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GENERIC NAME: quetiapine
BRAND NAME: Seroquel

DRUG CLASS AND MECHANISM: Quetiapine is an oral antipsychotic drug used for treating schizophrenia and bipolar disorder. Although the mechanism of action of quetiapine is unknown, like other anti-psychotics, it inhibits communication between nerves of the brain. It does this by blocking receptors on the nerves for several neurotransmitters, the chemicals that nerves use to communicate with each other. It is t

hought that its beneficial effect is due to blocking of the dopamine type 2 (D2) and serotonin type 2 (5-HT2) receptors.

PRESCRIPTION: Yes

GENERIC AVAILABLE: No

PREPARATIONS: Tablets: 25, 50, 100, 200, 300, and 400 mg

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STORAGE: Tablets should be stored at room temperature, 15-30°C (59-86°F).

PRESCRIBED FOR: Quetiapine is used alone or in combination with other drugs to treat schizophrenia and bipolar disorder.

DOSING: Quetiapine usually is taken two or t

hree times daily. The dose usually is increased slowly over several days or weeks to achieve the desired effect. Quetiapine can be taken with or without food.

The initial dose for bipolar disorder is 50 mg twice daily (100 mg/d). The dose can be increased by 100 mg/d to a daily dose of 400 mg/d. Most patients respond to 400-800 mg/d. Doses greater than 800 mg/d have not been studied.

The initial dose for schizophrenia is 25 mg twice daily (50 mg/d). The dose can be increased by 25-50 mg two

or three times daily. The target dose is 300-400 mg/d in two or three doses. Patients respond to 150-750 mg/d, and doses greater than 800 mg/d have not been evaluated.

DRUG INTERACTIONS: Phenytoin (Dilantin) and thioridazine (Mellaril) markedly decrease the amount of quetiapine that is absorbed from the intestine and thereby reduces its effectiveness. Therefore, patients taking phenytoin or thioridazine may require higher doses of quetiapine.

Quetiapine can cause hypotension (low blood pressure) and therefore increase the blood pressure lowering effects of antihypertensive drugs.

Quetiapine can increase the sedating effects of other drugs that sedate. Such drugs include narcotic pain relievers [for example, oxycodone and acetaminophen (Percocet, Roxicet, Tylox, Endocet)], barbiturates, sedatives such as alprazolam (Xanax) and clonazepam (Klonopin), ethanol, and blood pressure drugs that can cause orthostatic hypotension, such as prazosin (Minipress) and terazosin (Hytrin).

Quetiapine is eliminated from the body by an enzyme in the liver called cytochrome P450 3A. There is a concern that drugs that strongly interfere with the enzyme, for example, ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole (Diflucan), and erythromycin, clarithromycin (Biaxin), nefazodone (Serzone), verapamil (Calan, Isoptin, Verelan), or diltiazem (Cardizem, Tiazac, Dilacor) may cause elevated and toxic levels of quetiapine.

PREGNANCY: There are no adequate studies of quetiapine in pregnant women. Studies in animals are inconsistent. Some studies suggest effects on the fetus and others show no effects. Quetiapine should only be used in pregnancy if the physician feels that it is absolutely necessary and that the potential benefits justify the unknown risks.

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