ranging from 25 mg to 400 mg for precise titration
- Demonstrated high affinity for serotonin (5-HT2) and dopamine (D2) receptors
- Also exhibits antagonism at adrenergic α1 and α2 receptors, and histamine H1 receptors
- FDA-approved for multiple psychiatric indications including schizophrenia and bipolar disorder
- Bioavailability is not significantly affected by food intake
- Metabolized primarily via cytochrome P450 3A4 pathway
Benefits
- Effectively reduces positive symptoms of schizophrenia including hallucinations and delusions
- Demonstrates efficacy in managing acute manic and depressive episodes in bipolar disorder
- Improves overall mood and functional outcomes in adjunct treatment of major depressive disorder
- Extended-release formulation supports once-daily dosing, enhancing adherence
- Generally well-tolerated with a lower incidence of extrapyramidal symptoms compared to typical antipsychotics
- Provides rapid onset of action for acute agitation when appropriately dosed
Common use
Seroquel is primarily prescribed for the management of schizophrenia in adults and adolescents aged 13 years and older. It is also indicated for acute manic episodes associated with bipolar I disorder, both as monotherapy and as part of combination therapy. Additionally, it is used for the treatment of bipolar depression and as adjunctive therapy in major depressive disorder. Off-label uses may include treatment of anxiety disorders, insomnia, and dementia-related psychosis, though these applications require careful risk-benefit assessment by treating clinicians.
Dosage and direction
Dosage must be individualized based on clinical condition, patient response, and tolerability. For schizophrenia: initial dose of 25 mg twice daily, with increases of 25-50 mg two to three times daily to a target range of 300-400 mg daily by day 4. Maintenance dose typically ranges from 300-800 mg daily. For bipolar mania: similar titration to 400-800 mg daily by day 4. For bipolar depression: initial 50 mg once daily at bedtime, increasing to 300 mg daily by day 4. Extended-release formulation should be administered 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 for emergence of suicidal thoughts and behaviors, particularly during initial treatment and dosage adjustments. Regular assessment of weight, blood glucose, and lipid profiles is recommended due to potential metabolic effects. Caution is advised when prescribing to elderly patients with dementia-related psychosis due to increased mortality risk. Orthostatic hypotension may occur, particularly during initial dose titration. Patients should avoid alcohol consumption and be cautioned about operating machinery until they know how the medication affects them. Regular ophthalmologic monitoring is recommended due to potential cataract formation.
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. Use is also contraindicated in patients with severe hepatic impairment. The extended-release formulation is contraindicated in patients who have demonstrated hypersensitivity to other formulations of quetiapine.
Possible side effect
Common adverse reactions (≥5%) include somnolence, dry mouth, dizziness, constipation, asthenia, abdominal pain, postural hypotension, and weight gain. Metabolic side effects may include increased appetite, hyperglycemia, and dyslipidemia. Extrapyramidal symptoms, though less common than with typical antipsychotics, may occur. Other potential effects include tachycardia, elevated thyroid-stimulating hormone levels, and increased prolactin levels. Rare but serious adverse effects include neuroleptic malignant syndrome, tardive dyskinesia, seizures, and leukopenia.
Drug interaction
Strong CYP3A4 inhibitors (e.g., ketoconazole) may significantly increase quetiapine exposure. CYP3A4 inducers (e.g., carbamazepine, phenytoin, rifampin) may decrease quetiapine concentrations. Concomitant use with other central nervous system depressants may enhance sedative effects. May potentiate effects of antihypertensive medications. May enhance QTc-prolonging effects of other medications. Interactions may occur with dopamine agonists, levodopa, and other antipsychotic agents. Caution advised with drugs that affect electrolyte balance.
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 double or extra doses to make up for a missed dose. For the extended-release formulation, if missed within 12 hours of the next dose, skip the missed dose and resume regular schedule. If more than 12 hours have passed, take the missed dose and resume regular schedule.
Overdose
Symptoms of overdose may include sedation, tachycardia, hypotension, and QTc prolongation. In severe cases, coma, respiratory depression, and seizures may occur. Management involves supportive care with continuous cardiac monitoring. Gastric lavage may be considered if presentation is early. Activated charcoal may be administered. There is no specific antidote. Hemodialysis is unlikely to be effective due to high protein binding. Symptomatic treatment for hypotension and arrhythmias should be provided as needed.
Storage
Store at room temperature (15-30°C or 59-86°F). Protect from light and moisture. Keep in original container with lid tightly closed. Do not store in bathroom or other humid areas. Keep out of reach of children and pets. Do not use after expiration date printed on packaging. Properly dispose of any unused medication according to local regulations.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Treatment decisions should be made by qualified healthcare professionals based on individual patient circumstances. The prescribing physician should be consulted for complete information regarding indications, dosage, warnings, and precautions. Patients should not alter their dosage or discontinue medication without medical supervision.
Reviews
Clinical trials demonstrate Seroquel’s efficacy across multiple psychiatric indications. In schizophrenia studies, significant improvement in PANSS scores was observed compared to placebo. Bipolar disorder trials showed effective control of both manic and depressive symptoms. Most patients report improved symptom control and quality of life, though individual responses vary. Some patients note sedation and weight gain as significant concerns. Overall, it remains a valuable option in the psychiatric pharmacopeia when appropriately prescribed and monitored.