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Quetiapine

Dosage ;

Use;

Treatment of schizophrenia; treatment of acute manic or mixed episodes associated with bipolar I disorder

(as monotherapy or in combination with lithium or divalproex);

maintenance treatment of bipolar I disorder (in combination with lithium or divalproex);

treatment of acute depressive episodes associated with bipolar disorder;

adjunctive treatment of major depressive disorder

Use - Unlabeled/Investigational

Autism; delirium in the critically-ill patient;

psychosis/agitation related to Alzheimer's dementia

/agitation related to Alzheimer's dementia

Quetiapine More info

Dosing: Adult

Bipolar disorder: Oral:

Depression:

Immediate release tablet: Initial: 50 mg once daily the first day; increase to 100 mg once daily on day 2, further increasing by 100 mg/day each day until a target dose of 300 mg once daily is reached by day 4. Further increases up to 600 mg once daily by day 8 have been evaluated in clinical trials, but no additional antidepressant efficacy was noted.

Extended release tablet: Initial: 50 mg/day the first day; increase to 100 mg on day 2, further increasing by 100 mg/day each day until a target dose of 300 mg/day is reached by day 4.

Mania:

Immediate release tablet: Initial: 50 mg twice daily on day 1, increase dose in increments of 100 mg/day to 200 mg twice daily on day 4; may increase to a target dose of 800 mg/day by day 6 at increments ≤200 mg/day. Usual dosage range: 400-800 mg/day.

Extended release tablet: Initial: 300 mg on day 1; increase to 600 mg on day 2 and adjust dose to 400-800 mg once daily on day 3, depending on response and tolerance.

Maintenance therapy: Immediate release tablet: 200-400 mg twice daily with lithium or divalproex; Note: Average time of stabilization was 15 weeks in clinical trials.

Major depressive disorder (adjunct to antidepressants): Oral: Extended release tablet: Initial: 50 mg once daily; may be increased to 150 mg on day 3. Usual dosage range: 150-300 mg/day

Schizophrenia/psychoses: Oral:

Immediate release tablet: Initial: 25 mg twice daily; followed by increases in the total daily dose on the second and third day in increments of 25-50 mg divided 2-3 times/day, if tolerated, to a target dose of 300-400 mg/day in 2-3 divided doses by day 4. Make further adjustments as needed at intervals of at least 2 days in adjustments of 25-50 mg divided twice daily. Usual maintenance range: 300-800 mg/day.

Extended-release tablet: Initial: 300 mg once daily; increase in increments of up to 300 mg/day (in intervals of ≥1 day). Usual maintenance range: 400-800 mg/day.

Note: Dose reductions should be attempted periodically to establish lowest effective dose in patients with psychosis. Patients being restarted after 1 week of no drug need to be titrated as above.

ICU delirium: Oral: Initial: 50 mg twice daily; may increase as necessary on a daily basis in increments of 50 mg twice daily to a maximum dose of 400 mg/day (Devlin, 2010)

Dosing: Pediatric

Note: Total daily doses may also be divided into 3 doses per day.

Bipolar disorder: Children ≥10 years: Oral:

Mania: Immediate release tablet: Initial: 25 mg twice daily on day 1; increase to 50 mg twice daily on day 2, further increasing by 100 mg/day each day until a target dose of 400 mg/day is reached on day 5. May increase up to 600 mg/day at increments ≤100 mg/day; however, no additional benefit seen with 600 mg/day. Usual dosage range: 400-600 mg/day.

Maintenance therapy: Immediate release tablet: Continue therapy at lowest dose needed to maintain remission; periodically assess maintenance treatment needs.

Autism (unlabeled use): Children ≥10 years: Oral: 100-350 mg/day (1.6-5.2 mg/kg/day) (Martin, 1999)

Schizophrenia: Adolescents ≥13 years: Oral: Immediate release tablet: Initial: 25 mg twice daily on day 1; increase to 50 mg twice daily on day 2, further increasing by 100 mg/day each day until a target dose of 400 mg/day is reached on day 5. May increase up to 800 mg/day at increments ≤100 mg/day; however, no additional benefit seen with 800 mg/day. Usual dosage range: 400-800 mg/day; periodically assess maintenance treatment needs.

Dosing: Geriatric

Adults >65 years: 40% lower mean oral clearance of quetiapine in adults >65 years of age; higher plasma levels expected and, therefore, dosage adjustment may be needed; elderly patients usually require 50-200 mg/day of immediate release tablets or 50 mg/day of extended release tablets with a slower titration schedule. Increase immediate release dose by 25-50 mg/day or extended release dose by 50 mg/day to effective dose, based on clinical response and tolerability. If initiated with immediate release tablets, patient may transition to extended release formulation (at equivalent total daily dose) when effective dose has been reached. See “Note” in adult dosing.

Psychosis/agitation related to Alzheimer’s dementia (unlabeled use): Initial: 12.5-50 mg/day; if necessary, gradually increase as tolerated not to exceed 200-300 mg/day (Rabins, 2007)