Quetiapine (Seroquel) is an antipsychotic medication which works by changing the actions of chemicals in the brain. Quetiapine is used to treat bipolar disorder (manic depression) in adults and children who are at least 13 years old and also use together with antidepressant medications to treat the major depressive disorder in adults. Furthermore, it improves concentration and may help to think with clarity and also feel less nervous as well.

Generic Seroquel, Atrolak, Biquelle,

Quetiapine Fumarate

Qutan, Seroquin, Quel


Sun pharma, Innova, Intas Pharma

Tablet, Tablets(SR)

25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg

India, UK, NZ


I. Introduction

A. Brief Overview of Quetiapine

Quetiapine, commonly sold as Seroquel, is an atypical antipsychotic that has gained recognition for its substantial advantages in addressing various psychiatric conditions. It is primarily prescribed to manage bipolar disorder and schizophrenia. But it is also frequently employed as an alternative treatment option for major depressive disorder in cases where conventional approaches have proven inadequate.

B. Discovery and Development of Quetiapine

The story behind Quetiapine's journey from conceptualization to realization is an awe-inspiring testament highlighting notable milestones within psychiatric medication development. The pursuit for safer options within antipsychotic drug treatments gained momentum during the late 1980s, propelling researchers forward on an ambition-fueled quest for innovation. After extensive investigative endeavors entailing comprehensive pre-market studies, AstraZeneca harnessed groundbreaking findings by introducing Quetiapine in 1997. Its extraordinary efficiency and distinctly more tolerable side effects compared to its predecessors swiftly propelled it into the spotlight within medical circles.

C. Purpose of the Article

This article aims to offer a thorough comprehension of Quetiapine while maintaining a respectful tone. It delves into its composition, the underlying mechanism that makes it practical, as well as its pharmacodynamic and pharmacokinetic properties. The intended audience for this article includes healthcare professionals and patients as it strives to present extensive information regarding this widely utilized antipsychotic medication.

II. Composition of Quetiapine


A. Active Ingredients

Quetiapine fumarate comprises the active element in Quetiapine rendering it efficacious for therapeutic purposes. As a derivative of dibenzothiazepine, this compound carries antipsychotic properties.

B. Inactive Ingredients and Excipients

Quetiapine consists of various inactive ingredients, also referred to as excipients. These components do not play a role in the drug's therapeutic effects but aid in the delivery process. These excipients include lactose monohydrate: microcrystalline cellulose, sodium starch glycolate, and magnesium stearate. To coat the tablets, hypromellose, polyethylene glycol, and titanium dioxide may be utilized. It is essential to acknowledge that these excipients can differ among different manufacturers.

III. How Quetiapine Works

A. Mechanism of Action

Quetiapine demonstrates its therapeutic effects by employing a multifaceted mechanism of action. It is an antagonist for various neurotransmitter receptors in the brain, like serotonin, dopamine, histamine, and adrenergic receptors. By obstructing these receptors. Quetiapine aids in reinstating the equilibrium of certain innate substances in the brain. Consequently, this process contributes to alleviating symptoms associated with psychiatric disorders.

B. Pharmacodynamics and Pharmacokinetics

In terms of its pharmacodynamic properties. Quetiapine strongly prefers serotonin 5 HT2A and dopamine D2 receptors as it works against them. Additionally, it exhibits antagonistic behavior towards histamine H1 and adrenergic alpha1 receptors contributing to its calming effects. From a pharmacokinetic standpoint. When taken orally. Quetiapine is rapidly absorbed into the bloodstream, with peak plasma concentrations achieved within approximately 1.5 hours. Extensive metabolism occurs in the liver resulting in a terminal half-life averaging around six hours. Drug elimination primarily occurs through urine (approximately 73%) and feces (approximately 21%). These pharmacokinetic parameters can vary depending on age, gender, and hepatic function.

IV. Uses of Quetiapine

A. Approved Uses in Psychiatry

Quetiapine is an antipsychotic medication widely used in psychiatry due to its flexibility and broad range of effectiveness. It has received primary FDA approval for several indications. These include schizophrenia, where quetiapine has been shown to effectively manage both positive and negative symptoms such as hallucinations, delusions, apathy, and social withdrawal. In bipolar disorder, quetiapine is utilized for the treatment of manic and depressive episodes as well as for maintenance therapy to prevent mood episode recurrence. Additionally, when first-line antidepressants do not successfully treat the major depressive disorder, quetiapine can be added as adjunctive therapy to improve the therapeutic response12.

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B. Other FDA Approved Indications

Quetiapine has gained FDA approval as an augmenting treatment for mitigating psychosis symptoms in Parkinson’s disease patients. The endorsement is attributed to the drug’s notably minimal occurrence of extrapyramidal side effects1.

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V. Off-Label Use of Quetiapine

A. Use in Sleep Disorders

Quetiapine is sometimes prescribed “off-label” for insomnia, but the FDA does not approve this and should be avoided. The typical dosage of quetiapine for insomnia ranges from 25 to 200 mg per day1.

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B. Other Off-Label Uses in Neurology and Psychiatry

Quetiapine has a broad range of off-label use in various areas of neurology and psychiatry. One such area is Obsessive Compulsive Disorder (OCD), where several studies indicate the potential benefits of Quetiapine as an adjunctive therapy (Komossa et al., 2010). Another area is Post Traumatic Stress Disorder (PTSD), where Quetiapine is sometimes used to manage symptoms, particularly sleep disturbances, and hyperarousal (Cohrs, 2008). Additionally, Quetiapine may be considered for Generalized Anxiety Disorder when other treatment options have proven ineffective (Kapczinski et al., 2008). However, it is not typically the first-choice option (Maher et al., 2019).

C. Efficacy and Safety of Off-Label Use

Although using Quetiapine for off-label purposes is quite common, it is important to emphasize that these uses should be approached with caution and after carefully evaluating the benefits and risks. The effectiveness of off-label uses can significantly differ depending on the specific condition being treated and the patient's characteristics, highlighting the need for thorough clinical judgment. Moreover, it is crucial to consider safety as a primary concern when using Quetiapine. This medication has many potential side effects that clinicians must be mindful of. This is especially important when administering Quetiapine to populations with limited safety data, such as children or elderly patients. Therefore close monitoring for adverse effects is essential in these cases.

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VI. Dosage and Administration of Quetiapine

A. Standard Dosage Guidelines

The dosage of Quetiapine is determined based on the specific condition being treated. Regarding schizophrenia, initial dosages may involve taking 25 mg twice a day. This can be increased by 25 50 mg twice or thrice on the second and third days. Depending on how well it is tolerated. The goal is to reach a daily dosage range of 300 to 400 mg by the fourth day. For bipolar mania, it is recommended to start with an initial dose of 50 mg taken twice daily. This can then be increased to 400 mg by the second day. Additional adjustments up to 800 mg daily based on the individual patient's clinical response and tolerance. When used as an adjunctive treatment for major depressive disorder. Quetiapine typically begins with a dosage of 50mg taken once daily at bedtime. This dosage can then be increased to 150mg by the fourth day. Overall. It is essential to work closely with a healthcare professional to determine the most appropriate dosage for each individual based on their specific condition and response to treatment.

B. Adjustments Based on Individual Patient Factors

Adjustments may need to be made for certain patients. For instance, if an individual has hepatic impairment. It is recommended that the dose of Quetiapine be reduced by 50%. Moreover, healthcare providers should consider the potential effects of advancing age, renal impairment, and body weight on how Quetiapine is processed in the body when deciding on the most suitable dosage.

C. Administration Procedures and Best Practices

To ensure optimal utilization of Quetiapine, individuals are encouraged to take it once or twice daily at their discretion regarding meal times. The tablets must be ingested as they are and should not be divided, masticated, or pulverized. Considering Quetiapines' sedative attributes, allocating a more significant portion of the daily dose before retiring for bed could bolster adherence to the prescribed treatment schedule.

VII. Administration to Special Populations

A. Administration to Elderly Patients

In light of the augmented risk of adverse effects among elderly patients. An attentive approach is essential. It would be best to initiate treatment with a reduced daily dose of about 25 mg and subsequently adjust it gradually until attaining the minimally adequate level.

B. Quetiapine in Pregnancy and Lactation

Quetiapine may be considered for use during pregnancy if the advantages outweigh the potential risks to the developing fetus. However, it is not advisable for mothers who are nursing to use Quetiapine since the drug is present in breast milk.

C. Use in Children: Safety and Dosage Considerations

The safety and effectiveness of Quetiapine in pediatric patients have not undergone a thorough study. Consequently, it is crucial to exercise caution and closely monitor its use in children. Dosage adjustments should be implemented after observing the clinical response and tolerance levels carefully.

VIII. Interactions with Quetiapine

A. Drug-Drug Interactions

Various medications have the potential to interact with Quetiapine causing changes in its effects and potentially increasing side effects. For example, Drugs like carbamazepine and phenytoin which induce CYP3A4 can lead to decreased Quetiapine plasma concentrations. On the other hand, CYP3A4 inhibitors such as ketoconazole and ritonavir can result in increased Quetiapine plasma concentrations.

B. Food and Beverage Interactions

Consuming grapefruit and grapefruit juice can lead to a rise in the blood levels of Quetiapine. It is advisable to refrain from consuming them. Additionally, the intake of alcohol may augment the nervous system side effects of Quetiapine, such as dizziness, drowsiness, and difficulty concentrating.

C. Effects of Comorbid Conditions on Quetiapine Use

Specific medical conditions may influence quetiapine safety and effectiveness. For instance, patients with a record of cardiovascular issues might face a higher chance of experiencing adverse effects on their cardiovascular health. Similarly, individuals who suffer from liver disease may need to take a lower dosage of Quetiapine due to its slow elimination process.

IX. Side Effects of Quetiapine

A. Common Side Effects

Although Quetiapine has proven to be highly effective, it is essential to note that it may result in various common side effects. One such side effect is sedation or drowsiness, which tends to be more pronounced in the initial stages of treatment. Additionally, weight gain may occur with Quetiapine usage, potentially due to alterations in lipid and glucose metabolism. Patients should also be aware of the possibility of experiencing dizziness or lightheadedness. Especially when transitioning from sitting to standing positions rapidly. Lastly. It is worth mentioning that dry mouth can occur as a side effect of this medication, which could lead to dental health concerns if not addressed promptly.

B. Less Common but Serious Side Effects

Quetiapine has the potential to cause less common yet significant side effects. These can include tardive dyskinesia, a movement disorder that manifests through involuntary movements, especially in the face. Another rare but severe reaction is neuroleptic malignant syndrome, characterized by fever, altered mental status, muscle rigidity, and autonomic instability. Additionally, there is an increased risk of suicide in younger patients taking Quetiapine, making it crucial to monitor for any signs of suicidal thoughts or behaviors.

C. Managing Side Effects and Adverse Reactions

Managing side effects effectively usually requires a combination of preventive measures, diligent monitoring, and potential modifications to the treatment plan. One example would be managing weight gain through proper diet and exercise. At the same time, it is minimizing sedative effects by taking the maximum dose before going to bed. It is essential to report any severe side effects to a healthcare provider promptly.

X. Overdose of Quetiapine

A. Symptoms of Overdose

An overdose of Quetiapine can have severe consequences and should be addressed promptly by seeking medical assistance. Indications of such an overdose may include sedation or loss of consciousness, a rapid heart rate (known as tachycardia), low blood pressure (also known as hypotension), and even seizures.

B. Management and Treatment of Overdose

Managing Quetiapine overdose primarily involves implementing supportive measures given the absence of a specific antidote. These measures include ensuring the maintenance of the airway, breathing, and circulation, closely monitoring heart and vital signs, and potentially considering gastrointestinal decontamination based on the severity and timing of the overdose.

C. Prevention Strategies

To prevent overdose, healthcare professionals must adhere to careful prescription practices. This includes ensuring that patients are educated about the dangers of overdose and are regularly monitored about their response to therapy. Also, proper medication storage and disposal play a crucial role in preventing accidental ingestion or misuse.

XI. Contraindications and Warnings

A. Medical Conditions Contraindicated with Quetiapine Use

It is vital to consider that Quetiapine use may pose a potential risk for individuals with certain medical conditions. For instance, those with a history of severe heart disease, a recent occurrence of heart attack or stroke, or any condition that could impact the absorption, metabolism, or excretion of drugs (such as severe liver or kidney disease) should exercise caution when using this medication.

B. Other Contraindications

Individuals with known hypersensitivity to quetiapine or any of its inactive ingredients are advised against using this medication. It is important to avoid combining quetiapine with certain medications as there is a risk of experiencing severe drug-drug interactions.

C. Warnings: Situations Requiring Special Caution

There are several situations where particular caution should be exercised when using Quetiapine. Patients with a history of seizures, those with risk factors for stroke, and individuals with conditions that may worsen due to anticholinergic effects, such as glaucoma or urinary retention, fall into this category. Additionally, it is essential to inform patients about the possibility of impaired judgment, thinking, or motor skills caused by Quetiapine. They should be advised to refrain from driving or operating machinery until they understand how this medication impacts them.

XII. Careful Administration of Quetiapine

A. Monitoring Parameters during Treatment

Quetiapine treatment necessitates vigilant monitoring regarding specific parameters to maintain effectiveness and safety throughout its administration process. Mental status assessments operate effectively within this context by offering insights into therapeutic responses and providing a mechanism for detecting any signs suggestive of suicidal ideation or resulting behaviors. Besides these evaluations, it's also imperative to closely track aspects such as body weight and various metabolic parameters due to possible weight gain and lipid and glucose metabolism changes. In addition, monitoring blood pressure and heart rate becomes equally vital, primarily given the potential cardiovascular effects that may arise during the initial adjustment period. Finally, it is crucial to conduct liver function tests, especially among patients with a history of hepatic impairment.

B. Role of Healthcare Provider in Administration

The healthcare provider is responsible for ensuring the safe and effective utilization of Quetiapine. They must offer concise directions on proper dosing, administration procedures, and potential side effects. Furthermore, they should diligently observe the patient's response and ability to tolerate the medication while making necessary adjustments to the treatment plan.

XIII. Important Precautions with Quetiapine Use

A. Patient Education and Communication

Efficient communication between healthcare providers and patients is crucial in treating Quetiapine. It is essential to educate patients about the medications' purpose and possible side effects. Signs of severe adverse reactions. And the significance of following the prescribed regimen. Additionally, Scheduling regular follow-up appointments allows for monitoring the patient's progress and addressing any concerns or issues that may arise.

B. Lifestyle Considerations and Coping Strategies

Patients prescribed Quetiapine may need to consider making lifestyle adjustments to manage any potential side effects and effectively promote overall well-being. It is important to prioritize a balanced diet and regular physical exercise to help minimize the likelihood of weight gain. Additionally, practicing good sleep hygiene can assist in managing any possible sedation. Patients with pre-existing mental health conditions may find it advantageous to seek supportive counseling or therapy as an additional means of support.

XIV. Storage and Handling Precautions for Quetiapine

A. Ideal Storage Conditions

Preserving Quetiapines' integrity necessitates proper storage within its original packaging at room temperature. Shielding it from light and moisture contributes to maintaining its potency; hence avoid storing it where excessive humidity prevails (e.g., in Bathrooms). Furthermore, exercising care becomes essential: keep this medication out of reach for children and pets, mitigating any risks associated with accidental ingestion.

B. Safety Precautions in Handling and Disposal

Patients must remember to handle Quetiapine tablets with clean and dry hands while avoiding any urge to split, chew, or crush them. When getting rid of unused or expired Quetiapine, it is necessary to adhere to local regulations or pharmacy guidelines for proper disposal. Flushing the medication down the toilet or throwing it into general household waste should be avoided to prevent potential environmental harm and accidental consumption by others.

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