Select a medication above to begin.
Seroquel XR
quetiapine
Black Box Warnings .
Dementia-Related Psychosis
not approved for dementia-related psychosis; incr. mortality risk in elderly pts on antipsychotic tx for dementia-related psychosis; most deaths due to cardiovascular or infectious events
Suicidality
incr. suicidality risk in children, adolescents, and young adults w/ major depressive or other psychiatric disorders; weigh risk vs. benefit; in short-term studies of antidepressants vs. placebo, suicidality risk not incr. in pts >24 yo, and risk decr. in pts 65 yo and older; depression and certain other psychiatric disorders themselves assoc. w/ incr. suicide risk; observe all pts for clinical worsening, suicidality, or unusual behavior changes; advise families and caregivers of need for close observation and communication w/ prescriber; not approved for depression in peds pts
Adult Dosing .
Dosage forms: ER TAB: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg
schizophrenia
- [400-800 mg PO qpm]
- Start: 300 mg PO qpm, then incr. up to 300 mg/day prn; Max: 800 mg/day; Info: start 50 mg PO qpm in elderly or debilitated pts, then incr. by 50 mg/day; give on empty stomach or w/ light meal; do not cut/crush/chew tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
bipolar I disorder, manic/mixed
- [400-800 mg PO qpm]
- Start: 300 mg PO qpm x1, then 600 mg PO qpm x1, then may adjust by 200 mg/day prn; Max: 800 mg/day; Info: for acute monotherapy or acute or maint. lithium or valproate adjunct; start 50 mg PO qpm in elderly or debilitated pts, then incr. by 50 mg/day; give on empty stomach or w/ light meal; do not cut/crush/chew tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
bipolar disorder, acute depressive
- [300 mg PO qpm]
- Start: 50 mg PO qpm x1, then 100 mg PO qpm x1, then 200 mg PO qpm x1, then 300 mg PO qpm; Max: 300 mg/day; Info: start 50 mg PO qpm in elderly or debilitated pts, then incr. by 50 mg/day; give on empty stomach or w/ light meal; do not cut/crush/chew tab; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
major depressive disorder, adjunct tx
- [150-300 mg PO qpm]
- Start: 50 mg PO qpm x2 days, then 150 mg PO qpm x2 days; Max: 300 mg/day; Info: give on empty stomach or w/ light meal; do not cut/crush/chew tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
generalized anxiety disorder, tx-resistant (off-label)
- [50-150 mg PO qd]
- Start: 50 mg PO qd, then may incr. by 50 mg/day; Max: 300 mg/day; Info: give on empty stomach or w/ light meal; do not cut/crush/chew tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- hepatic impairment: start 50 mg qpm, then incr. by 50 mg/day
Peds Dosing .
- Dosage forms: ER TAB: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg
schizophrenia
- [13-17 yo]
- Dose: 400-800 mg PO qpm; Start: 50 mg PO qpm x1, then 100 mg PO qpm x1, then incr. by 100 mg/day; Max: 800 mg/day; Info: give on empty stomach or w/ light meal; do not cut/crush/chew tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
bipolar I disorder, acute manic
- [10-17 yo]
- Dose: 400-600 mg PO qpm; Start: 50 mg PO qpm x1, then 100 mg PO qpm x1, then incr. by 100 mg/day; Max: 600 mg/day; Info: give on empty stomach or w/ light meal; do not cut/crush/chew tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
renal dosing
- [see below]
- renal impairment: no adjustment
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- hepatic impairment: start 50 mg qpm, then incr. by 50 mg/day
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- electrolyte abnormalities, uncorrected
- hypokalemia
- hypomagnesemia
- long QT syndrome, congenital
- arrhythmia hx
- bradycardia
- QT prolongation
- abrupt withdrawal
- caution: QT prolongation family hx
- caution: MI, recent
- caution: CHF
- caution: pts <25 yo
- caution: elderly pts
- caution: psychosis, dementia-associated
- caution: hepatic impairment
- caution: leukopenia
- caution: leukopenia hx, drug-induced
- caution: neutropenia
- caution: neutropenia hx, drug-induced
- caution: major depressive disorder
- caution: suicide risk
- caution: neuroleptic malignant syndrome hx
- caution: tardive dyskinesia
- caution: seizure hx
- caution: seizure threshold, lowered
- caution: cardiovascular dz
- caution: cerebrovascular dz
- caution: hypotension
- caution: hypovolemia
- caution: dehydration
- caution: environmental temperature, high
- caution: aspiration pneumonia risk
- caution: dysphagia
- caution: diabetes mellitus
- caution: diabetes mellitus risk
- caution: hyperlipidemia
- caution: urinary retention
- caution: urinary retention hx
- caution: prostatic hypertrophy
- caution: constipation
- caution: IOP incr.
Drug Interactions .
Overview
quetiapine
atypical antipsychotic
- CYP3A4 substrate
- epoxide hydrolase inhibitor
- anticholinergic effects
- CNS depression
- decreases central histamine effects
- dopamine antagonist
- extrapyramidal effects
- hyperglycemic effects
- hyperprolactinemic effects
- hypertensive effects
- hyperthermia
- hypotensive effects
- lowers seizure threshold
- prolongs QT interval (conditional)
Contraindicated
- lefamulin
- pimozide
- potassium chloride
- potassium citrate
- thioridazine
Avoid/Use Alternative
- aclidinium inhaled
- adagrasib
- aldesleukin
- amifampridine
- amiodarone
- anagrelide
- apalutamide
- apomorphine
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- arsenic trioxide
- artemether/lumefantrine
- asenapine
- atazanavir
- azithromycin
- bedaquiline
- butalbital
- cabozantinib
- ceritinib
- chloroquine
- cisapride
- citalopram
- clarithromycin
- clofazimine
- clonidine
- clozapine
- cobicistat
- codeine
- crizotinib
- darunavir
- degarelix
- desflurane
- desipramine
- dexmedetomidine
- dexmedetomidine injection
- disopyramide
- dofetilide
- domperidone
- donepezil
- doxylamine
- dronedarone
- droperidol
- eluxadoline
- encorafenib
- ephedra
- epinephrine inhaled
- epirubicin
- eribulin
- erythromycin
- ethanol
- fexinidazole
- flecainide
- fluorouracil
- fosamprenavir
- furosemide
- gilteritinib
- glasdegib
- glucagon
- glycopyrronium topical
- goserelin
- haloperidol
- histrelin
- hydrocodone
- hydroxychloroquine
- hydroxyzine
- ibutilide
- inotuzumab ozogamicin
- isocarboxazid
- isoflurane
- ivosidenib
- kava
- kratom
- leuprolide
- levofloxacin
- levoketoconazole
- lofexidine
- lonafarnib
- lopinavir/ritonavir
- lurasidone
- metaxalone
- methadone
- metoclopramide
- midazolam
- midodrine
- mobocertinib
- moxifloxacin
- nelfinavir
- netupitant
- nilotinib
- oliceridine
- ondansetron
- osimertinib
- oxybate
- pacritinib
- paliperidone
- palonosetron
- panobinostat
- pasireotide
- pentamidine
- phenelzine
- pitolisant
- pramlintide
- procainamide
- promethazine
- propafenone
- quinidine (antiarrhythmic)
- quinidine (CYP2D6 inhibitor)
- quinine
- quizartinib
- revefenacin inhaled
- revumenib
- ribociclib
- ritonavir
- romidepsin
- ropeginterferon alfa-2b
- rucaparib
- selpercatinib
- sevoflurane
- sotalol
- telavancin
- tetrabenazine
- thalidomide
- tipranavir
- toremifene
- tramadol
- tranylcypromine
- triclabendazole
- trifluridine
- trimethobenzamide
- triptorelin
- vandetanib
- vemurafenib
- ziprasidone
- zuranolone
Monitor/Modify Tx
- abiraterone acetate
- acarbose
- acebutolol
- albuterol
- albuterol inhaled
- alfentanil
- alfuzosin
- aliskiren
- almotriptan
- alogliptin
- alprazolam
- amantadine
- amifostine
- amiloride
- amitriptyline
- amlodipine
- amoxapine
- amphetamine
- angiotensin II
- apraclonidine ophthalmic
- aprepitant
- aprocitentan
- arformoterol inhaled
- armodafinil
- articaine
- asciminib
- atenolol
- atogepant
- atomoxetine
- atropine ophthalmic
- avacopan
- avanafil
- axitinib
- azilsartan medoxomil
- baclofen intrathecal
- benazepril
- benzphetamine
- berberine
- berotralstat
- betamethasone
- betaxolol
- betaxolol ophthalmic
- bethanechol
- bevacizumab
- bexagliflozin
- bismuth subsalicylate
- bisoprolol
- bortezomib
- bosentan
- brexpiprazole
- brigatinib
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- budesonide
- bumetanide
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- bupropion
- butorphanol
- cabergoline
- caffeine
- caffeine citrate
- canagliflozin
- candesartan cilexetil
- cannabis
- captopril
- carbamazepine
- carfilzomib
- cariprazine
- carteolol ophthalmic
- carvedilol
- celecoxib
- cenobamate
- chloramphenicol
- chlordiazepoxide
- chloroprocaine
- chlorothiazide
- chlorpromazine
- chlorthalidone
- cilostazol
- ciprofloxacin
- clevidipine
- clobazam
- clofarabine
- clomipramine
- clonazepam
- clorazepate
- cocaine
- coenzyme Q-10
- colesevelam
- conivaptan
- copanlisib
- corticotropin
- cortisone
- cyclosporine
- dabrafenib
- danazol
- dapagliflozin
- darbepoetin alfa
- daridorexant
- deflazacort
- denileukin diftitox
- desmopressin
- desvenlafaxine
- dexamethasone
- dexmethylphenidate
- dextroamphetamine
- diazepam
- diclofenac
- diclofenac topical
- diethylpropion
- diflunisal
- dihydrocodeine
- dihydroergotamine
- diltiazem
- dinutuximab
- dipyridamole
- dobutamine
- dopamine
- doxapram
- doxazosin
- doxepin
- dronabinol
- droxidopa
- dulaglutide
- duloxetine
- duvelisib
- efavirenz
- eletriptan
- empagliflozin
- enalapril
- enalaprilat
- entacapone
- entrectinib
- enzalutamide
- ephedrine injection
- ephedrine oral
- epinephrine
- eplerenone
- epoetin alfa
- epoprostenol
- eptinezumab
- erenumab
- ergotamine
- ertugliflozin
- esketamine
- esmolol
- estazolam
- estetrol (contraceptive)
- estradiol (contraceptive)
- eszopiclone
- ethacrynic acid
- ethanol (in some formulations)
- ethinyl estradiol (contraceptive)
- etodolac
- etomidate
- etrasimod
- etravirine
- exenatide
- fedratinib
- felodipine
- fenfluramine
- fenoldopam
- fenoprofen
- fentanyl
- ferumoxytol
- fingolimod
- flaxseed
- flibanserin
- fluconazole
- fludrocortisone
- fluphenazine
- flurazepam
- flurbiprofen
- formoterol inhaled
- fosinopril
- foslevodopa
- fosphenytoin
- fostamatinib
- fremanezumab
- frovatriptan
- fruquintinib
- gabapentin
- gabapentin enacarbil
- galcanezumab
- garlic
- glimepiride
- glipizide
- glyburide
- grapefruit
- guanfacine
- hoodia
- hydralazine
- hydrochlorothiazide
- hydrocortisone
- hydromorphone
- ibrutinib
- ibuprofen
- idelalisib
- ifosfamide
- iloperidone
- iloprost
- iloprost inhaled
- imatinib
- imipramine
- indapamide
- indomethacin
- insulin
- iohexol
- iopamidol
- irbesartan
- iron sucrose
- isavuconazonium
- isosorbide dinitrate
- isosorbide mononitrate
- isradipine
- itraconazole
- ketamine
- ketoconazole
- ketoprofen
- ketorolac
- labetalol
- landiolol
- lanreotide
- leflunomide
- lemborexant
- lenacapavir
- lenvatinib
- letermovir
- levalbuterol inhaled
- levobunolol ophthalmic
- levodopa
- levomilnacipran
- levorphanol
- licorice
- lidocaine
- linagliptin
- liraglutide
- lisdexamfetamine
- lisinopril
- lixisenatide
- lorazepam
- lorlatinib
- losartan
- loxapine
- lubiprostone
- lumacaftor/ivacaftor
- lumateperone
- luspatercept
- macimorelin
- magnesium salicylate
- magnesium sulfate
- maraviroc
- mavacamten
- meclofenamate
- mefenamic acid
- meloxicam
- meperidine
- mepivacaine
- metformin
- methamphetamine
- methohexital
- methoxy polyethylene glycol-epoetin beta
- methyldopa
- methylene blue injection
- methylergonovine
- methylphenidate
- methylprednisolone
- methyltestosterone
- metolazone
- metoprolol
- mifepristone
- miglitol
- milnacipran
- milrinone
- minoxidil
- mirabegron
- mirtazapine
- mitapivat
- mitotane
- modafinil
- moexipril
- molindone
- morphine
- nabumetone
- nadolol
- nafcillin
- nalbuphine
- naproxen
- naratriptan
- nateglinide
- nattokinase
- naxitamab
- nebivolol
- nefazodone
- nelarabine
- niacin (vitamin B3)
- nicardipine
- nifedipine
- nimodipine
- niraparib
- nirogacestat
- nisoldipine
- nitric oxide
- nitrite
- nitroglycerin
- nitroprusside
- norepinephrine
- nortriptyline
- olanzapine
- olmesartan medoxomil
- olodaterol inhaled
- opicapone
- opium
- osilodrostat
- oxaprozin
- oxazepam
- oxybutynin
- oxycodone
- oxymetazoline nasal
- oxymorphone
- oxytocin
- ozanimod
- palopegteriparatide
- pazopanib
- pentazocine
- pentobarbital
- perindopril
- perphenazine
- pexidartinib
- phendimetrazine
- phenobarbital
- phenoxybenzamine
- phentermine
- phentolamine
- phenylephrine
- phenylephrine injection
- phenylephrine nasal
- phenylephrine ophthalmic
- phenylephrine rectal
- phenytoin
- pindolol
- pioglitazone
- piroxicam
- ponatinib
- ponesimod
- posaconazole
- pralsetinib
- pramipexole
- prazosin
- prednisolone
- prednisone
- pregabalin
- primidone
- procarbazine
- prochlorperazine
- propofol
- propranolol
- protriptyline
- pseudoephedrine
- quazepam
- quinapril
- ramipril
- ramucirumab
- rasagiline
- regorafenib
- remifentanil
- remimazolam
- repaglinide
- repotrectinib
- rifabutin
- rifampin
- rifapentine
- rimegepant
- riociguat
- ripretinib
- risperidone
- rizatriptan
- ropinirole
- ropivacaine
- rosiglitazone
- rotigotine transdermal
- sacubitril
- safinamide
- salmeterol inhaled
- salsalate
- saxagliptin
- selegiline
- selegiline transdermal
- semaglutide
- sildenafil
- silodosin
- siponimod
- sitagliptin
- sodium ferric gluconate complex
- solriamfetol
- sorafenib
- sotagliflozin
- sotorasib
- sparsentan
- spironolactone
- St. John's wort
- sufentanil
- sulindac
- sumatriptan
- sunitinib
- suvorexant
- tacrolimus
- tadalafil
- tagraxofusp
- tamsulosin
- tapentadol
- taurine
- telmisartan
- temazepam
- terazosin
- terbutaline
- teriflunomide
- testosterone
- thiothixene
- timolol
- timolol ophthalmic
- tirzepatide
- tivozanib
- tizanidine
- tolcapone
- tolmetin
- torsemide
- trametinib
- trandolapril
- trazodone
- treprostinil
- triamcinolone
- triamterene
- triazolam
- trifluoperazine
- trimipramine
- tucatinib
- ubrogepant
- vadadustat
- valsartan
- vamorolone
- vardenafil
- vasopressin
- venlafaxine
- verapamil
- vilanterol inhaled
- viloxazine
- voclosporin
- voriconazole
- vosoritide
- yohimbe
- zaleplon
- zavegepant
- ziconotide
- ziv-aflibercept
- zolmitriptan
- zolpidem
Caution Advised
- 5-HTP
- aceclidine ophthalmic
- acetazolamide
- allopurinol
- alosetron
- atropine
- baclofen
- barium
- belladonna alkaloids
- belzutifan
- benztropine
- bexarotene
- botulinum toxin
- brivaracetam
- brompheniramine
- buspirone
- busulfan
- cannabidiol
- carbinoxamine
- carisoprodol
- cetirizine
- chamomile, German
- chasteberry
- chlophedianol
- chlorambucil
- chlorpheniramine
- chlorzoxazone
- clemastine
- clidinium
- cyclobenzaprine
- cyclopentolate ophthalmic
- cyproheptadine
- danshen
- dantrolene
- darifenacin
- darolutamide
- deutetrabenazine
- dexbrompheniramine
- dexchlorpheniramine
- dichlorphenamide
- dicloxacillin
- dicyclomine
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- doxepin topical
- echinacea
- elafibranor
- elagolix
- enasidenib
- escitalopram
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fesoterodine
- flavoxate
- fluoxetine
- fluvoxamine
- galantamine
- ganaxolone
- ginkgo
- ginseng, Asian
- glofitamab
- glycerol phenylbutyrate
- glycopyrrolate
- glycopyrrolate inhaled
- griseofulvin
- homatropine
- hyoscyamine
- ipratropium inhaled
- ipratropium nasal
- lacosamide
- lamotrigine
- lasmiditan
- levetiracetam
- levocetirizine
- linvoseltamab
- lithium
- loperamide
- magnesium citrate
- meclizine
- melatonin
- meprobamate
- meropenem
- methocarbamol
- methscopolamine
- methsuximide
- metyrapone
- metyrosine
- mexiletine
- mosunetuzumab
- mycophenolate mofetil
- naltrexone
- neostigmine
- nevirapine
- odevixibat
- olutasidenib
- omaveloxolone
- orphenadrine
- oxcarbazepine
- paroxetine
- passion flower
- perampanel
- pheniramine
- pilocarpine ophthalmic
- polyethylene glycol
- polyethylene glycol/electrolytes
- potassium acid phosphate
- potassium gluconate
- potassium phosphate
- pyrilamine
- ramelteon
- rufinamide
- sarilumab
- scopolamine
- selinexor
- sertraline
- sodium picosulfate
- sofpironium topical
- solifenacin
- somatropin
- stiripentol
- sulfate bowel prep
- sunvozertinib
- suzetrigine
- tasimelteon
- tazemetostat
- tecovirimat
- telotristat ethyl
- thiotepa
- tiagabine
- tiotropium inhaled
- tocilizumab
- tolterodine
- topiramate
- tovorafenib
- treosulfan
- trihexyphenidyl
- triprolidine
- tropicamide ophthalmic
- trospium
- umeclidinium inhaled
- vaborbactam
- valbenazine
- valerian
- valproic acid
- vibegron
- vigabatrin
- vilazodone
- vinblastine
- vorasidenib
- zanubrutinib
- zonisamide
Adverse Reactions .
Serious Reactions
- suicidality
- depression exacerbation
- extrapyramidal sx
- tardive dyskinesia
- dystonia
- neuroleptic malignant syndrome
- hyperthermia
- hypothermia
- anaphylaxis
- acute generalized exanthematous pustulosis
- Stevens-Johnson syndrome
- drug rxn w/ eosinophilia and systemic sx
- hypotension, severe
- seizures
- syncope
- TIA
- stroke
- QT prolongation
- diabetes mellitus
- hyperglycemia
- hypothyroidism
- pancreatitis
- rhabdomyolysis
- agranulocytosis
- leukopenia
- neutropenia
- cataracts
- lens changes
- dysphagia, severe
- priapism
- intestinal obstruction
Common Reactions
- somnolence
- xerostomia
- dizziness
- hypotension, orthostatic
- BP incr. (peds pts)
- tachycardia
- hypotension
- constipation
- weight gain
- diarrhea (peds pts)
- appetite incr.
- dyspepsia
- tremor
- dysarthria
- dysphagia
- extrapyramidal sx
- blurred vision
- anemia
- rash
- ALT or AST transiently elevated
- abdominal pain
- back pain
- hyperprolactinemia
- cholesterol incr.
- hypertriglyceridemia
- asthenia
- headache
- fatigue
- insomnia
- irritability
- nausea
- vomiting
- peripheral edema
- fever
- URI sx
- impaired body temperature regulation
- anticholinergic effects
Safety/Monitoring .
Monitoring Parameters
lipid panel at baseline, then periodically; fasting glucose at baseline if diabetes risk factors, then periodically; BP at baseline in children/adolescents, then periodically; slit lamp exam at baseline, then q6mo; CBC w/ diff frequently during initial tx if pre-existing or hx of leukopenia/neutropenia; weight; sx suicidality, clinical worsening, and/or unusual behavior changes, especially during initial tx or after dose changes
Look/Sound-Alike Drug Names
QUEtiapine confused with: OLANZapine; sertraline
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy, esp. in 3rd trimester; risk of teratogenicity not expected based on limited human data, though risk of neonatal extrapyramidal and withdrawal sx based on human data w/ antipsychotics
Pregnancy Registry
encourage pts to enroll in National Pregnancy Registry for Atypical Antipsychotics at 1-866-961-2388 or www.womensmentalhealth.org
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; no known risk of infant harm based on limited human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver extensively; CYP450: 3A4 substrate
Excretion: urine 73%, feces 20%; Half-life: 6-7h, 7-12h (ER)
Subclass: Antipsychotics, 2nd generation ; Anxiolytics, Non-benzodiazepines ; Bipolar Disorder
Mechanism of Action
exact mechanism of action unknown; antagonizes dopamine D2 receptors, serotonin 5-HT2 receptors, others
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: AstraZeneca Pharmaceuticals LP
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral tablet, extended release:
- 50 mg (30 ea): $261.00
- 150 mg (30 ea): $461.00
- 200 mg (30 ea): $506.00
- 300 mg (30 ea): $661.00
- 400 mg (60 ea): $1,540.00
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