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What Is Seroquel (Quetiapine)?

Seroquel (generic name: quetiapine fumarate) is an atypical antipsychotic medication used to treat serious mental health conditions, including schizophrenia and bipolar disorder. It is available as immediate-release (IR) tablets taken two to three times daily and extended-release (XR) tablets taken once daily, often in the evening. Quetiapine works by acting on several neurotransmitter systems in the brain, chiefly serotonin (5-HT) and dopamine (D2) receptors, to help stabilize mood, improve thought processes, and reduce distressing symptoms such as hallucinations, delusions, agitation, and severe mood swings.

Clinically, Seroquel is valued for its relatively low propensity to cause movement disorders compared with some older antipsychotics, and for its efficacy across multiple symptom clusters (positive, negative, and mood symptoms). Its antihistaminic and alpha-adrenergic effects contribute to sedation and blood pressure changes, which can be helpful at times (for example, promoting sleep in acute agitation) but also necessitate careful monitoring.

How Seroquel Works

Quetiapine is considered a second-generation (atypical) antipsychotic with a receptor profile that includes antagonism at serotonin 5-HT2A and dopamine D2 receptors, as well as histamine H1 and adrenergic alpha-1/alpha-2 receptors. Its active metabolite, norquetiapine, additionally exhibits norepinephrine reuptake inhibition and partial agonism at 5-HT1A receptors. These combined actions are thought to:

• Reduce psychotic symptoms by balancing dopamine and serotonin signaling.
• Improve mood and anxiety symptoms through serotonergic modulation and noradrenergic activity.
• Produce sedation via H1 histamine receptor blockade, particularly at lower doses.
• Cause orthostatic hypotension (lightheadedness on standing) through alpha-1 adrenergic blockade.

This multi-receptor activity underpins Seroquel’s versatility across schizophrenia, bipolar mania, and bipolar depression, and its approved use of the XR formulation as adjunctive therapy in major depressive disorder (MDD) in some regions.

Approved Uses and Who May Benefit

• Schizophrenia in adults (and in adolescents in some jurisdictions): Seroquel can reduce hallucinations, delusions, disorganized thinking, and agitation, while also addressing negative symptoms like social withdrawal and flat affect.
• Bipolar disorder:
  • Acute mania or mixed episodes, as monotherapy or with mood stabilizers.
  • Bipolar depression (adult): Seroquel IR is often dosed once nightly and titrated to a target of 300 mg/day for depressive episodes.
  • Maintenance treatment: Sometimes used with mood stabilizers to reduce relapse risk.
• Adjunct in major depressive disorder (MDD) for Seroquel XR: In adults who have an inadequate response to antidepressants, adding Seroquel XR may improve depressive symptoms and sleep.

Important limitation: Seroquel is not approved for treating dementia-related psychosis and carries a boxed warning for increased mortality in elderly patients with dementia-related psychosis. Use in that population should be avoided unless a specialist determines a compelling indication and carefully assesses risks versus benefits.

How to Take Seroquel: Practical Instructions

Use Seroquel as directed by your doctor. Do not change your dose or stop taking it without medical guidance. Consistency is key to achieving symptom control and preventing relapse.

• Immediate-release (IR) tablets can be taken with or without food.
• Extended-release (XR) tablets are usually taken once daily in the evening. Swallow XR tablets whole; do not crush or chew. For optimal absorption, take XR without food or with a light meal (for example, 300 calories or less), depending on your prescriber’s advice.
• If you miss a dose, take it as soon as you remember. If it is close to your next dose, skip the missed dose and resume the regular schedule. Do not double doses.
• Do not suddenly stop taking Seroquel. Your clinician may reduce the dose gradually to minimize withdrawal-like symptoms (insomnia, nausea, headache, irritability) and rebound of underlying illness.

If you have any questions about timing, food interactions, or what to do if you miss multiple doses, ask your healthcare provider or pharmacist.

Typical Dosing and Titration

Doses vary widely based on diagnosis, age, other medications, and individual response. Your prescriber will tailor a schedule for you. Examples below are common adult starting and target ranges; always follow your clinician’s instructions.

• Schizophrenia (IR):
  • Day 1: 25 mg twice daily.
  • Increase in divided doses over 3–4 days to about 300–400 mg/day.
  • Usual effective range: 150–750 mg/day in divided doses.
• Schizophrenia (XR):
  • Begin at 300 mg once daily in the evening, with adjustments based on response.
  • Usual effective range: 400–800 mg once daily.
• Bipolar mania (IR):
  • Day 1: 50 mg twice daily.
  • Titrate to 400–800 mg/day in divided doses over several days as tolerated.
• Bipolar depression (IR):
  • Day 1: 50 mg at bedtime; Day 2: 100 mg; Day 3: 200 mg; Day 4: 300 mg at bedtime (target dose often 300 mg at bedtime).
• Adjunctive therapy for MDD (XR):
  • Often initiated at 50 mg nightly and titrated to 150–300 mg nightly.

Hepatic impairment: Lower starting doses and slower titration are recommended. Renal impairment generally does not require adjustment, but clinical judgment prevails.

Storage and Handling

Store Seroquel at 77°F (25°C). Brief storage between 59 and 86°F (15–30°C) is permitted. Keep tablets in a dry place away from excess heat and light. Do not store in bathrooms. Keep out of reach of children and pets. Safely discard expired or unused medication per your pharmacy’s guidance or local take-back programs.

Who Should Not Use Seroquel

• Anyone with a known allergy to quetiapine or any of the tablet ingredients.
• Individuals being treated with potent CYP3A4 inhibitors (such as certain azole antifungals or HIV protease inhibitors) without a prescriber-managed dose adjustment plan.
• Elderly patients with dementia-related psychosis unless a specialist determines that benefits outweigh the risks (increased mortality risk).

Inform your prescriber about all medical conditions before starting Seroquel, especially if you have:

• Past or current diabetes, prediabetes, weight problems, or high cholesterol.
• Cardiovascular disease, a history of low or high blood pressure, or a family/personal history of QT prolongation or arrhythmia.
• Seizure disorder, liver disease, thyroid disease, glaucoma, urinary retention, or trouble swallowing.
• A personal or family history of bipolar disorder, depression, suicidal thoughts, or other mood disorders.
• Substance or alcohol use disorder.
• Pregnancy, plans to become pregnant, or breastfeeding.

Drug and Food Interactions

Quetiapine is extensively metabolized by CYP3A4 in the liver. Many interactions stem from inhibition or induction of this enzyme or from additive CNS or cardiovascular effects.

• Strong CYP3A4 inhibitors increase quetiapine levels and side effects:
  • Examples: ketoconazole, itraconazole, clarithromycin, erythromycin, telithromycin, ritonavir and other HIV protease inhibitors, cobicistat, nefazodone.
  • Management: Avoid coadministration when possible. If essential, prescribers may significantly reduce the Seroquel dose and monitor closely.
• Strong CYP3A4 inducers decrease quetiapine levels and effectiveness:
  • Examples: carbamazepine, phenytoin, rifampin, St. John’s wort, phenobarbital.
  • Management: Avoid combining. If necessary, prescribers may increase Seroquel dose and monitor; dose changes are individualized.
• Alcohol, opioids, benzodiazepines, antihistamines, and other sedatives: Additive sedation and impairment. Avoid alcohol and use caution with sedatives.
• Antihypertensives and alpha-blockers: Increased risk of low blood pressure and dizziness, especially when starting or titrating Seroquel.
• Dopamine agonists and levodopa: Potential reduction in their effectiveness due to dopamine receptor antagonism.
• QT-prolonging drugs: Use caution with other agents that prolong the QT interval (for example, certain antiarrhythmics, some macrolides, and methadone); monitor if combined.
• Grapefruit and grapefruit juice: Can raise quetiapine levels by inhibiting CYP3A4. Avoid unless your prescriber says otherwise.

Always provide your healthcare team with a current list of prescription and nonprescription medications, vitamins, and herbal supplements before starting, stopping, or changing any drug.

Important Safety Information and Boxed Warnings

• Suicidality risk in younger people: Antidepressant-class warnings extend to Seroquel when used in children, adolescents, and young adults for mood disorders. Monitor for new or worsening depression, suicidal thoughts, agitation, irritability, or unusual behavior changes—especially at initiation and with dose changes.
• Dementia-related psychosis: Increased risk of death in elderly patients with dementia-related psychosis. Seroquel is not approved for this use.
• Somnolence and impaired judgment: Seroquel can cause drowsiness, dizziness, and slowed thinking. Do not drive or operate heavy machinery until you know how you respond. Avoid alcohol.
• Orthostatic hypotension and falls: Dizziness or fainting may occur, especially during initial titration or dose increases, in hot weather, with dehydration, or after alcohol. Rise slowly from sitting/lying positions.
• Metabolic effects: Weight gain, increases in blood glucose (including new-onset diabetes) and lipid abnormalities can occur. Symptoms of high blood sugar include increased thirst/urination, fatigue, and fruity breath. Report symptoms promptly and keep recommended lab appointments.
• Extrapyramidal symptoms (EPS) and tardive dyskinesia (TD): Although less frequent than with first-generation antipsychotics, EPS (restlessness, tremor, stiffness) and TD (involuntary repetitive movements) may occur. Risk increases with higher doses and longer duration. Report any abnormal movements promptly.
• Neuroleptic Malignant Syndrome (NMS): A rare but potentially fatal reaction characterized by high fever, rigid muscles, confusion, sweating, and fast or irregular heartbeat. Seek emergency care immediately if suspected.
• Leukopenia/neutropenia: Low white blood cell counts may occur. Those with prior low counts or drug-induced leukopenia need closer monitoring; report signs of infection promptly (fever, sore throat, chills).
• Seizure risk: Use caution in those with seizure disorders or risk factors for lowered seizure threshold.
• Lens changes: Rare reports and animal data suggest potential lens changes. Periodic eye exams may be recommended with long-term use.
• Hyperprolactinemia: Quetiapine generally has a lower risk of elevating prolactin than some antipsychotics, but increases can occur, potentially causing menstrual changes, galactorrhea, or sexual dysfunction. Report symptoms to your clinician.
• Priapism: Rare, prolonged painful erections require urgent medical attention to prevent long-term issues.
• Temperature regulation and dehydration: Use caution in heat, avoid overheating, and maintain hydration, as antipsychotics can impair the body’s ability to cool itself.

Common and Serious Side Effects

Many people tolerate Seroquel well, and some side effects lessen over time. Still, knowing what to expect helps you respond appropriately.

• Common side effects:
  • Sleepiness or drowsiness, fatigue, and lightheadedness.
  • Dry mouth, constipation, upset stomach, or nausea.
  • Increased appetite and weight gain.
  • Dizziness, especially upon standing.
  • Nasal congestion, sore throat.
  • Headache or mild tremor.
• Less common but important:
  • Restlessness or akathisia (a sense of inner restlessness).
  • Increases in blood pressure in children/adolescents.
  • Mood or behavior changes, including agitation or anxiety.
• Serious side effects—seek medical attention promptly:
  • Signs of severe allergic reaction: rash, hives, swelling of face/lips/tongue, difficulty breathing.
  • Fever, muscle rigidity, confusion, fast/irregular heartbeat, or heavy sweating (possible NMS).
  • Severe dizziness, fainting, chest pain, or shortness of breath.
  • Seizures.
  • Severe or persistent constipation with abdominal pain or vomiting.
  • New or worsening suicidal thoughts or behavior.
  • Uncontrolled muscle movements or facial tics.
  • Signs of high blood sugar (excessive thirst/urination, fatigue, fruity breath) or symptoms of pancreatitis (severe abdominal pain).
  • Persistent, painful erection lasting more than 4 hours (priapism).
  • Signs of infection: fever, chills, sore throat.

Report side effects to your prescriber. If you experience emergency symptoms (for example, difficulty breathing, chest pain, signs of stroke), call emergency services immediately.

Monitoring: What to Check and When

Because quetiapine can affect metabolism, blood pressure, and other systems, routine monitoring supports safe, effective treatment.

• Before starting:
  • Weight/BMI and waist circumference.
  • Blood pressure and pulse.
  • Fasting blood glucose or A1C, and fasting lipids.
  • Consider baseline CBC in those with history of low WBC.
  • Pregnancy test if applicable; discuss family planning.
• During treatment:
  • Weight and BMI at 4, 8, and 12 weeks, then quarterly.
  • Blood pressure and pulse regularly, especially early in treatment.
  • Fasting glucose/A1C and lipids at 3 months, then at least annually or more often if clinically indicated.
  • Eye exams periodically with long-term use.
  • CBC monitoring in individuals with prior low white counts or symptoms of infection.

If significant weight gain or metabolic changes occur, clinicians may adjust the dose, address lifestyle factors, add treatments to manage metabolic parameters, or consider an alternative medication.

Special Populations

• Older adults: Increased sensitivity to side effects like sedation, orthostatic hypotension, and movement symptoms. Start low, go slow. Avoid use in dementia-related psychosis due to increased mortality risk.
• Children and adolescents: Some indications and dosing differ by age and jurisdiction. Blood pressure elevations and metabolic effects may be more pronounced; careful monitoring is essential. Use only under specialist guidance.
• Pregnancy: Untreated mental illness carries risks to mother and baby. If you become pregnant while taking Seroquel, contact your prescriber promptly to discuss risks and benefits. Third-trimester exposure to antipsychotics can lead to transient neonatal symptoms (for example, agitation, breathing difficulties, feeding disorder). Decisions should be individualized.
• Breastfeeding: Quetiapine appears in breast milk at low levels. Some clinicians consider it compatible with breastfeeding with infant monitoring for sedation and feeding issues. Discuss with your obstetrician/pediatrician and psychiatrist to make an informed choice.
• Hepatic impairment: Lower starting doses and slower titration are recommended due to reduced metabolism.
• Renal impairment: Generally minimal dose adjustment required, but clinical monitoring is still important.
• Substance use disorders: Avoid alcohol and sedatives; quetiapine’s sedative properties can be risky when combined with CNS depressants.

Discontinuation and Switching

Do not stop Seroquel abruptly unless instructed by a clinician. A gradual taper helps reduce the risk of rebound insomnia, nausea, anxiety, irritability, and return of psychosis or mood symptoms. When switching to or from another antipsychotic or mood stabilizer, prescribers may cross-taper and monitor closely for symptom breakthrough, side effects, and interactions. Never adjust your medication plan on your own—coordination with your healthcare team is essential.

Overdose and Misuse

Overdose may cause profound drowsiness, low blood pressure, fast heartbeat, QT prolongation, and in severe cases, coma. If an overdose is suspected, seek emergency medical care immediately and bring the medication bottle for identification.

Quetiapine is sometimes misused for its sedative effects. Misuse increases the risk of dangerous interactions (for example, with opioids or alcohol), accidents, and medical complications. Always use Seroquel exactly as prescribed.

Cost, Access, and Responsible Use

Quetiapine is available as brand-name Seroquel and as generics, which can reduce cost. Prices vary widely among pharmacies and regions. Cost-saving options may include:

• Using generic quetiapine when appropriate.
• Pharmacy discount programs or coupons.
• Prescription assistance programs for eligible patients.
• Telehealth visits with licensed clinicians for evaluation and ongoing care, followed by e-prescriptions sent to your preferred pharmacy.

In the United States and many other countries, quetiapine is a prescription-only medication. Only purchase from licensed pharmacies that require a valid prescription. Be cautious of websites that advertise prescription drugs without a prescription; such practices are unsafe and often illegal. Your healthcare team can help you find reputable, affordable options to fill your prescription.

Comprehensive Use Tips

• Take doses at the same time each day to build a steady routine.
• Track side effects and bring notes to appointments—small adjustments can make a big difference.
• Pair medication with therapy and lifestyle supports when possible. Good sleep hygiene, moderated caffeine, regular meals, and physical activity can amplify benefits and mitigate metabolic effects.
• Avoid alcohol and recreational drugs; they can worsen symptoms and interact dangerously with Seroquel.
• Stay hydrated, especially in hot weather, and rise slowly from sitting or lying positions.
• Keep all lab and follow-up appointments to monitor health parameters and long-term safety.

Detailed Interaction Examples

• Medications that may raise quetiapine levels (higher side-effect risk):
  • Azole antifungals (ketoconazole, itraconazole).
  • Macrolide antibiotics (clarithromycin, erythromycin) and telithromycin.
  • HIV protease inhibitors (ritonavir, atazanavir, lopinavir) and cobicistat-containing regimens.
  • Nefazodone.
• Medications that may lower quetiapine levels (reduced effectiveness):
  • Carbamazepine and oxcarbazepine.
  • Phenytoin and phenobarbital.
  • Rifampin.
  • St. John’s wort (herbal).
• Other noteworthy interactions:
  • Antihypertensives (including alpha-blockers): additive blood pressure lowering.
  • Anticholinergic agents (for example, benztropine): additive constipation, dry mouth, urinary retention, or confusion—monitor especially in older adults.
  • QT-prolonging drugs (for example, amiodarone, sotalol, methadone, some macrolides): potential additive effect—assess risks and consider ECG monitoring when warranted.
  • Dopamine agonists/levodopa: quetiapine may blunt effects; monitor for reduced benefit in Parkinson’s disease therapy.

Because interactions can be complex and highly individualized, never start or stop medications, including over-the-counter products and supplements, without checking with your clinician or pharmacist.

Patient Experience and Expectations

Response patterns vary. Some people notice improvement in sleep and agitation within days, while core psychotic or depressive symptoms may take 2 to 6 weeks to improve, with continued gains over several months. It is common to require dose adjustments to balance effectiveness and tolerability. Good communication with your prescriber helps tailor therapy and reduces the risk of relapse. If you do not feel better after an adequate trial, do not be discouraged—there are alternative dosing strategies and other evidence-based options to explore.

Seroquel U.S. Sale and Prescription Policy

In the United States, Seroquel (quetiapine) is a prescription-only medication. Federal and state laws require a valid prescription from a licensed clinician to dispense Seroquel. Legitimate in-person and online pharmacies must verify a prescription before filling it. Purchasing quetiapine from sources that do not require a prescription is unsafe and often illegal.

HealthSouth Rehabilitation Hospital of Petersburg offers a legal and structured solution for accessing Seroquel—by connecting patients with qualified healthcare professionals for proper evaluation, diagnosis, and, when clinically appropriate, issuance of a valid prescription that can be filled at a licensed pharmacy. This approach complies with U.S. regulations and prioritizes patient safety, appropriate monitoring, and continuity of care. If you are interested in treatment with Seroquel or alternatives, the HealthSouth team can guide you through a legitimate care pathway, including telehealth options where available, without bypassing necessary medical oversight.

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