Generic Drug Name: Quetiapine
Brand Names: Seroquel, Seroquel XR
Classification:
Therapeutic: Antipsychotics, mood stabilizers
Pharmacologic: n/a
Indications:
- Schizophrenia
- Bipolar depression
- Acute manic episodes with bipolar I disorder
- Depression
Mechanism of Action:
Dopamine and serotonin antagonist. Also antagonizes Histamine H1 receptors and alpha1-adrenergic receptors.
Expected Response: decreased episodes of psychoses, depression, or acute mania.
Common Adult Doses: (ALWAYS CHECK YOUR ORDERS)
For schizophrenia:
Oral max dose 800 mg/day
Immediate release: 25 mg twice daily on Day 1, 50 mg two to three times a day on Day 2 and 3, up to 300-400 mg/day in two or three divided doses by day 4.
Extended release: 300 mg once daily. Increase by 300 mg/day.
For acute manic disorder in bipolar I:
Oral max dose 800 mg/day
Immediate release: 50 mg twice a day on Day 1, 100 mg twice a day on Day 2, 150 mg twice a day on Day 3, 200 mg twice a day on Day 4, and may increase to 400 mg twice a day on Day 6 if needed.
Extended release: 300 mg once a day on Day 1, 600 mg once a day on Day 2, then 400-800 mg once a day on Day 3.
Depression:
Oral max dose 300 mg/day
Extended release: 50 mg once daily on Days 1 and 2, then 150 mg once daily starting Day 3
Contraindications:
- Hypersensitivity to Quetiapine
- Lactating mothers
- With agents that also prolong QT interval
- Hx arrhythmias
- Congenital long QT syndrome
Side Effects:
Common
- Dizziness
- Weight gain
- Drowsiness
Life-Threatening
- Neuroleptic malignant syndrome
- Seizures
- Pancreatitis
- Drug reaction with eosinophilia and systemic symptoms (DRESS)
- Stevens-Johnson syndrome
Nursing Considerations:
Assessment
- Monitor mental status (mood, orientation, behavior) before and during therapy
- Assess for suicidal tendencies, especially during early therapy
- Monitor orthostatic blood pressures during dosage changes
- Monitor for extrapyramidal side effects (restlessness, muscle spasms, mask-like face, drooling, gait changes, etc.)
- Monitor for tardive dyskinesia (involuntary rhythmic mouth movements)
- Monitor for signs of neuroleptic malignant syndrome: fever, respiratory distress, tachycardia, seizures, diaphoresis, hypo or hypertension, pallor, or tiredness.
- Assess for rash which could indicate Stevens-Johnson syndrome
- Monitor for signs of pancreatitis: nausea, vomiting, anorexia, and persistent severe abdominal pain which can radiate to back.
- Monitor for signs of DRESS: fever, rash, lymphadenopathy, other organ involvement (liver, kidneys), or facial swelling.
- Trend lab work: liver enzymes, lipid panel, complete blood count, blood sugar, prolactin,
Nursing Diagnoses
- Risk for self-directed violence (indications)
- Disturbed thought process (indications)
- Imbalanced nutrition: risk for more than body requirements (side effects)
Implementation
- May be given with or without food
- Do not crush or chew extended release tablets
- Educate patient to
- take at the same time every day, do not double up doses if one is forgotten
- do not give to patients with dementia-related psychosis
- watch for extrapyramidal side effects
- change positions slowly as their blood pressure may drop more easily
- notify their provider immediately if they develop – thoughts of harm to self or others, worsening depression, trouble sleeping, extreme increase in activity and talking
- if female, let provider know if they plan to become pregnant or are pregnant or if they are breastfeeding or plan to
Expected Outcomes
- Decrease in excited, manic behavior
- Decrease in signs of depression with bipolar disorder
- Decrease in manic episodes in patients with bipolar I disorder
- Decrease in positive symptoms of schizophrenia (hallucinations, delusions)
- Decrease in negative symptoms of schizophrenia (social withdrawal, flat or blunt affect)
Reference
Vallerand, A. H. & Sanoski, C. A. (2019). Davis’s drug guide for nurses. (16th ed., pp. 1071-1073). F.A. Davis Company.
