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quetiapine fumarate

(kwe tie' ah peen)


Pregnancy Category C

Drug classes

Therapeutic actions
Mechanism of action not fully understood: Blocks dopamine and serotonin receptors in
the brain; also acts as a receptor antagonist at histamine and adrenergic receptor sites
(which may contribute to the adverse effects of orthostatic hypotension and somnolence).

• Treatment of schizophrenia in patients > 18 yr
• Adjunct or monotherapy for the treatment of manic episodes associated with
bipolar disorders
• Short-term treatment of acute manic episodes associated with bipolar I disorder,
as monotherapy or in combination with lithium or divalproex

Contraindications and cautions

• Contraindicated with coma or severe CNS depression, allergy to quetiapine,
• Use cautiously with CV disease, hypotension, hepatic dysfunction, seizures,
exposure to extreme heat, autonomic instability, tardive dyskinesia, dehydration,
thyroid disease, pregnancy.

Available forms
Tablets—25, 100, 200, 300 mg

• Schizophrenia: 25 mg PO bid. Increase in increments of 25–50 mg bid–tid on
days 2 and 3; dosage range by day 4: 300–400 mg/day in 2–3 divided doses.
Further increases can be made at 2-day intervals. Maximum dose, 800 mg/day.
• Manic episodes: 100 mg/day PO divided bid on day 1; increase to 400 mg/day PO
in bid divided doses by day 4 using 100-mg/day increments. Range, 400–
800 mg/day given in divided doses.
Not recommended for patients < 18 yr old.
Use lower doses and increase dosage more gradually than in other patients.
Route Onset Peak Duration
Oral Slow 1.5 hr Unknown
Metabolism: Hepatic; T1/2: 6 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces

Adverse effects
• Autonomic: Dry mouth, salivation, nasal congestion, nausea, vomiting, anorexia,
fever, pallor, flushed facies, sweating, constipation
• CNS: Drowsiness, insomnia, vertigo, headache, weakness, tremor, tardive
dyskinesias, neuroleptic malignant syndrome
• CV: Hypotension, orthostatic hypotension, syncope
• Hematologic: Increased ALT, total cholesterol and triglycerides
• Other: Risk of development of diabetes mellitus

• CNS effects potentiated by alcohol, CNS depressants
• Effects decreased with phenytoin, thioridazine, carbamazepine, phenobarbital,
rifampin, glucocorticoids; monitor patient closely and adjust dosages
appropriately when these drugs are added to or discontinued from regimen
• Increased effects of antihypertensives, lorazepam
• Decreased effects of levodopa, dopamine antagonists
• Potential for heatstroke and intolerance with drugs that affect temperature
regulation (anticholinergics); use extreme caution and monitor patient closely

Nursing considerations
• History: Coma or severe CNS depression; allergy to quetiapine, lactation,
pregnancy, CV disease, hypotension, hepatic dysfunction, seizures, exposure to
extreme heat, autonomic instability, tardive dyskinesia, dehydration, thyroid
disease, suicidal tendencies
• Physical: Body weight, T; reflexes, orientation, IOP; P, BP, orthostatic BP; R,
adventitious sounds; CBC, urinalysis, thyroid, liver, and kidney function tests

• Administer small quantity to any patient with suicidal ideation.
• Monitor elderly patients for dehydration and institute remedial measures
promptly; sedation and decreased sensation of thirst related to CNS effects of
drug can lead to severe dehydration.
• Monitor patient closely in any setting that would promote overheating.
• Regularly monitor patient for signs and symptoms of diabetes mellitus.
• Consult physician about dosage reduction and use of anticholinergic
antiparkinsonians (controversial) if extrapyramidal effects occur.
Teaching points
• Take this drug exactly as prescribed.
• This drug should not be used during pregnancy; using barrier contraceptives is
• Maintain fluid intake and use precautions against heat stroke in hot weather.
• These side effects may occur: Dizziness, drowsiness, fainting (avoid driving or
engaging in other dangerous activities); dry mouth, nausea, loss of appetite (use
frequent mouth care, eat frequent small meals, and increase fluid intake).
• Report sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors,
dark-colored urine, pale stools, yellowing of the skin or eyes.

Adverse effects in Italic are most common; those in Bold are life-threatening.