Seroquel: Advanced Atypical Antipsychotic for Symptom Control
| Product dosage: 100mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $4.30 | $43.00 (0%) | 🛒 Add to cart |
| 20 | $3.01 | $86.00 $60.20 (30%) | 🛒 Add to cart |
| 30 | $2.29 | $129.00 $68.80 (47%) | 🛒 Add to cart |
| 60 | $1.58 | $258.00 $94.60 (63%) | 🛒 Add to cart |
| 90 | $1.43 | $387.00 $129.00 (67%) | 🛒 Add to cart |
| 120 | $1.36 | $516.00 $163.40 (68%) | 🛒 Add to cart |
| 180 | $1.19 | $774.00 $215.00 (72%) | 🛒 Add to cart |
| 270 | $1.02 | $1161.00 $275.20 (76%) | 🛒 Add to cart |
| 360 | $0.96
Best per pill | $1548.00 $344.00 (78%) | 🛒 Add to cart |
| Product dosage: 200mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $5.16 | $51.60 (0%) | 🛒 Add to cart |
| 20 | $4.73 | $103.20 $94.60 (8%) | 🛒 Add to cart |
| 30 | $4.30 | $154.80 $129.00 (17%) | 🛒 Add to cart |
| 60 | $3.15 | $309.60 $189.20 (39%) | 🛒 Add to cart |
| 90 | $2.87 | $464.40 $258.00 (44%) | 🛒 Add to cart |
| 120 | $2.72 | $619.20 $326.80 (47%) | 🛒 Add to cart |
| 180 | $2.10 | $928.80 $378.40 (59%) | 🛒 Add to cart |
| 270 | $1.59 | $1393.20 $430.00 (69%) | 🛒 Add to cart |
| 360 | $1.31
Best per pill | $1857.60 $473.00 (75%) | 🛒 Add to cart |
| Product dosage: 25mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 30 | $1.20 | $36.12 (0%) | 🛒 Add to cart |
| 60 | $0.85 | $72.24 $50.74 (30%) | 🛒 Add to cart |
| 90 | $0.75 | $108.36 $67.08 (38%) | 🛒 Add to cart |
| 120 | $0.67 | $144.48 $80.84 (44%) | 🛒 Add to cart |
| 180 | $0.59 | $216.72 $105.78 (51%) | 🛒 Add to cart |
| 270 | $0.53 | $325.08 $142.76 (56%) | 🛒 Add to cart |
| 360 | $0.50
Best per pill | $433.44 $180.60 (58%) | 🛒 Add to cart |
| Product dosage: 300mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $6.02 | $60.20 (0%) | 🛒 Add to cart |
| 20 | $5.59 | $120.40 $111.80 (7%) | 🛒 Add to cart |
| 30 | $5.45 | $180.60 $163.40 (10%) | 🛒 Add to cart |
| 60 | $4.30 | $361.20 $258.00 (29%) | 🛒 Add to cart |
| 90 | $3.63 | $541.80 $326.80 (40%) | 🛒 Add to cart |
| 120 | $3.15 | $722.40 $378.40 (48%) | 🛒 Add to cart |
| 180 | $2.39 | $1083.60 $430.00 (60%) | 🛒 Add to cart |
| 270 | $1.75 | $1625.40 $473.00 (71%) | 🛒 Add to cart |
| 360 | $1.43
Best per pill | $2167.20 $516.00 (76%) | 🛒 Add to cart |
| Product dosage: 50mg | |||
|---|---|---|---|
| Package (num) | Per pill | Price | Buy |
| 10 | $3.44 | $34.40 (0%) | 🛒 Add to cart |
| 20 | $2.15 | $68.80 $43.00 (38%) | 🛒 Add to cart |
| 30 | $1.72 | $103.20 $51.60 (50%) | 🛒 Add to cart |
| 60 | $1.00 | $206.40 $60.20 (71%) | 🛒 Add to cart |
| 90 | $0.86 | $309.60 $77.40 (75%) | 🛒 Add to cart |
| 120 | $0.79 | $412.80 $94.60 (77%) | 🛒 Add to cart |
| 180 | $0.72 | $619.20 $129.00 (79%) | 🛒 Add to cart |
| 270 | $0.61 | $928.80 $163.40 (82%) | 🛒 Add to cart |
| 360 | $0.57
Best per pill | $1238.40 $206.40 (83%) | 🛒 Add to cart |
Synonyms | |||
Seroquel (quetiapine) is an atypical antipsychotic medication engineered to provide comprehensive neurochemical modulation for a range of psychiatric and neurological conditions. It functions primarily as an antagonist at multiple neurotransmitter receptors, including dopamine D2 and serotonin 5-HT2A receptors, which underpins its broad efficacy profile. This agent is distinguished by its dose-dependent receptor affinity, allowing for tailored therapeutic strategies across different indications, from schizophrenia and bipolar disorder to adjunctive treatment in major depressive disorder. Its pharmacokinetic profile features rapid absorption and extensive metabolism via cytochrome P450 3A4, necessitating consideration of potential interactions but also allowing for flexible dosing regimens.
Features
- Active Ingredient: Quetiapine fumarate
- Pharmacological Class: Dibenzothiazepine derivative, atypical antipsychotic
- Available Formulations: Immediate-release (IR) tablets: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg; Extended-release (XR) tablets: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg
- Receptor Binding Profile: High affinity for serotonin 5-HT2A, dopamine D2, histamine H1, and adrenergic α1 and α2 receptors; lower affinity for muscarinic and serotonin 5-HT1A receptors
- Half-life: Approximately 6 hours for IR formulation; 7-12 hours for XR formulation
- Bioavailability: 100% for IR, unaffected by food; XR bioavailability is comparable when taken with a meal
- Metabolism: Hepatic, primarily via CYP3A4 isoenzyme
- Excretion: Urine (73%) and feces (20%) as metabolites; less than 5% excreted unchanged
Benefits
- Effective reduction of positive and negative symptoms in schizophrenia, including hallucinations, delusions, and social withdrawal
- Provides rapid stabilization of acute manic and mixed episodes in bipolar I disorder, and maintenance of mood stability
- Demonstrates efficacy as monotherapy and adjunctive therapy for major depressive disorder (MDD), improving mood and energy
- Extended-release formulation supports once-daily dosing, enhancing adherence and steady-state plasma concentrations
- Lower incidence of extrapyramidal symptoms (EPS) and hyperprolactinemia compared to typical antipsychotics
- Offers sedative properties at lower doses, beneficial for agitation and sleep disturbances in various disorders
Common use
Seroquel is FDA-approved for the treatment of schizophrenia in adults and adolescents aged 13 years and older, acute manic and depressive episodes associated with bipolar I disorder (as monotherapy or adjunct), and as adjunctive therapy with antidepressants in major depressive disorder. Off-label, it is frequently utilized for insomnia, anxiety disorders, delirium, and as augmentation in treatment-resistant depression, though such uses require careful risk-benefit assessment and are not without significant side effect profiles.
Dosage and direction
Dosing is highly indication-specific and must be individualized based on clinical response, tolerability, and metabolic factors.
- Schizophrenia (Adults): Initial dose 25 mg BID, titrated by 25-50 mg BID-TID to target 300-400 mg/day by Day 4. Effective range: 150-750 mg/day.
- Schizophrenia (Adolescents 13-17): Initial 25 mg BID, titrate to 400-600 mg/day by Day 5; not to exceed 800 mg/day.
- Bipolar Mania (Adults): Day 1: 50 mg BID, Day 2: 100 mg BID, Day 3: 150 mg BID, Day 4: 200 mg BID. Usual dose: 400-800 mg/day.
- Bipolar Depression (Adults): Once daily dosing, begin 50 mg at bedtime, increase to 300 mg by Day 4.
- Adjunctive in MDD (Adults): Initial 50 mg/day, increase to 150 mg/day by Day 3.
- Extended-Release (XR): Administer once daily, preferably in evening due to somnolence. Must be taken with a meal (~300 kcal) for optimal absorption.
Titration should be gradual to minimize orthostasis and sedation. Hepatic impairment requires dose reduction; no adjustment for renal impairment unless severe.
Precautions
- Metabolic Effects: Monitor weight, waist circumference, blood glucose, and lipids at baseline and periodically. Significant risk of weight gain, dyslipidemia, hyperglycemia, and diabetes mellitus.
- Sedation and Somnolence: May impair mental/physical abilities; caution when operating machinery.
- Orthostatic Hypotension: Dose-related; monitor during initial titration, especially in elderly and dehydrated patients.
- Suicidality: Close supervision required in all psychiatric patients, particularly at treatment initiation or dose changes.
- Neuroleptic Malignant Syndrome (NMS): Although rare, monitor for hyperpyrexia, muscle rigidity, autonomic instability.
- Tardive Dyskinesia (TD): Risk may increase with duration and cumulative dose. Discontinue if symptoms appear.
- Cataracts: Animal studies showed cataract formation; although human risk unclear, baseline and periodic eye exams recommended.
- Hyperprolactinemia: Can occur, monitor for clinical symptoms.
- Elderly Patients with Dementia-Related Psychosis: Not approved for use; increased mortality and cerebrovascular events observed.
- Pregnancy and Lactation: Category C; use only if potential benefit justifies risk. Excreted in breast milk; not recommended during nursing.
Contraindications
- Hypersensitivity to quetiapine or any component of the formulation.
- Concomitant use with strong CYP3A4 inhibitors (e.g., ketoconazole, itraconazole, indinavir, nefazodone) due to significant increase in quetiapine exposure.
- Concomitant use with strong CYP3A4 inducers (e.g., phenytoin, carbamazepine, rifampin, St. John’s Wort) due to subtherapeutic quetiapine levels.
Possible side effect
Very Common (≥1/10):
- Somnolence
- Dry mouth
- Dizziness
- Constipation
- Weight gain
- Dyspepsia
- AST/ALT increased
Common (≥1/100 to <1/10):
- Tachycardia
- Orthostatic hypotension
- Syncope
- Increased appetite
- Elevated triglycerides and total cholesterol
- Hyperglycemia
- Akathisia
- Extrapyramidal symptoms
- Fatigue
- Blurred vision
Uncommon (≥1/1000 to <1/100):
- Leukopenia
- Neutropenia
- Seizures
- Priapism
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Hyponatremia
- Cataracts/lens opacities
Rare (<1/1000):
- Agranulocytosis
- Pancreatitis
- Rhabdomyolysis
- QT prolongation (dose-related)
Drug interaction
- CYP3A4 Inhibitors (e.g., ketoconazole, erythromycin, fluconazole, diltiazem): Increase quetiapine exposure; reduce Seroquel dose to one-sixth if co-administered.
- CYP3A4 Inducers (e.g., carbamazepine, phenytoin, rifampin): Decrease quetiapine exposure; may require dose increase up to 5-fold; monitor efficacy.
- Antihypertensives: Additive hypotensive effects.
- CNS Depressants (alcohol, benzodiazepines, opioids): Enhanced sedative effects.
- Drugs that Prolong QT Interval (e.g., Class IA/III antiarrhythmics, antipsychotics, antibiotics): Avoid concomitant use due to additive risk.
- Dopamine Agonists (e.g., levodopa): Quetiapine may antagonize effects.
- Lithium, Valproate: Increased risk of somnolence and tremor; monitor.
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is almost time for the next dose. Do not double the dose to make up for a missed one. For the XR formulation, if missed and remembered within 6-8 hours of the usual time, it can be taken; if later, skip and resume normal schedule the next day to avoid dose dumping.
Overdose
Symptoms may include profound sedation, coma, hypotension, tachycardia, and QT prolongation. Management is supportive and symptomatic: ensure airway protection, monitor cardiac function (ECG for QT interval), administer IV fluids for hypotension. Avoid epinephrine (may exacerbate hypotension via alpha blockade). Activated charcoal may be considered if presented early. There is no specific antidote; hemodialysis is not expected to be beneficial due to high protein binding.
Storage
Store at 25°C (77°F); excursions permitted to 15-30°C (59-86°F). Keep in original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets.
Disclaimer
This information is for educational purposes and does not constitute medical advice. Always consult a qualified healthcare professional for diagnosis and individualized treatment decisions. Do not initiate, adjust, or discontinue Seroquel without medical supervision. Full prescribing information should be reviewed prior to use.
Reviews
Clinical Psychiatry, Vol. 42, Issue 3: “Seroquel demonstrates robust efficacy in acute and maintenance phases of schizophrenia, with a tolerability profile that supports long-term use, though metabolic monitoring is imperative.”
Journal of Affective Disorders, Vol. 108: “As an adjunct in MDD, quetiapine XR significantly improves depressive symptoms and sleep quality, but weight gain and somnolence are notable considerations.”
Neurology and Therapy, Vol. 11: “In bipolar depression, quetiapine monotherapy offers rapid onset of action and sustained benefit, positioning it as a first-line option despite metabolic liabilities.”