Quetiapine

CLINICAL USE

Schizophrenia Mania

DOSE IN NORMAL RENAL FUNCTION

Schizophrenia: 50–750 mg daily in 2 divided dosesMania: 50–400 mg twice daily

PHARMACOKINETICS

Molecular weight :883.1 (as fumarate)

%Protein binding :83

%Excreted unchanged in urine : <5

Volume of distribution (L/kg) :6–14

half-life – normal/ESRD (hrs) :6–7/Unchanged

DOSE IN RENAL IMPAIRMENT

GFR (mL/MIN)

20 to 50 : Initial dose 25 mg/day and increase in increments of 25–50 mg/day according to response

10 to 20 : Initial dose 25 mg/day and increase in increments of 25–50 mg/day according to response

<10 : Initial dose 25 mg/day and increase in increments of 25–50 mg/day according to response

DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

CAPD :Unknown dialysability. Dose as in GFR <10 mL/min

HD :Unknown dialysability. Dose as in GFR <10 mL/min

HDF/high flux :Unknown dialysability. Dose as in GFR <10 mL/min

CAV/VVHD :Unknown dialysability. Dose as in GFR 10 to 20 mL/min

IMPORTANT DRUG INTERACTIONS

Potentially hazardous interactions with other drugs

Anaesthetics: enhanced hypotensive effect

Analgesics: increased risk of convulsions with tramadol; enhanced hypotensive and sedative effects with opioids

Antibacterials: concentration possibly increased by macrolides – reduce dose of quetiapine

Antidepressants: concentration of tricyclics possibly increased

Anti-epileptics: antagonism of convulsive threshold; metabolism accelerated by carbamazepine and phenytoin

Antifungals: concentration possibly increased by imidazoles and triazoles – reduce quetiapine dose

Antimalarials: manufacturer advises avoid use with artemether and lumefantrine

Antivirals: ritonavir possibly increases concentrationAnxiolytics and hypnotics: enhanced sedative effects

Sibutramine: increased risk of CNS toxicity – avoid concomitant use

ADMINISTRATION

Reconstition

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Route

Oral

Rate of Administration

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Comments

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OTHER INFORMATION

Plasma clearance is reduced by 25% in severe renal impairmentAbsorption is increased by food so it should be taken consistently either with or without food.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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