Seroquel (Quetiapine Fumarate)
Also sold as: Seroquel, Qutipin, Qutan, Quetidin, Mentapin
Pregnancy
Cat C
Lactation
Avoid
Schedule
H
Forms
Tablet IR 25mg, 50mg, 100mg, 200mg, 300mg, 400mg +1
Indications
- Schizophrenia
- Bipolar disorder — acute mania, bipolar depression, maintenance
- Major depressive disorder (MDD) — adjunct
- Generalised anxiety disorder (off-label, XR)
- Insomnia (low-dose off-label — controversial)
Adult Dosing
Schizophrenia
Start 25 mg BD Day 1; 50 mg BD Day 2; 100 mg BD Day 3; 150 mg BD Day 4; target 300-450 mg/day
Ongoing
Bipolar mania
50 mg BD Day 1; increase to 400-800 mg/day by Day 4
XR: 300 mg OD on Day 1, 600 mg OD on Day 2
Bipolar depression
XR: 50 mg OD at bedtime; increase to 300 mg OD over 4 days
Lower doses effective for depression than mania
Insomnia / Anxiety (low-dose)
12.5-50 mg PO at bedtime (off-label)
Low-dose — primarily antihistaminergic sedation; avoid long-term
Pediatric Dosing
Specialist guidance required; higher weight gain and metabolic risk in adolescents.
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any CrCl | No adjustment — hepatically metabolised |
Hepatic Adjustment
Start 25 mg/day; increase slowly in hepatic impairment
Pregnancy & Lactation
Pregnancy: Category C
Neonatal EPS and withdrawal reported. Use only if essential; lowest effective dose.
Lactation: Avoid
Excreted in breast milk. Avoid if possible.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| CYP3A4 inhibitors (ketoconazole, clarithromycin, ritonavir) | Up to 6-fold increase in quetiapine levels — reduce quetiapine dose by 67% | Major |
| CYP3A4 inducers (carbamazepine, rifampicin, phenytoin) | Reduce quetiapine levels by 80% — increase quetiapine dose 5-fold | Major |
| QT-prolonging drugs | Additive QT prolongation | Major |
| Antihypertensives / Nitrates | Additive hypotension | Moderate |
| CNS depressants / Alcohol | Additive sedation | Moderate |
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Side Effects
Common
- Somnolence (very common — often desired at low doses)
- Dry mouth
- Dizziness
- Constipation
- Weight gain
- Dyslipidaemia
- Hyperglycaemia
Serious / Discontinue If
- NMS
- Metabolic syndrome (significant — weight, glucose, lipids)
- QT prolongation
- Cataracts (lens changes — ophthalmology check recommended)
- Tardive dyskinesia
- Orthostatic hypotension
- Agranulocytosis (rare)
Contraindications
- QTc > 500 ms (relative)
- Concurrent CYP3A4 inhibitors (relative — dose adjust)
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Qutipin 100mg | Sun Pharma | 10 tab ₹85 |
| Qutan 100mg | Torrent | 10 tab ₹78 |
| Mentapin 25mg | Intas | 10 tab ₹45 |
| Seroquel 100mg XR | AstraZeneca | 10 tab ₹285 |
Monitoring Required
- Weight/BMI monthly × 3 months, then quarterly
- Fasting glucose and lipids (baseline, 3 months, annually)
- ECG (QTc)
- Eye examination (cataracts) at baseline and annually
- BP (orthostatic)
- Thyroid function (rare hypothyroidism)
Patient Counseling Points
- Take XR tablet whole — do not crush or chew
- Most sedating of atypicals — take at bedtime if possible
- Do NOT stop suddenly — rebound insomnia, nausea, agitation
- Avoid driving until response known
- Report any visual changes (cataracts)
- Diet and exercise important — significant weight gain risk
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Clinically reviewed by: Dr. Ananya Krishnan, MD (Psychiatry), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Quetiapine
- NICE Bipolar Guidelines 2014 (updated 2023)
- CANMAT Bipolar Guidelines 2023
- APA Schizophrenia Guidelines