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quetiapine
Seroquel · Seroquel XR
Second-generation antipsychotic⚠ Unverified beta content
At a glance
- Class
- Atypical antipsychotic (dibenzothiazepine)
- Black box
- ⚠ Increased mortality in elderly patients with dementia-related psychosis
- ⚠ Suicidal thoughts and behaviors (antidepressant class warning) – applies where labeled (e.g.,…
- Key monitoring
- Metabolic monitoring (ADA/APA schedule) — Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipids
- Orthostatic BP / HR
- Usual adult dose
- Schizophrenia (IR): 150–750 mg/day divided BID
- Call provider / escalate if
- High fever, severe muscle stiffness, confusion, sweating, fast heartbeat (NMS) • Fainting, palpitations • Involuntary movements of face/tongue
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- quetiapine (Seroquel, Seroquel XR) — atypical antipsychotic (dibenzothiazepine).
- Used for: Schizophrenia; Bipolar I – acute mania; Bipolar depression; Adjunct for MDD.
Usual adult dosing
- Schizophrenia (IR): 150–750 mg/day divided BID (Usual target 300–450 mg/day; titrate over days.)
- Bipolar mania: 400–800 mg/day
- Bipolar depression: 300 mg qHS
- MDD adjunct (XR): 150–300 mg qHS
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
- Suicidal thoughts and behaviors (antidepressant class warning) – applies where labeled (e.g., quetiapine, aripiprazole, olanzapine/fluoxetine) in patients ≤24 yrs.
Monitor
- Metabolic monitoring (ADA/APA schedule) — Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipids [Baseline; weight at 4, 8, 12 wks then quarterly; BP/glucose/lipids at 12 wks then annually (lipids q5y if normal); more often if abnormal]
- Orthostatic BP / HR [Baseline and during titration]
Nursing priorities
- Baseline psychiatric symptoms (positive/negative, agitation), suicidality, and aggression risk.
- Baseline vitals incl. orthostatic BP, weight/BMI, waist circumference.
- Assess for EPS, akathisia, and abnormal movements each shift/visit (AIMS at baseline and periodically per policy).
- Check orthostatic vitals; teach slow position changes; fall precautions.
- Weigh regularly and encourage healthy diet and activity.
Major interactions
- Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin, ritonavir): ↑ quetiapine – reduce dose to ~1/6.
- CYP3A4 inducers (carbamazepine, phenytoin, rifampin): ↓ quetiapine – may need higher dose.
- QT-prolonging drugs: Additive QT prolongation.
- Alcohol, benzodiazepines, opioids, other CNS depressants: Additive sedation.
Key teaching
- Take it every day even when you feel well. Do not stop suddenly.
- It can make you dizzy when you stand up – rise slowly.
- Weight gain and changes in blood sugar and cholesterol can happen. You will have regular weight and blood tests.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Increased mortality in elderly patients with dementia-related psychosis: not approved for treatment of dementia-related psychosis.
- Suicidal thoughts and behaviors (antidepressant class warning) – applies where labeled (e.g., quetiapine, aripiprazole, olanzapine/fluoxetine) in patients ≤24 yrs.
Other serious warnings
- Metabolic changes (hyperglycemia, dyslipidemia, weight gain)
- Neuroleptic malignant syndrome
- Tardive dyskinesia
- Orthostatic hypotension, syncope
- QT prolongation (esp. overdose, other QT drugs)
- Leukopenia/neutropenia
- Cataracts (labeled eye monitoring)
- Seizures
- Hypothyroidism
- Dysphagia / aspiration
Sources: FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PH
- Metabolic monitoring (ADA/APA schedule)Target: Weight/BMI, waist, BP, fasting glucose/A1c, fasting lipidsWhen: Baseline; weight at 4, 8, 12 wks then quarterly; BP/glucose/lipids at 12 wks then annually (lipids q5y if normal); more often if abnormal
- Orthostatic BP / HRWhen: Baseline and during titration
- ECG / QTcWhen: If cardiac risk or other QT drugs
- CBCBaseline if history of low WBC; monitor if fever/infection
- Eye examCataract surveillance per label/facility policy
- AIMS / EPSWhen: Baseline and at least every 6–12 months
Sources: FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PH · ADA/APA Consensus Development Conference on Antipsychotic Drugs and Ob
Assessment
- Baseline psychiatric symptoms (positive/negative, agitation), suicidality, and aggression risk.
- Baseline vitals incl. orthostatic BP, weight/BMI, waist circumference.
- Baseline AIMS (abnormal movements) and EPS screen.
- History of diabetes, dyslipidemia, cardiac disease, seizures, dementia.
- Substance use and medication/supplement list.
- Baseline lipids/glucose; ECG if cardiac risk or QT drugs.
Interventions
- Assess for EPS, akathisia, and abnormal movements each shift/visit (AIMS at baseline and periodically per policy).
- Check orthostatic vitals; teach slow position changes; fall precautions.
- Weigh regularly and encourage healthy diet and activity.
- Monitor adherence (consider cheeking checks per policy).
- Report fever, rigidity, or altered mental status immediately (NMS).
- Give XR in the evening, without food or with a light meal; swallow whole.
- Sedation is common early – fall precautions, especially at night.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- High fever, severe muscle stiffness, confusion, sweating, fast heartbeat (NMS)
- Fainting, palpitations
- Involuntary movements of face/tongue
- Excess thirst, frequent urination (high blood sugar)
- Fever or infection signs (low WBC)
- Seizure
- Trouble swallowing
- Suicidal thoughts
Sources: FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PH · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Somnolence / sedation
- Dizziness / orthostatic hypotension
- Dry mouth
- Constipation
- Weight gain, increased appetite
- Elevated lipids and glucose
- Tachycardia
Sources: FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PH
- Strong CYP3A4 inhibitors (ketoconazole, itraconazole, clarithromycin, ritonavir) Major↑ quetiapine – reduce dose to ~1/6.
- CYP3A4 inducers (carbamazepine, phenytoin, rifampin) Major↓ quetiapine – may need higher dose.
- QT-prolonging drugs MajorAdditive QT prolongation.
- Alcohol, benzodiazepines, opioids, other CNS depressants MajorAdditive sedation.
- AntihypertensivesAdditive hypotension.
Sources: FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PH
- Take it every day even when you feel well. Do not stop suddenly.
- It can make you dizzy when you stand up – rise slowly.
- Weight gain and changes in blood sugar and cholesterol can happen. You will have regular weight and blood tests.
- Report muscle stiffness, restlessness (can’t sit still), shaking, or unusual movements of the face or tongue.
- Avoid alcohol and street drugs; they add to drowsiness and can worsen symptoms.
- It can make you feel hot more easily – drink fluids and avoid overheating.
- It often makes you sleepy – take it at bedtime if directed.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Schizophrenia
- Bipolar I – acute mania
- Bipolar depression
- Adjunct for MDD (XR)
- Common off-label: insomnia/anxiety/agitation (low doses)
Dosing
- Schizophrenia (IR): 150–750 mg/day divided BIDUsual target 300–450 mg/day; titrate over days.
- Bipolar mania: 400–800 mg/day
- Bipolar depression: 300 mg qHS
- MDD adjunct (XR): 150–300 mg qHS
Sources: FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PH
Prescriber-oriented details; limited in this beta.
hepatic Adjustment
- Start 25 mg/day and titrate cautiously in hepatic impairment.
geriatric
- Start 50 mg/day; slower titration.
cyp Notes
- CYP3A4 substrate – adjust dose with strong inhibitors/inducers.
Sources: FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PH
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): SEROQUEL (QUETIAPINE) TABLET, FILM COATED [H2-PHARMA, LLC]
- ADA/APA Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes (Diabetes Care 2004) - metabolic monitoring schedule
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified
Reviewer notes – please double-check
- Cataract/eye examination recommendation language has changed between label versions – verify current label/facility policy.