| DRUG | SUPPLIED | DOSE | COMMENTS |
|---|---|---|---|
| QUETIAPINE (Paeds) (Seroquel, Seroquel XR) Mechanism of action: Atypical (second-generation) antipsychotic agent. Quetiapine is a dopamine, serotonin, and adrenergic antagonist, and a potent antihistamine with some anticholinergic properties. Ref: 44, 83, 120, 186, 187 Last update: 2022-04-23 |
immediate-release (IR) tablet: 25 mg 100 mg, 200 mg, 300 mg. extended-release (XR) tablet: 50 mg, 200 mg, 300 mg, 400 mg. (swallow XR tablet whole; do not split, crush or chew). |
Disruptive behaviors Children < 12 years old: Initial: (IR form) 12.5 mg PO at HS or 12.5 mg PO BID Doses may be titrated to effect by 50-100 mg per week Suggested dose range: 100-250 mg/day Bipolar disorder/psychosis Adolescents: Initial: (IR form) 25 mg PO at HS or 12.5 mg PO BID. Doses may be titrated to effect by 50-100 mg per week XR form: 50 mg once daily on day 1; increase to 100 mg once daily on day 2, further increase by 100 mg once daily. Recommended administration time of XR tablet is daily at 1700h Suggested dose range: 400-600 mg/day in bipolar disorder or 400-800 mg/day in schizophrenia. Higher daily doses may be used in exceptional circumstances Adults: Usual daily dose: 300-600 mg/day to a maximum of 800 mg/24 hr. Higher daily doses may be used in exceptional circumstances XR tablet: start with 300 mg PO on day 1 followed by 600 mg PO on day 2, then up to 800 mg/day based on clinical effects. Recommended administration time of XR tablet is daily at 1700h |
Second-generation antipsychotic (SGA). Used for treatment of psychosis, agitation, bipolar disorder (mania or depression), anxiety, disruptive behaviours. Reduced risk of extrapyramidal symptoms and, dystonic reactions compared to other SGAs. Common adverse effects: sedation, orthostatic hypotension, tachycardia, dizziness, anticholinergic effects (dry mouth, constipation, blurred vision), increased appetite. Gradual dosage titration required, especially with IR formulation due to hypotension/dizziness. Sedation, hypotension and tachycardia are reduced with XR tablets. May allow more rapid dose titration compared to IR tablets. Administer XR tablets once daily at suppertime (1700h) or 6 hours prior to bedtime in younger patients (~6 hr to peak blood levels with XR tablets, compared to ~2 hr with IR tablets). No evidence to support long-term efficacy and safety of low doses for treatment of insomnia. Risk of metabolic abnormalities (including weight gain, hyperglycemia and lipid abnormalities). Must do baseline & periodic assessment of height, weight, waist circumference, blood pressure, fasting glucose & lipid profile. Refer to www.camesaguideline.org for more information. Standard Prescription: quetiapine {XR} __mg PO ___(frequency) |