Seroquel

Seroquel (Quetiapine) is an FDA-approved antipsychotic medication used to treat mental health conditions like bipolar I disorder, schizophrenia, & depressive episodes associated with bipolar disorders. It comes in oral tablet form with strengths ranging from 25 to 400 mg. The medication operates by balancing neurotransmitters in the brain, which helps alleviate symptoms of these disorders. Common side effects may occur that include dry mouth & drowsiness, with more serious risks like tardive dyskinesia and neuroleptic malignant syndrome. Seroquel’s use requires careful dosage adjustments and monitoring due to potential interactions with other drugs & effects on various health conditions.

Seroquel (Quetiapine) is an antipsychotic drug approved by the FDA for treating several severe mental health disorders, including schizophrenia in adults and children aged 13 and older and bipolar I disorder, covering both manic and depressive episodes in adults and children from 10 years of age. Available as an oral tablet, Seroquel comes in six different strengths, ranging from 25 mg to 400 mg, allowing for flexible dosing tailored to patient needs.

The medication is believed to work by modulating the levels of neurotransmitters like serotonin & dopamine in the brain, addressing imbalances that contribute to the symptoms of schizophrenia and bipolar disorder. Treatment typically starts with a low dosage that is gradually increased to mitigate potential side effects such as dizziness, dry mouth, or drowsiness. The aim is to find the minimum effective dose that adequately controls symptoms. For schizophrenia, doses may range from 150 mg to 750 mg per day, divided across several doses. In cases of bipolar disorder, the maintenance dose generally lies between 400 mg and 800 mg per day, divided into two doses.

While Seroquel is effective for many, it carries significant risks. Boxed warnings include an increased risk of death in older adults with dementia-related psychosis and suicidal thoughts in younger people. Other serious side effects include tardive dyskinesia, seizures, and metabolic changes like high blood sugar and cholesterol levels. Interaction with other medications and specific health conditions like heart disease or diabetes can further complicate treatment. Therefore, Seroquel’s use must be closely monitored by a healthcare provider to manage both therapeutic effects and potential risks effectively.

Seroquel is an FDA-approved medication used to treat several mental health conditions:

• Schizophrenia
• Manic Episodes of Bipolar I Disorder (Bipolar Mania)
• Bipolar I Disorder
• Depressive Episodes of Bipolar Disorder (Bipolar Depression)

Forms & Strengths of Seroquel?

Seroquel comes as an oral tablet and has six strengths:

• 25 mg
• 50 mg
• 100 mg
• 200 mg
• 300 mg
• 400 mg

What Are the Recommended Dosage of Seroquel?

For Manic Episodes of Bipolar I Disorder

Adults

• Starting Dosage:
• • Day 1: 50 mg twice per day
  • Day 2: 100 mg twice per day
  • Day 3: 150 mg twice per day
  • Day 4: 200 mg twice per day
• Dose Adjustment: After day 4, the dosage can be increased to find the right amount, typically 400-800 mg per day.
• Maintenance Dosage: 400-800 mg per day, divided into two doses.
• Maximum Dosage: 800 mg per day.

Children (Ages 10 to 17)

• Starting Dosage:
• • Day 1: 25 mg twice per day
  • Day 2: 50 mg twice per day
  • Day 3: 100 mg twice per day
  • Day 4: 150 mg twice per day
  • Day 5: 200 mg twice per day
• Dose Adjustment: After day 5, the dosage can be increased by 100 mg each day as needed.
• Typical Dosage: 400-600 mg per day.
• Maximum Dosage: 600 mg per day.

Dosage for Schizophrenia

Adults

• Starting Dosage:
• • Day 1: 25 mg two times every day
  • Day 2: 50 mg two times every day
  • Day 3: 100 mg two times every day
  • Day 4: 100 mg thrice every day
• Dose Adjustment: After day 4, your doctor may increase the dose by 50-100 mg every two or more days to find the right amount.
• Maintenance Dosage: Typically 400-800 mg per day, divided into two or three doses.
• Maximum Dosage: 800 mg per day.

Children (Ages 13 to 17)

• Starting Dosage:
• • Day 1: 25 mg twice per day
  • Day 2: 50 mg twice per day
  • Day 3: 100 mg twice per day
  • Day 4: 150 mg twice per day
  • Day 5: 200 mg twice per day
• Dose Adjustment: After day 5, the dose may be increased by 100 mg each day as needed.
• Maintenance Dosage: Typically 400-800 mg per day, divided into two or three doses.
• Maximum Dosage: 800 mg every day.

Dosage for Depressive Episodes of Bipolar Disorder

Adults

• Starting Dosage:
• • Day 1: 50 mg once per day
  • Day 2: 100 mg once per day
  • Day 3: 200 mg once per day
  • Day 4: 300 mg once per day
• Maintenance Dosage: Typically 300 mg per day until symptoms improve.
• Clinical Trials: Depressive symptoms generally improved within eight weeks of starting treatment.

[Note: Remember, these recommendations may vary from person to person. Discuss it with your doctor, and they’ll customize your dosage accordingly.]

• Starting Dose: Your doctor will usually start you on a low dose and gradually adjust it to find the optimal amount that effectively manages your symptoms.
• Minimum Effective Dose: The goal is to prescribe the smallest dosage that provides the desired and tailored effect.
• With or Without Food: You can take Seroquel with or without food, but avoid grapefruit & grapefruit juice as they can interact with the other medication.
• Once Per Day Dosage: Take your dose at bedtime.
• Twice Per Day Dosage: Take one dose in the morning and one in the evening.
• Three Times Per Day Dosage: Take one dose in the morning, one in the afternoon, and one at bedtime.
• Consistency: Follow your doctor’s instructions for specific times to take Seroquel to maintain a steady level in your body.
• Medication Reminders: Use alarms, timers, or a reminder app on your phone to ensure you don’t miss a dose.
• Prescription Labels: If you have trouble reading your prescription label, ask your pharmacist about large print, braille, or text-to-speech options.
• Easy-Open Containers: If you have difficulty opening medication bottles, request easy-open containers from your pharmacist, who can also suggest tools to assist with opening lids.
• Swallow Whole: Do not crush, split, or chew Seroquel tablets. If you have any trouble swallowing pills, talk to your primary caregiver or pharmacist. They may recommend a different treatment option.

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

Seroquel’s exact mechanism is not fully understood, but it is believed to work by maximizing the availability of neurotransmitters such as dopamine & serotonin in the brain. These neurotransmitters are often imbalanced in conditions like schizophrenia and bipolar disorder, hindering proper communication between brain cells. By correcting these imbalances, Seroquel helps alleviate symptoms associated with these mental illnesses. The drug starts to take effect within 1.5 hours, often causing drowsiness initially, but it may take several days to weeks for significant symptom improvement. Clinical trials have shown that depressive symptoms in bipolar disorder may ease within eight weeks, while manic symptoms may improve within three weeks of starting treatment.

Mild Side Effects: Most mild side effects of Seroquel are temporary and may disappear as your body adjusts to the medication. However, if they worsen or persist, it’s essential to consult your doctor. Mild side effects of Seroquel may include:

• Increased levels of liver enzymes (indicates liver damage)
• Weight Gain
• Sore Throat
• Dizziness
• Dry Mouth
• Headache
• Feeling Weak
• Sleepiness
• Mild Allergic Reaction
• Constipation
• Lethargy (not having the motivation or energy to do anything)
• Abdominal Pain
• Indigestion (Upset Stomach)
• Unusual Dreams or Nightmares
• Dry Mouth

Serious Seroquel Side Effects: Serious side effects are less common but require immediate medical attention. Contact your doctor immediately if you experience any of the following, and call 911 if any symptoms feel life-threatening. Serious side effects of Seroquel are rare but can be severe and require prompt medical intervention:

• Blood disorders, such as neutropenia.
• Tardive dyskinesia
• Severe allergic reaction
• Orthostatic hypotension
• Neuroleptic malignant syndrome
• Changes in metabolism, such as:
  • changes in cholesterol levels
  • hyperglycemia (high blood sugar level)
  • weight gain.
• Hypothyroidism
• Cataracts
• Seizures
• Problems with movement and thinking
• High blood level of prolactin
• Suicidal thoughts and behaviours.
• Maximized risk of death in older adults with psychosis related to dementia.

[Note: Remember, this list may not cover all possible side effects. Always consult with your healthcare giver for medical advice about side effects.]

Seroquel comes with specific FDA-boxed warnings, which are the most severe form of warnings issued by the Food and Drug Administration. These warnings highlight significant risks associated with the drug:

• Maximized Risk of Death in Older Adults with Dementia-Related Psychosis: Seroquel and other antipsychotic drugs may increase the risk of death when used to treat psychosis in older adults with dementia. Psychosis involves losing touch with reality, while dementia indicates a decline in brain function. Due to this elevated risk, Seroquel is typically not prescribed for older adults (ages 65 and older) with dementia-related psychosis. Discuss any concerns about this risk with the doctor.
• Risk of Suicidal Behaviors or Thoughts: Seroquel can increase the risk of suicidal behaviors or thoughts, particularly in children and young adults under the age of 24. It is not approved for use in children younger than ten years. If you experience any changes in behavior or thoughts, such as:
  • Increased or new anxiety
  • Worsening or new depression
  • Panic attacks
  • Insomnia
  • Agitation or nervousness
  • Aggressive behavior
  • Impulsivity
  • Restlessness

It’s essential to inform your doctor immediately. These behavioral changes may occur soon after starting the medication or following a dosage adjustment. Your primary caregiver will monitor you closely for these symptoms and may consider an alternative treatment if suicidal thoughts or behaviors develop.

Before starting Seroquel, it’s crucial to discuss your complete health history with your doctor. Here are several factors and conditions that may affect your ability to use Seroquel safely:

• Heart or Blood Pressure Issues: Seroquel may affect heart rhythm and blood pressure. If you have heart disease or issues with your blood pressure, discuss the risks with your doctor.
• Diabetes: Seroquel may raise your blood sugar levels, potentially exacerbating diabetes or increasing the risk of developing diabetes-related complications.
• Cholesterol Levels: The medication may impact your cholesterol levels, possibly leading to complications such as heart attacks or strokes. Regular monitoring might be required.
• Vision Problems: Usage of Seroquel could lead to vision issues like cataracts or glaucoma. If you already have these conditions, you may need more frequent eye examinations.
• Thyroid Function: Seroquel could reduce thyroid gland activity. If you have hypothyroidism, your condition might worsen.
• Liver Health: Discuss liver health with your doctor, as Seroquel could exacerbate liver problems or affect liver enzyme levels.
• Urinary or Gastrointestinal Issues: Seroquel might cause urinary retention or constipation, especially if you have preexisting conditions affecting these systems.
• Blood Cell Count: The drug can lower white blood cell levels, which is crucial for fighting infections.
• Dehydration Risks: Seroquel might affect your body’s temperature regulation, increasing dehydration risk, especially in hot weather or among elderly populations.
• Seizure Risk: If you have a history of seizures, Seroquel might increase seizure risk.
• Withdrawal and Dependence: Gradually taper off Seroquel under medical supervision to avoid withdrawal symptoms, as abrupt cessation can lead to discontinuation syndrome.
• Pregnancy and Breastfeeding: Discuss potential risks of taking Seroquel during pregnancy or while breastfeeding, as the drug could affect the fetus or baby.
• Fertility Issues: Seroquel may affect fertility by altering hormone levels, specifically prolactin, which can impact ovulation in females and potentially cause erectile dysfunction in males.

• If you miss a dose of Seroquel, take it as soon as you remember.
• If it’s almost time for your next dose that is scheduled, skip the missed dose. Do not double up doses.
• If you have missed taking Seroquel for more than a week, consult your doctor. They may even restart your treatment at a lower dose and gradually adjust it.
• Consider setting medication reminders using an alarm, timer, or a mobile app to ensure consistent dosing.

[Note: If you have missed a dose of your medication and are unsure about when to take the next one, immediately consult your doctor or pharmacist.]

• Taking more Seroquel than prescribed can lead to severe side effects and, in extreme cases, could be fatal.
• If you suspect an overdose, don’t wait for symptoms to appear. Contact your primary caregiver or seek emergency medical attention immediately.
• Overdose may require hospitalization to manage the effects safely and effectively.

[Note: If you consumed more than the recommended dose, get medical help right away or call the Poison Help line at 1-800-222-1222.]

• Store Seroquel tablets at room temperature, ideally at 77°F (25°C).
• Temporarily, it is acceptable to store the drug between 59° and 86°F (15°C and 30°C).
• Keep the Seroquel tablets in a tightly sealed container to protect them from moisture.
• Avoid storing Seroquel in damp or moist areas, such as kitchens or bathrooms, to prevent damage to the medication.
• When you no longer need Seroquel, ensure it is disposed of safely. This is crucial to prevent accidental ingestion by children or pets and to avoid environmental harm.

[Note: Discuss with your healthcare professional about the proper disposal of any unused medicine and any questions you may have regarding its storage.]

Seroquel may interact with a variety of medications and supplements, which can influence how well the drug works or exacerbate side effects. It’s crucial to discuss all current medications with your healthcare provider before starting Seroquel.

Drugs to Avoid with Seroquel

Certain drugs may pose risks when taken with Seroquel, especially those known to cause QT prolongation, a serious heart rhythm condition:

• Antipsychotics: Chlorpromazine, thioridazine, ziprasidone (Geodon)
• Class 1A Antiarrhythmic Drugs: Quinidine, procainamide
• Class III Antiarrhythmic Drugs: Amiodarone (Pacerone), sotalol (Betapace AF)
• Antimicrobial Drugs: Azithromycin (Zithromax, Z-Pak), moxifloxacin
• Other: Methadone (Methadose, a pain medication)

Other Potential Drug Interactions

• Antifungal Drugs: Itraconazole and ketoconazole may reduce Seroquel’s effectiveness.
• HIV Drugs: Indinavir and ritonavir could diminish the effectiveness of Seroquel.
• Heartburn Medication: Cimetidine (Tagamet) might affect how Seroquel works.
• Seizure Medications: Carbamazepine and phenytoin could lessen Seroquel’s therapeutic effect.
• Parkinson’s Disease Medications: Levodopa/carbidopa (Sinemet, Rytary, Duopa), bromocriptine (Parlodel), and ropinirole might have diminished effectiveness when taken with Seroquel.
• Anticholinergic Drugs: These drugs, including amitriptyline and over-the-counter drugs like diphenhydramine, might lead to increased anticholinergic effects like dry mouth and constipation.
• Central Nervous System (CNS) Affecting Drugs: Benzodiazepines (such as alprazolam and lorazepam), other antipsychotics, and antidepressants may increase CNS side effects such as drowsiness and impaired thinking.
• Blood Pressure Medications: ARBs (such as valsartan), ACE inhibitors (such as lisinopril), beta-blockers (such as metoprolol), and diuretics (such as furosemide) can further lower blood pressure when taken with Seroquel.

What Are the Other Seroquel Interactions?

Before starting Seroquel, discussing all supplements, herbs, and medications you’re currently taking with your doctor and pharmacist is essential. This conversation helps avoid potential negative interactions between Seroquel and other substances you’re using.

• Seroquel and Herbs and Supplements: Some herbs and supplements could interfere with how well Seroquel works or react adversely with the medication. Always consult with your primary caregiver prior to adding any new herbs or any supplements to your routine while on Seroquel.
• Seroquel and Lab Tests: Seroquel might alter the results of specific lab tests, such as urine screens for drugs. Do not stop taking Seroquel before a scheduled test without guidance from your healthcare provider. Instead, make sure the lab personnel know you are taking Seroquel, as it may affect test outcomes.
• Seroquel and Foods: Specific foods, especially grapefruit and grapefruit juice, may interact with Seroquel. These foods can increase the intensity of side effects or make them more likely to occur. It’s generally advised to avoid grapefruit products while taking Seroquel. If you have concerns about diet and Seroquel, discuss them with your doctor.
• Seroquel and Alcohol: Consuming alcohol while taking Seroquel is not recommended. Alcohol can enhance some side effects of Seroquel, such as drowsiness and cognitive impairment. For individuals with conditions like schizophrenia or bipolar disorder, alcohol can exacerbate symptoms or trigger episodes of psychosis.

[Note: This isn’t a complete list, and there could be other drugs that interact with Seroquel. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

If you’re looking for alternatives to Seroquel for your condition, it’s important to discuss it with your doctor. They can suggest other medications that might be more suitable for you. Here are some alternatives:

Alternatives for Bipolar Disorder

• For treating bipolar disorder, several options include:
  • Seroquel XR (quetiapine extended-release)
  • Latuda (lurasidone)
  • Geodon (ziprasidone)
  • Zyprexa (olanzapine)
  • Risperdal (risperidone)
  • Vraylar (cariprazine)
  • Abilify (aripiprazole)
  • Saphris (asenapine)
  • Fanapt (iloperidone)
  • Invega (paliperidone)
  • Rexulti (brexpiprazole)
• Mood stabilizers, often used as antiseizure drugs, are also commonly prescribed:
  • Lamictal (lamotrigine)
  • Equetro, Tegretol (carbamazepine)
  • Valproic acid (valproic acid)
  • Lithium (lithium)
  • Divalproex (divalproex)
• Additionally, combinations of an antipsychotic with an antidepressant, like Symbyax (olanzapine/fluoxetine), are used for bipolar disorder.

Alternatives for Schizophrenia

• Several second-generation antipsychotic drugs are available that may be used to treat schizophrenia, including:
  • Rexulti (brexpiprazole)
  • Latuda (lurasidone)
  • Clozaril (clozapine)
  • Saphris (asenapine)
  • Seroquel XR (quetiapine extended-release)
  • Abilify (aripiprazole)
  • Invega (paliperidone)
  • Fanapt (iloperidone)
  • Zyprexa (olanzapine)
  • Vraylar (cariprazine)
  • Risperdal (risperidone)
• There are also long-acting injectable antipsychotics:
  • Aristada (aripiprazole lauroxil)
  • Risperdal Consta (risperidone)
  • Abilify Maintena (aripiprazole)
  • Invega Sustenna, Invega Trinza, Invega Hafyera (paliperidone palmitate)
  • Haloperidol decanoate (haloperidol)
• First-generation antipsychotics include:
  • Haldol (haloperidol)
  • Chlorpromazine
  • Perphenazine

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.]

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