What is Quetiapine?
Quetiapine (Quetiapina) is a drug used to treat bipolar disorder, depression and schizophrenia. The product ingredient is Quetiapine fumarate.
Quetiapine’s brand names are: Seroquel and Seroquel XR.
Mechanism of action (MOA) of Quetiapine
Atypical antipsychotic that interacts with a wide range of neurotransmitter receptors. It presents affinity for cerebral serotonin (5-HT2 ) and D1 /D2 dopamine receptors, as well as for alpha 1 adrenergic and histaminergic receptors, alpha 2 adrenergic receptors and 5HT1A of serotonin…
Therapeutic Indications, Uses, Benefits and Dosage of Quetiapine
Oral:
– Schizophrenia, adults:
Immediate release tablets (2 times/day): total daily dose in the 1 to 4 days of treatment: 50 mg (day 1), 100 mg (day 2), 200 mg (day 3) and 300 mg (day 4). From the 4th day, titrate at the usual effective dose: 300-450 mg/day. Depending on the clinical response and tolerability of the patient, adjust within the range of 150-750 mg/day.
Prolonged-release tablets (1 time/day, without food): 300 mg on day 1 and 600 mg on day 2. Recommended dose/day: 600 mg, if clinically justified increase to 800 mg/day Depending on the clinical response and tolerability of the patient, adjust within the range of 400-800 mg/day.
– Moderate to severe manic episode in bipolar disorder, adults:
Immediate release tablets (2 times/day): total daily dose in the 1 to 4 days of treatment: 100 mg (day 1), 200 mg (day 2), 300 mg (day 3) and 400 mg (day 4). Subsequent adjustment up to 800 mg/day on day 6 in increments not > to 200 mg/day. The usual effective dose is in the range of 400-800 mg/day.
Prolonged-release tablets: dose as in schizophrenia.
– Major depressive episode in bipolar disorder, adults: give 1 time/day (at bedtime). Total daily dose in the 1 to 4 days of treatment: 50 mg (day 1), 100 mg (day 2), 200 mg (day 3) and 300 mg (day 4). Recommended dose/day: 300 mg.
– Prevention of recurrence in patients with bipolar disorder, whose manic or depressive episode has responded to treatment with quetiapine, adults: adjust dose depending on patient response and tolerability, within the range of 300-800 mg/day.
– Additional treatment of major depressive episodes in major depressive disorder (MND) that have not had an optimal response with antidepressants in monotherapy (prolonged-release tablets): administer 1 time/day (before bedtime), ads: 50 mg on days 1-2, and 150 mg on days 3-4. Elderly: start at 50 mg/day 1-3 days, increasing to 100 mg/day on day 4 and 150 mg/day on day 8.
In hepatic insufficiency: start with 25 mg/day (50 mg/day in extended release comp.), increase in increments of 25-50 mg/day until effective dose.
Method of administration
Immediate release tablets: with or without food.
Prolonged-release tablets: no food, swallow whole, do not break, chew, or crush.
Contraindications of Quetiapine
Hypersensitivity to quetiapine, concomitant with cytochrome P450 3A4 inhibitors (such as HIV protease inhibitors, azol-type antifungals, erythromycin, clarithromycin and nefazodone).
Quetiapine Warnings and Precautions
Elderly, elderly with Parkinson’s disease, liver disease, diabetes, and risk factors for diabetes, known cardiovascular disease, cerebrovascular disease, or other conditions predisposing to hypotension; history of seizures; history of alcohol or drug abuse; family history of prolonged QT; patients at risk for aspiration pneumonia.
Stop treatment if tardive dyskinesia, MNS, or neutrophil count <1.0 X 10 9 /l appears. Caution with substances that increase the QTc and neuroleptic interval, especially in the elderly, congenital long QT syndrome, CHF, cardiac hypertrophy, hypokalemia or hypomagnesemia. Gradual withdrawal from treatment to avoid withdrawal symptoms.
Not approved for treatment of dementia-related psychosis. Clinically monitor changes in lipids (triglycerides and cholesterol), glucose, and weight.
Not recommended in children and adolescents < 18 years. Risk of venous thromboembolism; pancreatitis; suicidal thinking, self-injury and suicide, cardiomyopathy and myocarditis. Re-evaluate tto. in patients with suspected heart disease or myocarditis.
Patients with intestinal obstruction/oil should be monitored with close monitoring and urgent care. Sleep apnea syndrome: caution in patients who concomitantly receive CNS depressants and who have a history or risk of sleep apnea, such as those who are overweight/obese or male. Concomitant with substances that have anticholinergic (muscarinic) effects.
With current diagnosis or history of urinary retention, clinically significant prostatic hypertrophy, intestinal obstruction or related conditions, elevated intraocular pressure or narrow angle glaucoma.
In case of overdose with prolonged-release quetiapine, sedation peak and pulse peak are delayed and recovery is prolonged. Also in case of overdose with extended release quetiapine, gastric bezoar formation has been reported and an appropriate imaging diagnosis is recommended to decide treatment.
Liver failure
Caution. It is extensively metabolized by the liver. In hepatic insufficiency: start with 25 mg/day (50 mg/day in tablets extended release), increase in increments of 25-50 mg/day until effective dose.
Interactions with Quetiapine
- Risk of adverse reactions reflecting anticholinergic effects when quetiapine is used at recommended doses, concomitant with other substances having anticholinergic effects and in cases of overdose.
- Quetiapine should be used with concomitant caution with substances with anticholinergic (muscarinic) effects.
- Caution with: other central-acting drugs and alcohol.
- Contraindicated with: cytochrome P450 3A4 inhibitors (such as HIV protease inhibitors, azol-type antifungals, erythromycin, clarithromycin and nefazodone), grapefruit juice.
- Increased clarification with: carbamazepine, phenytoin, thioridazine.
- Caution when quetiapine is prescribed with substances known to cause electrolyte imbalance or increase the QT interval or with neuroleptics concomitantly.
Pregnancy and Quetiapine
It will only be used if the benefits justify the potential risks.
Breastfeeding
The effects of quetiapine on human fertility have not been evaluated. Effects related to elevated prolactin levels have been observed in rats, although these are not directly relevant to humans.
Effects on driving ability
Quetiapine acts on the central nervous system and can produce: drowsiness, dizziness, visual alterations and decreased ability to react.
These effects, as well as the disease itself, make it advisable to be cautious when driving vehicles or operating dangerous machinery, especially until each patient’s particular sensitivity to the medication has been established.
Adverse reactions and side effects of Quetiapine
Decreased Hb, leukopenia, decreased neutrophil count, increased eosinophils; hyperprolactinemia, decreased total T4, decreased free T4, decreased total T3, increased TSH; elevated serum triglyceride levels, elevated total cholesterol, decreased HDL cholesterol, increased weight, increased appetite, increased blood glucose at hyperglycemic levels.
Abnormal dreams and nightmares, suicidal ideation and behavior; drowsiness, dizziness, headache, syncope, extrapyramidal symptoms, dysarthria; tachycardia, palpitations; blurred vision.
Orthostatic hypotension; rhinitis, dyspnea; dry mouth, constipation, dyspepsia, vomiting; elevation of serum transaminase (ALT, AST), elevation of GT gamma levels; withdrawal symptoms, mild asthenia, peripheral edema, irritability, pyrexia.Following periodic evaluation of pharmacovigilance data, drug eruption with eosinophilia and systemic symptoms has been reported.
⭐⭐⭐⭐⭐ VIDEO OF QUETIAPINE/SEROQUEL (DRUG)
Source: The content of this active ingredient has been written taking into account the clinical and molecular information of all medicines authorised and marketed in the United States under the Unique Ingredient Identifier (UNII) by the Substance Registration System (SRS) of the Food and Drug Administration (FDA) and the United States Pharmacopeia (USP).
In order to know in detail the information authorized by the FDA for each drug, you should consult the corresponding medication guide authorized by the FDA.
Resources:
UNII: BGL0JSY5SI
ChemIDplus
DrugPortal
PubChem CID: 5002
NCI Thesaurus: C61917