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quetiapine
generic
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: TAB: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg; ER TAB: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg
schizophrenia
- [immediate-release form]
- Dose: 150-750 mg/day PO divided bid-tid; Start: 25 mg PO bid, then incr. by 50-150 mg/day up to 300-400 mg/day PO divided bid-tid by day 4, then may adjust dose by 50-100 mg/day no more frequently than q2 days prn; Max: 800 mg/day; Info: start 25 mg PO qpm in elderly or debilitated pts, then incr. by 25-50 mg/day; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. WBC
- [extended-release form]
- Dose: 400-800 mg ER PO qpm; Start: 300 mg ER PO qpm, then incr. up to 300 mg/day prn; Max: 800 mg/day ER; Info: start 50 mg ER 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 ER tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
bipolar I disorder, manic
- [immediate-release form]
- Dose: 200-400 mg PO bid; Start: 50 mg PO bid, then incr. by 100 mg/day up to 200 mg PO bid by day 4, then may incr. by 200 mg/day prn; Max: 800 mg/day; Info: for acute monotherapy or acute or maint. lithium or valproate adjunct; start 25 mg PO qpm in elderly or debilitated pts, then incr. by 25-50 mg/day; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. WBC
bipolar I disorder, manic/mixed
- [extended-release form]
- Dose: 400-800 mg ER PO qpm; Start: 300 mg ER PO qpm x1, then 600 mg ER PO qpm x1, then may adjust by 200 mg/day prn; Max: 800 mg/day ER; Info: for acute monotherapy or acute or maint. lithium or valproate adjunct; start 50 mg ER 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 ER tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
bipolar disorder, acute depressive
- [immediate-release form]
- Dose: 300 mg PO qhs; Start: 50 mg PO qhs x1, then 100 mg PO qhs x1, then 200 mg PO qhs x1, then 300 mg PO qhs; Max: 600 mg/day; Info: doses >300 mg rarely more effective; start 25 mg PO qhs in elderly or debilitated pts, then incr. by 25-50 mg/day; D/C if ANC <1000; consider D/C if unexplained decr. WBC
- [extended-release form]
- Dose: 300 mg ER PO qpm; Start: 50 mg ER PO qpm x1, then 100 mg ER PO qpm x1, then 200 mg ER PO qpm x1, then 300 mg ER PO qpm; Max: 300 mg/day ER; Info: start 50 mg ER 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 ER tab; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
major depressive disorder, adjunct tx
- [extended-release form]
- Dose: 150-300 mg ER PO qpm; Start: 50 mg ER PO qpm x2 days, then 150 mg ER PO qpm x2 days; Max: 300 mg/day ER; Info: give on empty stomach or w/ light meal; do not cut/crush/chew ER 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)
- [immediate-release form]
- Dose: 50-150 mg PO qd; Start: 25 mg PO qd, then incr. by 25-50 mg/day; Max: 300 mg/day; Info: periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. WBC
- [extended-release form]
- Dose: 50-150 mg ER PO qd; Start: 50 mg ER 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 ER 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
- [immediate-release form]
- hepatic impairment: start 25 mg qd, then incr. by 25-50 mg/day
- [extended-release form]
- hepatic impairment: start 50 mg ER qpm, then incr. by 50 mg/day
Peds Dosing .
- Dosage forms: TAB: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, 400 mg; ER TAB: 50 mg, 150 mg, 200 mg, 300 mg, 400 mg
schizophrenia
- [immediate-release form, 13-17 yo]
- Dose: 400-800 mg/day PO divided bid-tid; Start: 25 mg PO bid x1 day, then 50 mg PO bid x1 day, then incr. by 100 mg/day up to 200 mg PO bid by day 5, then may incr. by 50-100 mg/day prn; Max: 800 mg/day; Info: periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. WBC
- [extended-release form, 13-17 yo]
- Dose: 400-800 mg ER PO qpm; Start: 50 mg ER PO qpm x1, then 100 mg ER PO qpm x1, then incr. by 100 mg/day; Max: 800 mg/day ER; Info: give on empty stomach or w/ light meal; do not cut/crush/chew ER tab; periodically reassess need for tx; D/C if ANC <1000; consider D/C if unexplained decr. in WBC
bipolar I disorder, acute manic
- [immediate-release form, 10-17 yo]
- Dose: 400-600 mg/day PO divided bid-tid; Start: 25 mg PO bid x1 day, then 50 mg PO bid x1 day, then incr. by 100 mg/day up to 200 mg PO bid by day 5, then may incr. by 50-100 mg/day prn; Max: 600 mg/day; Info: for monotherapy or lithium or valproate adjunct; D/C if ANC <1000; consider D/C if unexplained decr. WBC
- [extended-release form, 10-17 yo]
- Dose: 400-600 mg ER PO qpm; Start: 50 mg ER PO qpm x1, then 100 mg ER PO qpm x1, then incr. by 100 mg/day; Max: 600 mg/day ER; Info: give on empty stomach or w/ light meal; do not cut/crush/chew ER 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
- [immediate-release form]
- hepatic impairment: start 25 mg qd, then incr. by 25-50 mg/day
- [extended-release form]
- hepatic impairment: start 50 mg ER qpm, then incr. by 50 mg/day