Quetiapine

What is Quetiapine

Quetiapine is an atypical antipsychotic structurally similar to clozapine, a dibenzodiazepine antipsychotic.

Atypical antipsychotics, also known as second generation antipsychotics (SGAs), are considered to be the standard of care for schizophrenia and related disorders, and may be considered as first-line treatment options for the management of psychosis (with the exception of clozapine).

Similar to other atypical antipsychotics, quetiapine carries a risk of metabolic changes including hyperglycemia, diabetes, dyslipidemia, and weight gain, and may increase the risk of cardiac events, such as QT prolongation.

Quetiapine causes anticholinergic effects, sedation, and orthostatic hypotension.

A meta-analysis found that efficacy favored the comparator SGAs (e.g., olanzapine, risperidone, paliperidone) as assessed by the Positive and Negative Syndrome Scale (PANSS), although the clinical impact of these data are not clear.

In the same meta-analysis, quetiapine induced less movement disorders, fewer parkinsonian symptoms, and less increases in prolactin than the comparator drugs.

Brand Name

• Seroquel
• Seroquel XR

Indications

1. behavioral or psychological symptoms of dementia
2. bipolar depression
3. bipolar disorder
4. borderline personality disorder
5. dementia with Lewy bodies
6. depression
7. mania
8. obsessive-compulsive disorder (OCD)
9. schizophrenia

Side Effects

1. abdominal pain
2. acne vulgaris
3. acute generalized exanthematous pustulosis (AGEP)
4. agitation
5. agranulocytosis
6. akathisia
7. amblyopia
8. amenorrhea
9. amnesia
10. anaphylactoid reactions
11. anemia
12. angina
13. anorexia
14. anxiety
15. aphasia
16. apnea
17. appetite stimulation
18. arthralgia
19. asthenia
20. ataxia
21. atopic dermatitis
22. atrial fibrillation
23. AV block
24. back pain
25. blepharitis
26. blurred vision
27. bone fractures
28. bone pain
29. bowel ischemia
30. breast discharge
31. bundle-branch block
32. cardiomyopathy
33. chills
34. choreoathetosis
35. confusion
36. conjunctivitis
37. constipation
38. contact dermatitis
39. cough
40. cyanosis
41. cystitis
42. dehydration
43. delirium
44. dental caries
45. depression
46. diabetes mellitus
47. dizziness
48. drowsiness
49. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
50. dysarthria
51. dysgeusia
52. dyskinesia
53. dysmenorrhea
54. dyspepsia
55. dysphagia
56. dysphemia
57. dyspnea
58. dystonic reaction
59. dysuria
60. ecchymosis
61. ejaculation dysfunction
62. elevated hepatic enzymes
63. emotional lability
64. eosinophilia
65. epistaxis
66. euphoria
67. exfoliative dermatitis
68. fatigue
69. fecal incontinence
70. fever
71. flatulence
72. galactorrhea
73. gastritis
74. gastroesophageal reflux
75. GI bleeding
76. GI obstruction
77. gingivitis
78. glossitis
79. glycosuria
80. gout
81. gynecomastia
82. hallucinations
83. headache
84. hearing loss
85. heart failure
86. hematemesis
87. hemolysis
88. hemorrhoids
89. hepatic failure
90. hepatic necrosis
91. hepatitis
92. hiccups
93. hypercholesterolemia
94. hyperglycemia
95. hyperhidrosis
96. hyperkinesis
97. hyperprolactinemia
98. hypertension
99. hypertensive crisis
100. hyperthyroidism
101. hypertriglyceridemia
102. hyperventilation
103. hypoesthesia
104. hypoglycemia
105. hypokalemia
106. hyponatremia
107. hypotension
108. hypothermia
109. hypothyroidism
110. ileus
111. impotence (erectile dysfunction)
112. increased urinary frequency
113. infection
114. infertility
115. irritability
116. lethargy
117. leukocytosis
118. leukopenia
119. leukorrhea
120. libido decrease
121. libido increase
122. maculopapular rash
123. malaise
124. mania
125. melena
126. migraine
127. musculoskeletal pain
128. myalgia
129. myasthenia
130. myocarditis
131. myoclonia
132. nasal congestion
133. nausea
134. neuroleptic malignant syndrome
135. neuropathic pain
136. neutropenia
137. nightmares
138. nocturia
139. ocular hypertension
140. ocular pain
141. oral ulceration
142. orthostatic hypotension
143. otalgia
144. palpitations
145. pancreatitis
146. paranoia
147. paresthesias
148. pelvic pain
149. peripheral edema
150. pharyngitis
151. photosensitivity
152. polydipsia
153. polyuria
154. priapism
155. pruritus
156. pseudoparkinsonism
157. psoriasis
158. psychosis
159. QT prolongation
160. rash
161. renal failure (unspecified)
162. restless legs syndrome (RLS)
163. restlessness
164. rhabdomyolysis
165. rhinitis
166. seborrhea
167. seizures
168. serotonin syndrome
169. SIADH
170. sinus tachycardia
171. sinusitis
172. skin discoloration
173. skin ulcer
174. somnambulism
175. Stevens-Johnson syndrome
176. stomatitis
177. stroke
178. suicidal ideation
179. syncope
180. tardive dyskinesia
181. teeth grinding (bruxism)
182. thrombocytopenia
183. tinnitus
184. torsade de pointes
185. toxic epidermal necrolysis
186. urinary incontinence
187. urinary retention
188. vaginal bleeding
189. vaginitis
190. vertigo
191. vomiting
192. water intoxication
193. weight gain
194. weight loss
195. withdrawal
196. xerophthalmia
197. xerostomia

Monitoring Parameters

• AIMS assessment
• blood glucose
• CBC
• glycosylated hemoglobin A1c (HbA1c)
• LFTs
• neurologic function
• ophthalmologic exam
• pregnancy testing
• serum creatinine
• serum electrolytes
• serum lipid profile
• serum prolactin
• thyroid function tests (TFTs)
• weight

Contraindications

• abrupt discontinuation
• agranulocytosis
• alcoholism
• ambient temperature increase
• anticholinergic medications
• bradycardia
• brain tumor
• breast cancer
• breast-feeding
• cardiac arrhythmias
• cardiac disease
• cataracts
• cerebrovascular disease
• children
• coadministration with other CNS depressants
• constipation
• coronary artery disease
• dehydration
• dementia
• diabetes mellitus
• driving or operating machinery
• dysphagia
• ethanol ingestion
• females
• geriatric
• heart failure
• hematological disease
• hepatic disease
• hypercholesterolemia
• hypertension
• hyperthermia
• hypertriglyceridemia
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypotension
• hypothermia
• hypothyroidism
• hypovolemia
• increased intraocular pressure
• infertility
• leukopenia
• long QT syndrome
• malnutrition
• myocardial infarction
• neonates
• neurological disease
• neutropenia
• obesity
• orthostatic hypotension
• Parkinson’s disease
• pregnancy
• pregnancy testing
• prostatic hypertrophy
• QT prolongation
• reproductive risk
• seizure disorder
• strenuous exercise
• stroke
• suicidal ideation
• tardive dyskinesia
• thyroid disease
• urinary retention

Interactions

• Abarelix
• Acarbose
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
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• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
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• Acetaminophen; Dichloralphenazone; Isometheptene
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