Table 8.
Quetiapine Dosage and Monitoring
| Guideline | Dose | Patient monitoring parameters | Specific side effects | Specific drug interactions |
|---|---|---|---|---|
| APA | 25-400 mg/d | General AAP guidance only | General AAP guidance only | General AAP guidance only |
| BAP | No specific recommendations but cited Vieta et al., 2013 and not El-Khalili et al., 2010 in relation to dosing (El-Khalili et al., 2010; Vieta et al., 2013) | General AAP guidance only | General AAP guidance only | – |
| CANMAT | 150–300 mg/d | – | Cautioned in patients with prolonged QT interval | High potential for drug-drug interactions (3A4 substrate). Increases serum levels of CYP34A CYP substrates. |
| CPG-S | – | – | – | – |
| ICSI | General AAP guidance only | – | – | – |
| MPG | 150 or 300 mg/d. See guidelines for recommendations in cases of hepatic impairment | General AAP guidance, plus annual thyroid function tests | General AAP guidance, plus dry mouth, sedation, constipation, weight gain risk in longer term. Transient rises in AST, ALT and GGT, rarely jaundice and hepatitis. Severe cases of fatal hepatic failure and hepatocellular damage reported (Preskorn, 2012; Das et al., 2017; Datapharm Communications Ltd, 2017; Truven Health Analytics, 2018). Very low relative risk of akathisia, parkinsonism, and prolactin elevation. Low relative risk of anticholinergic effects, moderate relative risk of sedation, weight gain and hypotension. Moderate relative risk of effect on QTc. Small risk of TFT abnormality (Remington et al., 2007; Leucht et al., 2009). Moderate propensity for increasing plasma lipids (Smith et al., 2010). Low risk of sexual dysfunction (Bobes et al., 2003; Byerly et al., 2004; Knegtering et al., 2004; Montejo González et al., 2005), but studies conflicting(Atmaca et al., 2005; Kelly and Conley, 2006). | General AAP guidance/see guidelines |
| NICE | – | – | – | – |
| RANZCP | General AAP guidance only | General AAP guidance only | General AAP guidance, plus high levels of sedation | – |
| TMAP | 100 mg/d x 3 days, then 200 mg/d, max 400 mg/d (target range 150–400 mg/d) | General AAP guidance only | General AAP guidance, plus cataract formation, dry mouth, glucose dysregulation, headache, hyperlipidaemia, increased appetite, orthostatic hypotension, sedation, weight gain | Erythromycin, fluconazole, ketoconazole, phenytoin, St John’s wort, thioridazine, valproate |
| WFSBP | 50 mg/d, increased to 150 mg at day 3, increased to 300 mg/d dependent on response. Higher doses not studied as add on for TRD | – | Sedation, weight gain | – |
Abbreviations: –, not reported by guideline; AAPs, atypical antipsychotics; ALT, alanine aminotransferase; APA, American Psychiatric Association; AST, aspartate aminotransferase; BAP, British Association of Psychopharmacology; CANMAT, Canadian Network for Mood and Anxiety Disorders; CPG-S, Clinical Practice Guidelines in the Spanish NHS; GGT, gamma-glutamyl transpeptidase; ICSI, Institute for Clinical Systems Improvement; MPG, Maudsley Prescribing Guidelines; NICE, National Institute for Health and Care Excellence; QTc, corrected Q-T interval; RANZCP, Royal Australian and New Zealand College of Psychiatrists; TMAP, Texas Medication Algorithm Project; TFT, thyroid function test; TRD, treatment resistant depression; WFSBP, World Federation of Societies of Biological Psychiatry.