Quetiapine

The usual recommended starting dose for schizophrenia is 25 mg twice daily. Quetiapine is usually started with a low dose in order to allow the body to get used to it. This dose is increased as tolerated to a target dose of 150 mg twice daily. No more than 400 mg twice daily should be taken as the safety of higher doses has not been established.

For manic episodes associated with bipolar disorder, the recommended starting dose is 50 mg twice daily. This dose is increased every day up to 400 mg twice daily as tolerated. Most people respond to doses between 200 mg and 400 mg twice daily.

For depressive episodes associated with bipolar disorder, the recommended starting dose is 50 mg once daily, usually at bedtime. This dose is increased every day up to 300 mg once daily as tolerated.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

Quetiapine can be taken with or without food. Do not stop taking Quetiapine or change the time of the day you take it without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor to ensure that you are getting the maximum benefit from the medication. If you miss a dose by a few hours, take it as soon as possible and continue with your regular schedule. If most of the day has passed since the missed dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store Quetiapine at room temperature, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

In addition to its desired action, this medication may cause some adverse effects, notably: it may cause dryness of the mouth; it may cause headaches; it may cause constipation - to prevent this, drink plenty of water or juice, and eat more dietary fibre; it may cause drowsiness or dizziness - use caution when getting up from a lying or sitting position and use caution if driving; it may cause weight gain, mostly with prolonged use. Each person may react differently to a treatment. If you think this medication may be causing adverse effects (including those described here, or others), talk to your health care professional. He or she can help you to determine whether or not the medication is the source of the problem.

25 mg
Each peach, round, biconvex, coated tablet, debossed with "25" on one side and plain on the other side, contains quetiapine fumarate equivalent to 25 mg of quetiapine free base. Nonmedicinal ingredients: dibasic calcium phosphate, lactose, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate; coating: polyethylene glycol, iron oxide red, iron oxide yellow, titanium dioxide, and hydroxypropyl methylcellulose.

50 mg
Each pale yellow, round, biconvex, coated tablet debossed with “50” on one side and plain on the other side, contains quetiapine fumarate equivalent to 50 mg of quetiapine free base. Nonmedicinal ingredients: dibasic calcium phosphate, lactose, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate; coating: polyethylene glycol, iron oxide yellow, titanium dioxide, and hydroxypropyl methylcellulose.

100 mg
Each yellow, round, biconvex, coated tablet, debossed with "100" on one side and plain on the other side, contains quetiapine fumarate equivalent to 100 mg of quetiapine free base. Nonmedicinal ingredients: dibasic calcium phosphate, lactose, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate; coating: polyethylene glycol, iron oxide yellow, titanium dioxide, and hydroxypropyl methylcellulose.

150 mg
Each pale yellow, round, biconvex, coated tablet, debossed with “P” logo on one side and “150” on the other side, contains quetiapine fumarate equivalent to 150 mg of quetiapine free base. Nonmedicinal ingredients: dibasic calcium phosphate, lactose, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate; coating: polyethylene glycol, iron oxide yellow, titanium dioxide, and hydroxypropyl methylcellulose.

200 mg
Each white, round, biconvex, coated tablet, debossed with "200" on one side and plain on the other side, contains quetiapine fumarate equivalent to 200 mg of quetiapine free base. Nonmedicinal ingredients: dibasic calcium phosphate, lactose, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate; coating: polyethylene glycol, titanium dioxide, talc, and hydroxypropyl methylcellulose.

300 mg
Each white, capsule-shaped, biconvex, coated tablet, debossed with "300" on one side and plain on the other side, contains quetiapine fumarate equivalent to 300 mg of quetiapine free base. Nonmedicinal ingredients: dibasic calcium phosphate, lactose, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate; coating: polyethylene glycol, titanium dioxide, talc, and hydroxypropyl methylcellulose.

Quetiapine should not be taken by anyone who is allergic to quetiapine or to any of the ingredients of the medication.

There may be an interaction between quetiapine and any of the following:

• Abiraterone
• aclidinium
• alcohol
• Alfuzosin
• alpha agonists (e.g., Clonidine, methyldopa)
• amantadine
• Amiodarone
• amphetamines (e.g., Dextroamphetamine, Lisdexamfetamine)
• angiotensin converting enzyme inhibitors (ACEIs; Captopril, Enalapril, Ramipril)
• angiotensin receptor blockers (ARBs; e.g., Candesartan, Irbesartan, Losartan)
• certain antihistamines (e.g., Chlorpheniramine, Dimenhydrinate Diphenhydramine)
• anti-Parkinsons medications (e.g., amantadine, Apomorphine, Bromocriptine, levodopa, Pramipexole, Ropinirole) – dopamine agonists
• other antipsychotics (e.g., Chlorpromazine, Clozapine, Haloperidol, Olanzapine, Risperidone)
• Aprepitant
• atropine
• azelastine
• "azole" antifungal medications (e.g., fluconazole, ketoconazole)
• barbiturates (e.g., butalbital, pentobarbital Phenobarbital)
• benzodiazepines (e.g., Alprazolam, Diazepam, Lorazepam)
• benztropine
• beta-adrenergic blockers (e.g., Atenolol, Propranolol, Sotalol)
• beta 2-agonists (e.g. formoterol, olodaterol, salbutamol, salmeterol)
• Bosentan
• Bosutinib
• brimonidine
• Buprenorphine
• Buspirone
• calcium channel blockers (e.g., Amlodipine, Diltiazem, Nifedipine, Verapamil)
• cannabis
• chloral hydrate
• chloroquine
• conivaptan
• Darifenacin
• Deferasirox
• Dexamethasone
• Dextromethorphan
• diabetes medications (e.g., chlorpropamide, glipizide, Glyburide, insulin, Metformin, Rosiglitazone)
• Disopyramide
• diuretics (water pills; e.g., Furosemide, Hydrochlorothiazide, triamterene)
• dofetilide
• Domperidone
• Donepezil
• Dronedarone
• Enzalutamide
• ergot alkaloids (e.g., ergotamine, Dihydroergotamine)
• Famotidine
• Fesoterodine
• Fingolimod
• Flavoxate
• Flecainide
• Galantamine
• general anesthetics (medications used to put people to sleep before surgery)
• Glucagon
• glycopyrrolate
• grapefruit juice
• HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine, nevirapine)
• HIV protease inhibitors (e.g., atazanavir, darunavir, lopinavir, ritonavir)
• hydroxychloroquine
• Indapamide
• ipratropium
• Ivabradine
• kava kava
• Leuprolide
• lithium
• Loperamide
• macrolide antibiotics (e.g., azithromycin, clarithromycin, erythromycin)
• Maprotiline
• Mefloquine
• Methadone
• Methylphenidate
• Metoclopramide
• Metronidazole
• mifepristone
• Mirabegron
• Mirtazapine
• Mitotane
• Modafinil
• monoamine oxidase inhibitors (M.O.S. e.g., Moclobemide, Rasagiline, Selegiline, Tranylcypromine)
• muscle relaxants (e.g., Baclofen, Cyclobenzaprine, methocarbamol, orphenadrine)
• Nabilone
• narcotic pain relievers (e.g., Codeine, Fentanyl, Morphine, Oxycodone)
• nefazodone
• Nitroglycerin
• Octreotide
• Olopatadine
• oxybutynin
• pentamidine
• potassium chloride
• Primaquine
• procainamide
• Propafenone
• quinidine
• quinine
• quinolone antibiotics (e.g., ciprofloxacin, Norfloxacin, Ofloxacin)
• rifabutin
• rifampin
• Rivastigmine
• Romidepsin
• St. John's wort
• scopolamine
• seizure medications (e.g., Clobazam, Ethosuximide, felbamate, Levetiracetam, phenobarbital, Phenytoin, primidone, Topiramate, Valproic acid, zonisamide)
• selective serotonin reuptake inhibitors (SSRIs; e.g., Citalopram, Fluoxetine, Paroxetine, Sertraline)
• serotonin antagonists (anti-emetic medications; e.g., Granisetron, Ondansetron)
• serotonin/norepinephrine reuptake inhibitors (SNRIs; e.g., Desvenlafaxine, Duloxetine, Venlafaxine)
• simeprevir
• Solifenacin
• sulfamethoxazole
• Tacrolimus
• Tamoxifen
• Tapentadol
• Tetrabenazine
• thalidomide
• tiotropium
• Tocilizumab
• Tolterodine
• Tramadol
• Trazodone
• tricyclic antidepressants (e.g., Amitriptyline, Clomipramine, Desipramine, Trimipramine)
• Trimethoprim
• "triptan" migraine medications (e.g., Eletriptan, Sumatriptan)
• Tryptophan
• tyrosine kinase inhibitors (e.g., Dasatinib, imatinib, Nilotinib)
• umeclidinium
• Vardenafil
• Warfarin
• Zolpidem
• Zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with Quetiapine. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take Quetiapine.

Anemia: Quetiapine may cause low levels of red blood cells. If you experience symptoms of reduced red blood cell count (anemia) such as shortness of breath, feeling unusually tired or pale skin, contact your doctor as soon as possible.

Your doctor will do blood tests regularly to monitor the number of specific types of blood cells, including red blood cells, in your blood.

Bleeding: Quetiapine may cause a reduced number of platelets in the blood, which can make it difficult to stop cuts from bleeding. If you notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, notify your doctor as soon as possible. Your doctor will order routine blood tests to make sure potential problems are caught early.

Blood cholesterol: Quetiapine has been associated with increased blood cholesterol levels. If you have elevated blood cholesterol levels, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Blood Clots: Quetiapine may increase the chance of blood clot formation, causing reduction of blood flow to organs or the extremities.

If you have a history of clotting you may be at increased risk of experiencing blood clot-related problems such as Heart Attack, stroke, or clots in the deep veins of your leg. Discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

If you experience symptoms such as sharp pain and swelling in the leg, difficulty breathing, chest pain, blurred vision, or difficulty speaking, contact your doctor immediately.

Body temperature: Quetiapine, like other antipsychotic medications, can disrupt the body's ability to control body temperature. People who exercise vigorously, are exposed to extreme heat, are dehydrated, or are taking anticholinergic medications (e.g., Benztropine, Oxybutynin) are more at risk. Contact your doctor as soon as possible if you feel very hot and are unable to cool off.

Cataracts: Changes in the lens of the eye may develop with long-term use of quetiapine. Regular eye exams are recommended before and after treatment with Quetiapine. If you notice any change in your vision, contact your physician as soon as possible.

Dependence/Tolerance: There have been reports of dependence, tolerance, misuse and abuse of quetiapine. People with a history of drug or alcohol dependence should be closely monitored by their doctor while using Quetiapine.

Diabetes: Like other antipsychotic medications, quetiapine may cause loss of control of blood sugars, making diabetes worse, or causing symptoms of diabetes to appear. If you have diabetes, discuss this link with your doctor. If you have diabetes or are at risk for diabetes (e.g., family history of diabetes, Obesity), discuss with your doctor how Quetiapine may affect your medical condition and whether any special monitoring is needed.

Drowsiness/reduced alertness: Quetiapine may cause dizziness and drowsiness. Avoid operating hazardous machinery (including cars) until you are certain that the medication does not impair your mental alertness, judgment, or physical coordination.

Enlarged prostate: Quetiapine may worsen symptoms of an enlarged prostate, such as reduced urine flow. If you have a prostate condition, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Glaucoma: People with glaucoma (increased pressure in the eyes) may find that Quetiapine makes the symptoms of glaucoma worse. If you have glaucoma, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Heart conditions: If you have a heart condition such as Angina, heart failure, and irregular heartbeat, or have had a heart attack, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Heart rhythm: Quetiapine can cause changes to the normal rhythm of the heart, including an irregular heartbeat called QT prolongation. QT prolongation is a serious life-threatening condition that can cause fainting, seizures, and sudden death. If you are at risk for heart rhythm problems (e.g., people with heart failure, angina, low potassium or magnesium levels), discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Hormonal changes: In rare instances, quetiapine can cause an increase in a certain hormone called prolactin, and may lead to production of breast milk in women and altered monthly periods. It may also lead to swelling of the breasts in men. High levels of prolactin combined with a condition called hypogonadism, may increase the risk of Osteoporosis in men and women.

Infection: Quetiapine can reduce the number of cells that fight infection in the body (white blood cells). Tell your doctor immediately if you notice signs of an infection, such as fever or chills, severe diarrhea, shortness of breath, prolonged dizziness, headache, stiff neck, weight loss, or listlessness. Your doctor will do blood tests regularly to monitor the number of specific types of blood cells in your blood.

Kidney problems: If you have kidney problems, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause Quetiapine to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Quetiapine may also cause changes to liver function, including liver failure. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Low Blood Pressure: Quetiapine may cause a lowering of blood pressure when rising from a sitting or lying position, or a racing heart rate, especially during the first few weeks of treatment. If you feel dizzy or lightheaded or feel your pulse is racing, and this feeling does not go away after a few minutes, call your doctor. Because Quetiapine can cause dizziness or lightheadedness, do not get up too quickly after you have been sitting or lying for prolonged periods.

Movement disorders: There is a risk of developing tardive dyskinesia (TD), a condition where repetitive, uncontrollable, and purposeless movements (such as grimacing; tongue protrusion; lip smacking; puckering; rapid eye blinking; rapid movements of the arms, legs, and body trunk). If you experience any of these symptoms, contact your doctor immediately.

Neuroleptic malignant syndrome (NMS): A risk of developing this condition has been associated with antipsychotic medications, including quetiapine. If you experience increased sweating and sensations of warmth, muscle stiffness, emotional and behavioural changes, or irregular heartbeat, contact your doctor immediately. People taking Quetiapine should take care to avoid becoming overheated or dehydrated.

Pancreatitis: Quetiapine can cause the pancreas to become inflamed. If you have a history of pancreatitis, gallstones, Alcoholism, or high triglycerides, you may be more at risk of experiencing this. Report signs of pancreatitis such as abdominal pain on the upper left side, back pain, nausea, fever, chills, rapid heartbeat, or swollen abdomen to your doctor immediately.

Seizures: If you have a history of seizures, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Sleep Apnea: This mediation may cause sleep apnea. If you have sleep apnea, or are taking medications which cause sedation or sleepiness, discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Stopping the medication: Stopping Quetiapine suddenly may cause symptoms such as difficulty sleeping, upset stomach, headache, diarrhea, vomiting, dizziness, and irritability. A gradual reduction in dose over a period of at least 1 or 2 weeks is recommended. If you are thinking of stopping the medication, check with your doctor first.

Suicidal or agitated behaviour: Adults and children taking Quetiapine may feel agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or they may want to hurt themselves or others. These symptoms may occur within several weeks after starting Quetiapine. If you experience these side effects or notice them in a family member who is taking Quetiapine, contact your doctor immediately. Your doctor will monitor you closely for these side effects while you are taking Quetiapine.

Thyroid changes: Quetiapine is associated with a decrease in thyroid hormone. If you have low thyroid (hypothyroidism), discuss with your doctor how Quetiapine may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Quetiapine, and whether any special monitoring is needed.

Pregnancy: The safety of quetiapine use during pregnancy is not known. The use of Quetiapine by the mother in the last 3 months of pregnancy has resulted in the newborn experiencing withdrawal effects. Quetiapine should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking Quetiapine, contact your doctor immediately.

Breast-feeding: Quetiapine passes into breast milk. If you are a breast-feeding mother and are taking quetiapine it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and efficacy of Quetiapine have not been established for children under 18 years of age.

Seniors: There may be a higher risk of strokes, heart attacks, infections (e.g., pneumonia) and deaths associated with the use of antipsychotic medications by seniors. Talk to your doctor about the risks and benefits of using Quetiapine. If you notice the following signs and symptoms, get medical attention immediately:

• signs of a stroke: sudden weakness or numbness in the face, arms or legs (often on one side of the body); speech problems; vision problems; balance problems or dizziness; confusion; sudden severe headache with no known cause
• signs of a heart attack: discomfort or pain in the chest, back, neck, jaw, arms, or stomach; sweating; shortness of breath; nausea; lightheadedness; feeling of impending doom.

This medication is typically used only once a day. However, your pharmacist may have suggested a different schedule that is more appropriate for you. Important: Follow the instructions on the label. Do not use more of this product, or more often, than prescribed. It must be used regularly and continuously to maintain its beneficial effects. Be sure to keep an adequate supply on hand. This medication should be swallowed whole. It should not be split, crushed or chewed. This medication may be taken with or without food. Avoid grapefruit and grapefruit juice during your treatment. Grapefruit can seriously affect how this medication works. Consuming alcohol may intensify the effect of this product. Limit alcohol consumption to occasional small quantities.