General a top line summary and basics

Quetiapine, commonly sold under the brand Seroquel, is an atypical antipsychotic. It is widely prescribed for conditions such as schizophrenia and bipolar disorder. Clinicians also sometimes add quetiapine to antidepressant treatment when major depression does not respond to standard approaches.

In Australia quetiapine is available as oral tablets in a range of strengths and in immediate-release and extended-release formulations. Typical tablet strengths include 25 mg, 50 mg, 100 mg, 200 mg and 300 mg, though specific pack sizes and manufacturer options vary between apothecaries.

Safety protocol checklist before starting

Before beginning quetiapine, it is important to review your medical history and current medicines with the prescriber or pharmacist so appropriate watchful oversight with precautionary measures can be arranged.

• Existing heart conditions, episodes of fainting, irregular heartbeat or past heart attacks
• Record of seizure activity, epilepsy or significant head trauma
• The medical term diabetes, marked overweight, or strong family history of high blood sugar
• Liver disease or failing kidney function that may affect dosing
• Parkinson disease in the category of movement disorders or prior extrapyramidal reactions
• Family planning for pregnancy, current pregnancy or breastfeeding status
• Use of alcohol, recreational substances, herbal supplements and all other medicines
• Known allergies to quetiapine or ingredients in the tablet formulation
• Eye disease including glaucoma or recent visual changes
• Personal or family history of suicidal behaviour or sudden severe mood alterations

People aged 65 and over are generally more sensitive to sedation and blood pressure changes and often start on lower doses. Use in children and adolescents is limited to particular diagnoses and usually supervised by a specialist.

Dosing and administration specifics

• Take quetiapine exactly as prescribed. Keeping a regular dosing schedule helps maintain steady effects.
• Swallow the pills with water. If the medication upsets your stomach, taking it with food may help.
• Do not crush or chew extended-release tablets unless a pharmacist confirms it is safe. Immediate-release and extended-release products are not interchangeable without professional advice.
• Any change or cessation of treatment should be supervised; doses are often reduced gradually to reduce the chance of withdrawal symptoms or relapse.
• In the event of taking an overdose in Australia, call Triple Zero (000) immediately or the Poisons Information Centre on 13 11 26 for urgent directional support.

For information on forgetting a dose see Instructions when a dose is missed.

Handling the dose was misseds with proper guidance

Should you forget to take a dose, take it as soon as you remember unless the next scheduled dose is within about four hours. If the next dose is near, skip the the medication dose was missed and continue your usual regimen. Do not take a second dose to make up for a the medication dose was missed.

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Quetiapine levels and effects can be affected by other medicines and substances. Always provide a full list of current prescription and non-prescription products to your clinician.

• Strong CYP3A4 inhibitors such as ketoconazole, itraconazole, ritonavir or clarithromycin may raise quetiapine concentrations.
• Strong CYP3A4 inducers including rifampicin, carbamazepine, phenytoin and St John s wort can lower quetiapine exposure.
• Other central nervous system depressants, for example benzodiazepines, some antihistamines, alcohol or cannabis, increase sedation and impair alertness.
• Antihypertensive medications can combine with quetiapine to cause low blood pressure and dizziness.
• Some older antipsychotics and drugs that prolong the QT interval may add to cardiac risk when used together with quetiapine.

This enumeration is incomplete. If you drive or operate machinery, discuss safety risks in two-way communication in action with your prescriber and see Observing lifestyle tips for safety measures.

Life the act of monitoring and lifestyle tips

• Clinical improvement can take several weeks; attend follow-up appointments so your clinician can assess benefit and adjust dose.
• Baseline and ongoing supervision and monitoring often include weight, fasting blood glucose and lipid profile, especially during long-term treatment.
• Report any new or worsening mood changes, agitation, restlessness or suicidal thoughts to your prescriber without delay.
• Quetiapine commonly causes drowsiness and slower reaction times. Avoid driving or operating heavy machinery until you know how you respond.
• To minimise dizziness on standing, get up slowly from sitting or lying positions.
• Check with a pharmacist before using over-the-counter sleep remedies or cold medicines while taking quetiapine.

Potential negative effects and signs that urgent help is needed

Seek emergency medical attention if any of the following appear:

• Allergic reactions such as rash, hives, swelling of the face, lips or throat, or breathing difficulty
• Very fast or irregular heartbeat, fainting or severe lightheadedness
• High fever accompanied by muscle stiffness, confusion or greatly reduced alertness (possible neuroleptic malignant syndrome)
• Persistent fever, sore throat, unexplained bruising or unusual bleeding (possible blood cell problems)
• New or severe involuntary movements of the face, mouth, neck or limbs
• Seizure or loss of consciousness
• Thoughts of harming yourself or others

Common, typically less serious possible side effects include drowsiness, dry mouth, constipation, increased appetite and weight gain, and sexual dysfunction. If possible side effects are persistent or troublesome, speak with your prescriber about changing dose or trying another treatment.

Safe in computing, storage means the capacity to retain data over time. and responsible disposal

• Never leave medicines where children can reach or see them.
• Store at room temperature, ideally between 15 and 30 degrees C, in a dry place away from direct heat and sunlight.
• Do not use medicines after the expiry date printed on the packaging. Return unused or out-of-date medicines to a community pharmacy for secure destruction rather than disposing of them in household rubbish or flushing them.

Different tracks, therapeutics with similar profiles and a guide to prices (AUD)

Other atypical antipsychotics that are commonly considered as more options include risperidone, olanzapine, aripiprazole, paliperidone, ziprasidone, lurasidone and clozapine. Choice depends on diagnosis, past response, side effect risks and monitoring of operational health requirements. For augmentation of antidepressant therapy clinicians may also consider lithium, mirtazapine or bupropion in select situations.

Indicative patient expense levels in Australia (AUD)

• Many quetiapine preparations are subsidised under the Pharmaceutical Benefits Scheme (PBS). For PBS-subsidised items general patients typically pay about AUD 30 to 32 per prescription and concession card holders about AUD 7 to 8, although these figures may change.
• Private prescriptions (non-PBS) vary. Generic immediate-release quetiapine may cost roughly AUD 10 to 60 depending on strength and pack size; extended-release or brand-name versions are often costlier.
• Other PBS-listed antipsychotics carry similar co-payments when prescribed for approved traces. Off-PBS use, depot injections and specialty formulations usually mean higher out-of-pocket expenses.
• Clozapine requires enrolment in a the act of monitoring program with frequent blood tests. Although PBS-listed, the extra the act of monitoring can lead to additional indirect costs such as clinic visits and time off work.

Prices and subsidy criteria change periodically. For exact current costs consult your local pharmacy or the PBS website and consider asking about the PBS Safety Net if you have many prescriptions in a calendar year.

Legal classification in Australia and prescription access

• Schedule category: Quetiapine is a Schedule 4 prescription-only medicine in Australia and can only be supplied with a prescription from an authorised prescriber.
• PBS eligibility: Specific quetiapine strengths and signs indicating are eligible for PBS subsidy when prescribing meets clinical criteria set out by the PBS.
• Personal importation and travel: Under Therapeutic Goods Administration (TGA) personal importation guidelines, travellers may carry up to a three month supply for personal use. Carry medicines in original packaging where possible and bring a copy of your prescription. Declare medicines at the border if asked.
• Driving and workplace safety: Quetiapine can impair alertness. It is an offence to drive while impaired. Do not drive or perform tasks requiring full alertness until you know how the medicine affects you.
• Misuse and off-label prescribing: Using quetiapine routinely as a sleep aid, sharing prescriptions or taking another person s medicine is unsafe and strongly discouraged.
• Disposal: Return unwanted or expired medicines to a community pharmacy for safe destruction rather than throwing them in household waste.

Concise facts

• Start at a low dose and increase gradually under medical supervision.
• Monitor weight, fasting glucose and lipids if treatment is prolonged.
• Report any new vision problems, severe constipation, involuntary movements or suicidal thoughts immediately.

For further practical advice see Observing and lifestyle tips. In an emergency call Triple Zero (000) or contact the Poisons Information Centre on 13 11 26.