Over the last decade all atypical drugs except for clozapine have received a Food and Drug Administration FDA bipolar indication. In October, the FDA approved quetiapine XR monotherapy for the treatment of acute depressive episodes of bipolar disorder and acute manic or mixed episodes in bipolar I disorder based on two placebo-control trials. Quetiapine was also approved as adjunct therapy with lithium and divalproex for the treatment of acute manic or mixed episodes as well as maintenance of bipolar I disorder. This drug profile of quetiapine XR will address chemistry, pharmacodynamics, pharmacokinetics, metabolism, safety and tolerability and clinical trials in bipolar disorder. Bipolar disorder is a life-long clinical illness characterized by the presence of cycling episodes of mania or hypomania and mostly episodes of depression. Treatment of bipolar disorder must also address: 1 acute intervention for manic or depressive episodes, 2 maintaining long term remission and 3 prevention of recurrence.

Quetiapine is an atypical antipsychotic approved for the treatment of patients with psychotic disorders. Symptoms associated with intoxication were coma without arterial hypotension, persistent tachycardia, hyperglycemia, and transient hypothyreoidism. Management consisted of intubation for airway protection, gastric lavage, the use of activated charcoal, i. Despite the extremely high dose of quetiapine, the patient recovered completely without residual symptoms. Quetiapine is indicated and approved for the treatment of psychotic disorders in adults by the U.

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Next: Dosage for Bipolar Mania. Next: Major Depressive Disorder. Advise families and caregivers of the need for close observation and communication with the prescriber. Additional signs may include elevated creatine phosphokinase, myoglobinuria rhabdomyolysis, and acute renal failure. Management should include immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy, intensive symptomatic treatment, and medical monitoring, and treatment of any concomitant serious medical problems. The relationship of atypical use and glucose abnormalities is complicated by the possibility of increased risk of diabetes in the schizophrenic population and the increasing incidence of diabetes in the general population.

Either immediate-release or extended-release tablets may be given; dosage titrated upward over 4 days. Generally, in maintenance phase, patients continue to receive same dosage on which they were stabilized. Drug reaction with eosinophilia and systemic symptoms DRESS, falls, nocturnal enuresis, retrograde amnesia, syndrome of inappropriate antidiuretic hormone secretion SIADH, Stevens-Johnson syndrome SJS, toxic epidermal necrolysis TEN, decreased platelet count, serious liver reactions including hepatitis, liver necrosis, and hepatic failure, agranulocytosis, intestinal obstruction, ileus, colon ischemia, urinary retention, sleep apnea, and acute generalized exanthematous pustulosis AGEP. Increased risk of hyperglycemia and diabetes; in some cases, hyperglycemia concomitant with use of atypical antipsychotics has been associated with ketoacidosis, hyperosmolar coma, or death; monitor blood glucose of high-risk patients for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness; monitor glucose regularly in patients with diabetes or at risk for diabetes. Can elevate prolactin levels, and elevation can persist during chronic administration; hyperprolactinemia may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotropin secretion; this, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Orthostatic vital signs should be monitored in patients who are vulnerable to hypotension elderly patients, patients with dehydration, hypovolemia, concomitant treatment with antihypertensive medications.

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Quetiapine is a dopamine D 1, dopamine D 2, 5-HT 2, alpha 1 -adrenoceptor, and histamine-1 receptor antagonist. Patients can be switched from immediate-release to modified-release tablets at the equivalent daily dose; to maintain clinical response, dose titration may be required. An ECG may be required, particularly if physical examination identifies cardiovascular risk factors, personal history of cardiovascular disease, or if the patient is being admitted as an inpatient. See also Prescribing in the elderly. Cerebrovascular disease; elderly; history or risk factors for 300 mg seroquel xr apnoea; patients at risk of aspiration pneumonia; treatment of depression in patients under 25 years increased risk of suicide. Agranulocytosis; confusion; embolism and thrombosis; neuroleptic malignant syndrome discontinue—potentially fatal.

It is very important that you take the medicine at about the same time every day. It will work best if you do this. It is important that you keep taking each dose of this medicine on time even if you are feeling well. If you forget to take a dose on time, take it as soon as you remember. If it is almost time for the next dose, do not take the missed dose. Return to your normal dosing schedule.

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This means that medicine is delivered around the clock. If you miss a dose, take it as soon as you remember. If it is close to the next dose, skip the missed dose. Do not take 2 doses at the same time unless your doctor tells you to. The most common side effects in adults across all indications are drowsiness, dry mouth, constipation, dizziness, increased appetite, upset stomach, weight gain, fatigue, disturbance in speech and language, and stuffy nose.

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Quetiapine fumarate is used for the symptomatic management of psychotic disorders e. Drug therapy is integral to the management of acute psychotic episodes in patients with schizophrenia and generally is required for long-term stabilization to sustain symptom remission or control and to minimize the risk of relapse. Antipsychotic agents are the principal class of drugs used for the management of all phases of schizophrenia. Patient response and tolerance to antipsychotic agents are variable, and patients who do not respond to or tolerate one drug may be successfully treated with an agent from a different class or with a different adverse effect profile. Short-term efficacy of quetiapine for the management of schizophrenia has been established by placebo-controlled studies of 6 weeks' duration principally in hospitalized patients with schizophrenia. Schizophrenia is a major psychotic disorder that frequently has devastating effects on various aspects of the patient's life and carries a high risk of suicide and other life-threatening behaviors.

Bipolar disorder is a chronic disease requiring continuous treatment. Bipolar I disorder is a syndrome involving at least one manic episode, while bipolar II disorder involves at least one hypomanic episode and one major depressive episode. For each evaluation, the measured values at each time point and summary statistics mean, standard deviation of changes were calculated. The patient characteristics of the initial 8-week double-blind study were described previously. This open-label extension study evaluated the long-term safety and efficacy of 300 mg seroquel xr treatment in Japanese patients with bipolar depression who had completed the initial 8-week double-blind study. Changes of body weight, metabolic parameters, and blood prolactin levels are common after the administration of atypical antipsychotics.

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