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
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  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
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  • Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
  • Acetaminophen; Codeine
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  • Acetaminophen; Dichloralphenazone; Isometheptene
  • Acetaminophen; Diphenhydramine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
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  • Aspirin, ASA; Caffeine; Dihydrocodeine
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  • Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
  • Chlorpheniramine; Hydrocodone
  • Chlorpheniramine; Hydrocodone; Phenylephrine
  • Chlorpheniramine; Hydrocodone; Pseudoephedrine
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  • food
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  • Saxagliptin
  • Scopolamine
  • Secobarbital
  • Selegiline
  • Selpercatinib
  • Semaglutide
  • Sertraline
  • Sevoflurane
  • SGLT2 Inhibitors
  • Short-acting beta-agonists
  • Sibutramine
  • Simeprevir
  • Simvastatin; Sitagliptin
  • Siponimod
  • Sitagliptin
  • Sodium picosulfate; Magnesium oxide; Anhydrous citric acid
  • Solifenacin
  • Sorafenib
  • Sotalol
  • Sparfloxacin
  • St. John’s Wort, Hypericum perforatum
  • Sufentanil
  • Sulfonylureas
  • Sunitinib
  • Suvorexant
  • Tacrolimus
  • Tamoxifen
  • Tapentadol
  • Telaprevir
  • Telavancin
  • Telithromycin
  • Telotristat Ethyl
  • Temazepam
  • Terbutaline
  • Tetrabenazine
  • Tezacaftor; Ivacaftor
  • Thiazide diuretics
  • Thiethylperazine
  • Thiopental
  • Thioridazine
  • Thiothixene
  • Tiotropium; Olodaterol
  • Tipranavir
  • Tolcapone
  • Tolterodine
  • Toremifene
  • Tramadol
  • Trandolapril; Verapamil
  • Tranylcypromine
  • Trazodone
  • Triamcinolone
  • Triazolam
  • Tricyclic antidepressants
  • Trifluoperazine
  • Trihexyphenidyl
  • Triprolidine
  • Triptorelin
  • Trospium
  • Tucatinib
  • Umeclidinium; Vilanterol
  • Valproic Acid, Divalproex Sodium
  • Vandetanib
  • Vardenafil
  • Vemurafenib
  • Venlafaxine
  • Verapamil
  • Voriconazole
  • Vorinostat
  • Zafirlukast
  • Zaleplon
  • Ziconotide
  • Ziprasidone
  • Zolpidem
  • Zonisamide
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