II. Class

  1. Atypical Antipsychotic (Second Generation agent)
  2. Neuroleptic
  3. Dibenzothiazepine Antipsychotic

III. Mechanism

  1. Dopamine, Serotonin, histamine and adrenergic antagonist

IV. Indications

  1. Schizophrenia
  2. Psychosis in Dementia
  3. Mania (not FDA approved)
  4. Bipolar Disorder (not FDA approved)
  5. Autism (not FDA approved)
  6. Insomnia (not FDA approved)

V. Dosing

  1. Adults
    1. Initial: 25 mg PO bid-tid
    2. Increase in 25-50 mg/day increments
    3. Target: 300-400 mg/day divided bid-tid
    4. Maximum dose: 750 mg/day
  2. Elderly
    1. Initial dose: 12.5 mg PO qhs
    2. Titrate up every few days (caution due to Sedation)

VII. Adverse Effects: Overdose

VIII. Drug Interactions

  1. Increase Antipsychotic levels (toxicity risk): Monitor for toxicity
    1. Clarithromycin
    2. Erythromycin
    3. Grapefruit juice
    4. Fluconazole
    5. Itraconazole
    6. Ketoconazole
    7. Quinidine
  2. Decrease Antipsychotic levels (lower efficacy)
    1. Barbiturates
    2. Carbamazepine
    3. Phenytoin
    4. Rifampin
    5. Theophylline
  3. Other effects
    1. Avoid concurrent use of other medications prolonging QT Interval
      1. See Prolonged QT Interval due to Medication

IX. Monitoring

  1. See Antipsychotic
  2. Screen for Cataract formation every 6 months
  3. Consider EKG, electrolyte and Magnesium monitoring due to QT Interval prolongation risk

X. Pharmacokinetics

  1. Metabolized by Cytochrome P450 3A4

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Cost: Medications

quetiapine (on 8/17/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
QUETIAPINE FUMARATE 100 MG TAB Generic $0.13 each
QUETIAPINE FUMARATE 200 MG TAB Generic $0.23 each
QUETIAPINE FUMARATE 25 MG TAB Generic $0.07 each
QUETIAPINE FUMARATE 300 MG TAB Generic $0.34 each
QUETIAPINE FUMARATE 400 MG TAB Generic $0.32 each
QUETIAPINE FUMARATE 50 MG TAB Generic $0.11 each
seroquel (on 6/22/2016 at Medicaid.Gov Survey of pharmacy drug pricing)
SEROQUEL 100 MG TABLET Generic $0.13 each
SEROQUEL 200 MG TABLET Generic $0.23 each
SEROQUEL 25 MG TABLET Generic $0.07 each
SEROQUEL 300 MG TABLET Generic $0.34 each
SEROQUEL 400 MG TABLET Generic $0.32 each
SEROQUEL XR 150 MG TABLET $14.22 each
SEROQUEL XR 200 MG TABLET $15.62 each
SEROQUEL XR 300 MG TABLET $20.61 each
SEROQUEL XR 400 MG TABLET $24.14 each
SEROQUEL XR 50 MG TABLET $7.92 each

Ontology: quetiapine (C0123091)

Definition (NCI) A dibenzothiazepine derivative with antipsychotic property. Quetiapine fumarate antagonizes serotonin activity mediated by 5-HT 1A and 5-HT2 receptors. With a lower affinity, this agent also reversibly binds to dopamine D1 and D2 receptors in the mesolimbic and mesocortical areas of the brain leading to decreased psychotic effects, such as hallucinations and delusions. In addition, quetiapine also binds to other alpha-1, alpha-2 adrenergic and histamine H1 receptors.
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C069541
SnomedCT 108443001, 386850001
LNC LP21161-2, MTHU012935
English 2-(2-(4-dibenzo(b,f)(1,4)thiazepine-11-yl-1-piperazinyl)ethoxy)ethanol, quetiapine, quetiapine (medication), quetiapine [Chemical/Ingredient], QUEtiapine, QUETIAPINE, Quetiapine, Quetiapine (product), Quetiapine (substance)
Spanish quetiapina (producto), quetiapina (sustancia), quetiapina

Ontology: Seroquel (C0287163)

Definition (CHV) brand name of quetiapine, a drug used to treat schizophrenia and bipolar disorder
Definition (CHV) brand name of quetiapine, a drug used to treat schizophrenia and bipolar disorder
Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C069541
English quetiapine (Seroquel), seroquel, seroquel [brand name], SEROquel, AstraZeneca Brand of Quetiapine Fumarate, Zeneca Brand of Quetiapine Fumarate, Seroquel