Names and pronunciation
(kwe-tie′a-peen) SEROquel, SEROquel XR
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Individual generic drug information
Extracted information for QUEtiapine only.
(kwe-tie′a-peen) SEROquel, SEROquel XR
Source page 1113
Func. class.: Antipsychotic, atypical
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Chem. class.: Dibenzothiazepine DO NOT CONFUSE: Seroquel/ Desyrel//Serzone/Sinequan Quetiapine/ Olanzapine
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ACTION: Functions as an antagonist at multiple neurotransmitter receptors in the brain, including 5HT1A, 5HT2, dopa- mine D1, D2, H1, and adrenergic α1, α2 receptors
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USES: Bipolar disorder, bipolar I dis- order, depression, mania, schizophrenia
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Extracted information for QUEtiapine only.
CONTRAINDICATIONS: Hyper- sensitivity, breastfeeding Precautions: Pregnancy, geriatric patients, hepatic/cardiac disease, breast cancer, long-term use, seizures, QT prolongation, brain tumor, hematologic disease, torsades de pointes, cataracts, dehydration, abrupt discontinuation
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Black Box Warning: Children, suicidal ideation, increased mortality in elderly patients with dementia-related psychosis Black Box Warning: Assess mental status before initial administration, AIMS assess- ment; affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances; suicidal thoughts/behaviors (child/young adult); dementia (geriatric patients), com- plete a full assessment in all new patients Black Box Warning: Not to be used in child <10 yr (imm rel) or <18 yr (ext rel) Black Box Warning: Suicide: restrict amount of product given; usually suicidal thoughts/behaviors occur early during treatment and among children/adoles- cents/young adults • Baseline blood glucose, LFTs, neuro- logic function, ophthalmologic exam, weight, monitor glucose often in diabetes mellitus, thyroid function tests, serum electrolytes/creatinine/lipid profile/pro- lactin • B/P standing, lying; pulse, respira- tions; determine q4hr during initial treat- ment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes • Dizziness, faintness, palpitations, tachy- cardia on rising • EPS: including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudopar- kinsonism (rigidity, tremors, pill rolling, shuffling gait) • Serious rash: assess for Stevens- Johnson syndrome, discontinue product; may cause rash, fever, joint pain, lesions • Pancreatitis: assess for nausea, vom- iting, severe abdominal pain • Metabolic syndrome: weight gain, in- creased cholesterol/triglycerides, increased BMI, hypertension • Neuroleptic malignant syndrome: hyperthermia, increased CPK, altered mental status, muscle rigidity, seizures, tachycardia, diaphoresis, hypo/hyperten- sion, fatigue; notify prescriber immedi- ately if symptoms occur • Constipation, urinary retention daily; if these occur, increase bulk, water in diet • Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting possible; patient should not stand still for long period of time • DRESS: fever, hepatitis, swelling of face, myositis, monitor eosinophils that may be elevated, discontinue • Hyperprolactinemia: sexual dysfunc- tion, menstrual changes • Beers: avoid in older adults except for schizophrenia, bipolar disorder, or short-term use as an antiemetic for che- motherapy; increased risk for stroke, dementia-related psychosis • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; pregnant women taking product should enroll in the National Pregnancy Registry for Atypical Antipsychotics, 1-866-961-2388; EPS may develop in the infant; breastfeeding isn’t recommended, excreted in breast milk Black Box Warning: Suicide: to notify prescriber of suicidal thoughts/behaviors, primarily among children/adolescents/ young adults, or worsening depression, severe anxiety, panic attacks, insomnia • To have eye exam before treatment and yearly q6mo; cataracts may occur • To notify providers before surgery
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SIDE EFFECTS CNS: EPS, pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia; drowsiness, insomnia, agitation, anxiety, headache, seizures, neuroleptic malignant syndrome, dizziness, dystonia, restless legs CV: Orthostatic hypotension, tachycardia, QT prolongation, CV disease, Parkinson’s disease, cardiomyopathy, myocarditis ENDO: SIADH, hyperglycemia GI: Pancreatitis, nausea, anorexia, constipation, abdominal pain, dry mouth HEMA: Leukopenia, agranulocytosis INTEG: Rash, DRESS META: Hyponatremia MISC: Asthenia, back pain, fever, ear pain MS: Rhabdomyolysis RESP: Rhinitis SYST: Stevens-Johnson syndrome, anaphylaxis
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INTERACTIONS Increase: QT prolongation—class IA/III antidysrhythmics, some phenothiazines, β-agonists, local anesthetics, tricyclics, haloperidol, methadone, chloroquine, clarithromycin, droperidol, erythromycin, pentamidine, macrolides (clarithromycin) Increase: CNS depression—alcohol, opi- oid analgesics, sedative/hypnotics, anti- histamines Increase: hypotension—alcohol, antihy- pertensives Increase: QUEtiapine clearance, decrease QUEtiapine effect—phenytoin, thiorida- zine, barbiturates, glucocorticoids, car- BAMazepine, rifampin Increase: QUEtiapine action—fluconazole, itraconazole, ketoconazole (CYP3A4 inhibitors), increase CYP3A4 inhibitor after discontinuation of inhibitor Decrease: quetiapine action—CYP3A4 inducers (carbamazepine, barbiturates, phenytoins, rifAMPin); reduce CYP3A4 inducer after discontinuation Decrease: effect of voriconazole, consider dosage change Decrease: effects of DOPamine agonists, levodopa, LORazepam Drug/Lab Test Increase: cholesterol, triglycerides, LFTs, glucose, prolactin Decrease: thyroid tests, WBC False positive: methadose/TCAs urine immunoassays
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Extracted information for QUEtiapine only.
DOSAGE AND ROUTES Bipolar mania • Adult: PO 100 mg divided twice daily on day 1; 200 mg divided twice daily on day 2; 300 mg divided twice daily on day 3; 400 mg divided twice daily on day 4; with further dosage adjustments in incre- ments of not more than 200 mg/day up to MAX 800 mg/day by day 6; usual effective dose is 400 to 800 mg/day Schizophrenia • Adult: PO (not at risk for hypotension) 25 mg bid on day 1, increase by 25-50 mg divided 2 to 3× on day 2 and day 3 to a target of 300-400 mg/day in divided doses by day 4, further dosage adjustment can be made in 25-50 mg bid increments, max 800 mg/day; (XR) 300 mg/day in PM, range 400-800 mg/day, max 800 mg/day • Adolescent 13-17 yr: PO 25 mg bid on day 1, 50 mg bid on day 2, 100 mg bid on day 3, 150 mg bid on day 4, 200 mg bid on day 5; ext rel 50 mg on day 1, then 100 mg on day 2, 200 mg on day 3, 300 mg on day 4, 400 mg on day 5 • Geriatric: PO EXT REL 50 mg/day may increase in 50 mg/day increments Major depression • Adult: PO EXT REL 50 mg/day in PM on days 1, 2; on day 3, 4, give 150 mg in PM; 300 mg once daily thereafter • Geriatric, debilitated or at risk for hy- potension: PO EXT REL 50 mg on day 1 and 2, may increase by 50 mg/day based on response
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Available forms: Tabs 25, 50, 100, 200, 300, 400 mg; ext rel tab 50, 150, 200, 300, 400 mg
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Administer: • Reduced dose to geriatric patients • Avoid use of CNS depressants • Store in tight, light-resistant container • If there is a week or more absence of therapy, initiate at beginning dose • Immediate release: without regard to meals • Ext rel: without food or with light meal ≤300 calories; swallow whole; do not split, crush, chew; can switch from im- mediate release to extended release by Q giving total daily dose daily
Source page 1113
Extracted information for QUEtiapine only.
Assess: • CV status: QT prolongation, tachycar- dia, orthostatic B/P
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Evaluate: • Therapeutic response: decrease in emotional excitement, hallucinations, de- lusions, paranoia; reorganization of pat- terns of thought, speech
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • Not to become overheated, to drink plenty of fluids • To rise slowly to prevent orthostatic hypotension • To take medication only as prescribed; not to crush, chew ext rel product; not to use with alcohol; to take regular tabs without regard to food or only a light meal <300 calories, ext rel without food; not to use other products unless approved by prescriber • Not to stop abruptly • That follow-up is necessary, including LFTs, blood glucose, neurologic, choles- terol profile, weight, to report hypoglyce- mic symptoms • If drowsiness occurs, to avoid hazard- ous activities such as driving • To avoid use of OTC, herbals, supple- ments, alcohol meds unless directed by prescriber • To notify prescriber if pregnancy is planned, suspected; not to breastfeed • To notify prescriber immediately of fever, difficulty breathing, fatigue, sore throat, rash, bleeding, agitation, panic attacks
Source page 1115
Extracted information for QUEtiapine only.
PHARMACOKINETICS Extensively metabolized by liver, half-life ≥6 hr, peak 11⁄2 hr, ext rel 6 hr, inhibits P450 CYP3A4 enzyme system, 83% protein bind- ing, excretion: <1% unchanged urine
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Filter the extracted dose blocks for this individual drug.
Bipolar mania
• Geriatric: PO EXT REL 50 mg/day may increase in 50 mg/day increments Major depression
Candidate age grouping · source page 1113
Bipolar mania
• Geriatric, debilitated or at risk for hy- potension: PO EXT REL 50 mg on day 1 and 2, may increase by 50 mg/day based on response
Candidate age grouping · source page 1113