Seroquel® (quetiapine)
All FDA warnings are at the end of this fact sheet. Please consult them before taking this medication.
Brand and Generic Names
- Brand names: Seroquel®, Seroquel XR®
- Seroquel® Tablets (immediate-release): 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg
- Seroquel® XR Tablets (extended-release): 50 mg, 150 mg, 200 mg, 300 mg, 400 mg
- Generic name: quetiapine
What are Seroquel® and Seroquel XR® and what do they treat?
Quetiapine is a second generation antipsychotic (SGA) medication approved for the treatment of schizophrenia and bipolar disorder. Bipolar disorder involves episodes of depression and/or mania. Quetiapine can improve symptoms of schizophrenia such as: hallucinations, delusions, and disorganized thinking; in some people, improvement in social isolation, reduced speech productivity and motivation also occur. It can also help control the mood swings of bipolar mania and depression. The remainder of this medication sheet will focus primarily on schizophrenia.
What is the most important information I should know about Seroquel® or Seroquel XR® ?
Relapse is very common in schizophrenia and the most frequent cause is that patients stop taking their medication. Even when medication is taken exactly as prescribed, relapse may still occur for some people. Therefore it is recommended that you take your medication exactly as prescribed by your healthcare provider as this has been shown to decrease risk of relapse.
- Schizophrenia requires long-term treatment. Only your healthcare provider can determine the length of quetiapine treatment that is right for you.
- Do not stop taking quetiapine or change your dose, without talking to your healthcare provider first.
- Some people may develop side effects on quetiapine such as extrapyramidal effects (restlessness, tremor, stiffness) or tardive dyskinesia (slow or jerky movements that one cannot control, often starting in the mouth with tongue rolling or chewing movements). These symptoms are likely to be less severe and occur less often than with the older antipsychotic medications (e.g., Haldol® [haloperidol], Prolixin® [fluphenazine], and Thorazine® [chlorpromazine]). If you develop movements that you cannot control, call your healthcare provider immediately.
- Many second generation or atypical antipsychotics may cause an increase in weight, blood sugar levels, or lipid levels. If you gain more than 5% of your original weight during therapy, talk to your healthcare provider about whether switching to another antipsychotic medication should be considered.
- Quetiapine treatment may be associated with strokes and/or transient ischemic attacks (TIAs) in elderly people with dementia and accompanying behavior problems. This safety concern has not been proven confidently, but there is some evidence. Talk with your health care provider if you are concerned or have questions.
- Both older first and newer second generation antipsychotics have been associated with the risk of sudden cardiac death due to an arrhythmia (irregular conduction of an electrical impulse in the heart). To minimize this possibility, antipsychotic medications should be used in the smallest effective dose in situations where the benefits outweigh the risks, such as schizophrenia or bipolar disorder. Often an EKG tracing may be ordered to monitor for conduction changes.
- Quetiapine treatment must be monitored by a healthcare provider. Be sure to keep all of your scheduled appointments so that you stay healthy while on quetiapine.
- You should not take illegal drugs or drink alcohol while taking quetiapine.
Are there specific concerns about Seroquel® or Seroquel XR®and pregnancy?
If you are planning on becoming pregnant, notify your healthcare provider so that he/she can best manage your medications. People living with schizophrenia who wish to become pregnant face important decisions, each with risks and benefits related to how the illness, medications and the risks to the fetus may interact. This is a complex decision as untreated schizophrenia has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to discuss with your doctor and caregivers.
Breastfeeding while on quetiapine is not recommended.
What should I discuss with my healthcare provider before taking Seroquel® or Seroquel XR®?
- Symptoms of schizophrenia which are bothersome to you
- If you had any serious side effects to other antipsychotic medications like muscle stiffness, muscle cramping, shaking, tardive dyskinesia, neuroleptic malignant syndrome, weight gain, or diabetes. (See the NAMI Hearts and Minds Program.)
- If you have had an allergic reaction to quetiapine or any other medication
- History of heart problems, such as heart rhythm problems, long QT syndrome, or heart attacks. These illnesses may make quetiapine unsafe for you to take.
- Medical problems you have, especially diabetes, high cholesterol or triglycerides, increased body weight, seizures, or kidney disease or impairment
How should I take Seroquel® or Seroquel XR®?
- Symptoms of schizophrenia which are bothersome to you
- If you had any serious side effects to other antipsychotic medications like muscle stiffness, muscle cramping, shaking, tardive dyskinesia, neuroleptic malignant syndrome, weight gain, or diabetes. (See the NAMI Hearts and Minds Program).
- If you have had an allergic reaction to quetiapine or any other medication
- History of heart problems, such as heart rhythm problems, long QT syndrome, or heart attacks. These illnesses may make quetiapine unsafe for you to take.
- Medical problems you have, especially diabetes, high cholesterol or triglycerides, increased body weight, seizures, or kidney disease or impairment
How should I take Seroquel®or Seroquel XR®
- Immediate-release quetiapine can be taken with or without food but should be taken with a full glass of water. It is usually taken two or three times daily.
- Extended-release quetiapine should be taken without food or with a light meal. It is usually taken once daily, typically in the evening. It should be swallowed whole and not split, chewed, or crushed.
- Only your doctor can determine the correct dose for you. Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.
- Use a calendar or pill box to help you remember to take your medication. Or, have a family member or friend remind you or check in with you to be sure you are taking your medication.
What happens if I miss a dose of Seroquel® or Seroquel XR®?
If you miss a dose of quetiapine, take it as soon as you remember it, if it is not too close to when your next dose is due – discuss this with your health care provider. Do not double your next dose or take more than what is prescribed.
What should I avoid while taking Seroquel® or Seroquel XR®?
- Smoking cigarettes, using illegal drugs, or drinking alcohol.
- Some people get drowsy on quetiapine, avoid driving a car until you are sure how the medication will affect you.
What happens if I overdose with Seroquel® or Seroquel XR®?
- If an overdose occurs, whether intentional or accidental, immediate medical attention is necessary. Call your doctor or emergency medical service (911).
- The following may occur in an overdose: increased heart rate, low blood pressure, sedation, heart rhythm changes. In severe cases, people can develop coma, and death is possible.
What are the possible side effects of Seroquel® or Seroquel XR®?
What are the common side effects seen with quetiapine?
Side effects commonly seen with quetiapine are relatively minor and mayinclude dry mouth, sedation, drowsiness, constipation, stomach upset, dizziness, heart palpitations, and low blood pressure (particularly when standing up quickly and especially when your dose is being increased) which could result in fainting.
What are the more serious side effects of antipsychotics?
- With newer second generation antipsychotics (SGA), more commonly seen are diabetes/weight gain/increased cholesterol and triglycerides as noted in stronger warnings mandated by the FDA in individual drug labeling. For the relative risk of weight gain and diabetes seen with the various drugs, see Table 2 in the Consensus Conference on Antipsychotic Drugs. These guidelines make recommendations for the monitoring of cardiac risk factors while on atypical antipsychotics.
Please also consult the Metabolic and Diabetes tab on the Hearts and Minds section for the current monitoring information regarding triglycerides, cholesterol, fasting blood glucose, etc. to help plan preventative interventions.
- Less commonly seen, but important, is the early death/dementia risk as noted in the FDA boxed warning. In some clinical trials, it was determined that elderly people developed strokes at a higher rate than those on placebo medication (sugar pill). The SGA group has less tardive dyskinesia (TD), neuroleptic malignant syndrome, seizures, and changes in heart rhythm than older drugs but not zero.
What do I do about the more serious risks?
Please let your doctors know if you have any of these medical conditions prior to starting quetiapine.
It is important to be aware of prevention with attention to nutrition, exercise, and reducing your plate size (because the medications may reduce your ability to feel full after eating). For more ideas, see the NAMI Hearts and Minds Program.
Also, obtain Abnormal Involuntary Movement testing (AIMS) to monitor for TD. While it is less common with newer antipsychotics, it has been reported. If you are taking an older FGA, then regular AIMS testing is needed for monitoring, so you can make good choices about the use of the drug when weighing the risks and benefits.
Are there any risks for taking Seroquel® or Seroquel XR®for long periods of time?
Tardive dyskinesia (TD) is a side effect that may develop with prolonged use of antipsychotics. Medications such as quetiapine have been shown to have a much lower risk of TD compared to older antipsychotics, such as Haldol® (haloperidol). Should you develop symptoms of TD, such as grimacing, sucking and smacking of lips, and other movements that you cannot control, contact your healthcare provider immediately.
No one can predict how much weight a person will gain on any medicine, but an approach that includes exercise and diet and monitoring for weight gain and diabetes is recommended.
What other drugs interact with this medication?
It is always important to tell your health care provider about all medications you are taking, including over-the-counter medications and herbal products.
Some medications and even grapefruit juice may increase the blood levels of quetiapine, which could possibly result in an increase in side effects. Tell your doctor if you are prescribed Luvox®(fluvoxamine), Biaxin®(clarithromycin), erythromycin, or Nizoral® (ketoconazole).
Other medications may decrease the amount of quetiapine in the blood resulting in decreased effectiveness. Two such medications that are commonly used to treat bipolar disorder include Tegretol®(carbamazepine) and Trileptal®(oxcarbazepine). Other medications with similar effects include Provigil®(modafinil), Mysoline®(primidone), and Dilantin® (phenytoin).
Because of its potential for causing hypotension (low blood pressure), caution should be used when quetiapine is administered with other high blood pressure medications.
Caution should be used when taking quetiapine with other central nervous system medications.
Caution should be used when taking quetiapine with medications known to cause electrolyte imbalance or increase QT interval.
Quetiapine may decrease the effects of levodopa and dopamine agonists.
How long does it take for Seroquel® or Seroquel XR® to work?
Quetiapine rebalances dopamine and serotonin to improve thinking, mood, and behavior. Improvement of some symptoms may be noticed in some patients within a few weeks. The full benefit of quetiapine may not be seen for 6-12 weeks or longer.
FDA ALERT [06/0606]
Both conventional and atypical antipsychotics are associated with an increased risk of mortality in elderly patients treated for dementia-related psychosis.
Antipsychotics are not indicated for the treatment of dementia-related psychosis. |
Updated by
Shelley Seiler, Pharm.D., BCPP
(August 2010)
NAMI wishes to thank the College of Psychiatric and Neurologic Pharmacists for producing this fact sheet.
Reviewed by Dr. Ken Duckworth, NAMI Medical Director
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