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quetiapine fumarate

(kwe tie' ah peen)


Seroquel

Pregnancy Category C

Drug classes
Dibenzothiazepine
Antipsychotic

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).

Indications
• 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,
lactation.
• 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

Dosages
ADULTS
• 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.
PEDIATRIC PATIENTS
Not recommended for patients < 18 yr old.
GERIATRIC OR DEBILITATED PATIENTS OR PATIENTS WITH HEPATIC
IMPAIRMENT
Use lower doses and increase dosage more gradually than in other patients.
Pharmacokinetics
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

Interactions
Drug-drug
• 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
Assessment
• 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

Interventions
• 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
advised.
• 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.