Quetiapine - Revision history

MDElliottMD: home-claude house-rule fix (terminology)

2026-05-23T10:40:58Z

home-claude house-rule fix (terminology)

← Older revision		Revision as of 10:40, 23 May 2026
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	\| pregnancy_details = Quetiapine crosses the placenta in modest amounts (umbilical cord-to-maternal plasma ratio approximately 24%, lower than risperidone or olanzapine).<ref name="newport2007">Newport DJ, Calamaras MR, DeVane CL, Donovan J, Beach AJ, Winn S, Knight BT, Gibson BB, Viguera AC, Owens MJ, Nemeroff CB, Stowe ZN. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. American Journal of Psychiatry. 2007;164(8):1214-1220. PMID: 17671284.</ref> The pregnancy literature on atypical neuroleptics has substantially attenuated earlier concerns about teratogenicity; recent large cohort analyses using active-comparator designs and confounding-by-indication adjustment have found no consistent signal for major congenital malformations with quetiapine specifically.<ref name="huybrechts2016">Huybrechts KF, Hernandez-Diaz S, Patorno E, Desai RJ, Mogun H, Dejene SZ, Cohen JM, Panchaud A, Cohen L, Bateman BT. Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiatry. 2016;73(9):938-946. PMID: 27540849.</ref> Quetiapine is therefore frequently used in pregnancy when neuroleptic treatment is clinically necessary, both for primary indications such as bipolar disorder and schizophrenia and as a substitute for higher-risk medicines such as [[Valproic acid\|valproate]].		\| pregnancy_details = Quetiapine crosses the placenta in modest amounts (umbilical cord-to-maternal plasma ratio approximately 24%, lower than risperidone or olanzapine).<ref name="newport2007">Newport DJ, Calamaras MR, DeVane CL, Donovan J, Beach AJ, Winn S, Knight BT, Gibson BB, Viguera AC, Owens MJ, Nemeroff CB, Stowe ZN. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. American Journal of Psychiatry. 2007;164(8):1214-1220. PMID: 17671284.</ref> The pregnancy literature on atypical neuroleptics has substantially attenuated earlier concerns about teratogenicity; recent large cohort analyses using active-comparator designs and confounding-by-indication adjustment have found no consistent signal for major congenital malformations with quetiapine specifically.<ref name="huybrechts2016">Huybrechts KF, Hernandez-Diaz S, Patorno E, Desai RJ, Mogun H, Dejene SZ, Cohen JM, Panchaud A, Cohen L, Bateman BT. Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiatry. 2016;73(9):938-946. PMID: 27540849.</ref> Quetiapine is therefore frequently used in pregnancy when neuroleptic treatment is clinically necessary, both for primary indications such as bipolar disorder and schizophrenia and as a substitute for higher-risk medicines such as [[Valproic acid\|valproate]].

	Third-trimester exposure is associated with transient neonatal symptoms, including extrapyramidal signs, feeding difficulty, respiratory distress, and uncommonly withdrawal, typically resolving within days. [[Gestational diabetes\|Gestational diabetes]] risk may be modestly elevated by maternal quetiapine; routine glucose screening in pregnancy applies. Breastfeeding while taking quetiapine produces low infant ~~drug~~ exposure (relative infant dose typically less than 1%), and quetiapine is among the neuroleptics considered compatible with breastfeeding.		Third-trimester exposure is associated with transient neonatal symptoms, including extrapyramidal signs, feeding difficulty, respiratory distress, and uncommonly withdrawal, typically resolving within days. [[Gestational diabetes\|Gestational diabetes]] risk may be modestly elevated by maternal quetiapine; routine glucose screening in pregnancy applies. Breastfeeding while taking quetiapine produces low infant medicine exposure (relative infant dose typically less than 1%), and quetiapine is among the neuroleptics considered compatible with breastfeeding.

	For women with bipolar disorder or schizophrenia maintained on quetiapine who become pregnant, continuation is generally preferred to discontinuation because of relapse risk; the medicine's relative safety profile in pregnancy makes the maternal mental health argument straightforward. For women on quetiapine off-label for sleep or anxiety, pregnancy is an appropriate occasion to deprescribe in favor of behavioral interventions or, where pharmacotherapy is required, evidence-based alternatives such as the SSRI [[Sertraline\|sertraline]].		For women with bipolar disorder or schizophrenia maintained on quetiapine who become pregnant, continuation is generally preferred to discontinuation because of relapse risk; the medicine's relative safety profile in pregnancy makes the maternal mental health argument straightforward. For women on quetiapine off-label for sleep or anxiety, pregnancy is an appropriate occasion to deprescribe in favor of behavioral interventions or, where pharmacotherapy is required, evidence-based alternatives such as the SSRI [[Sertraline\|sertraline]].
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	Management is primarily supportive: airway protection, intravenous fluids for hypotension, ECG monitoring with attention to QT and arrhythmias, cardiac monitoring for at least 24 hours in significant ingestions. [[Activated charcoal\|Activated charcoal]] may be considered within one hour of ingestion if the airway is protected. [[:Category:Vasopressors\|Vasopressors]] ([[Norepinephrine (medication)\|norepinephrine]] preferred over [[Dopamine (medication)\|dopamine]], given quetiapine's alpha-1 antagonism) for refractory hypotension. There is no specific antidote. [[Hemodialysis\|Hemodialysis]] is not effective owing to the large volume of distribution.		Management is primarily supportive: airway protection, intravenous fluids for hypotension, ECG monitoring with attention to QT and arrhythmias, cardiac monitoring for at least 24 hours in significant ingestions. [[Activated charcoal\|Activated charcoal]] may be considered within one hour of ingestion if the airway is protected. [[:Category:Vasopressors\|Vasopressors]] ([[Norepinephrine (medication)\|norepinephrine]] preferred over [[Dopamine (medication)\|dopamine]], given quetiapine's alpha-1 antagonism) for refractory hypotension. There is no specific antidote. [[Hemodialysis\|Hemodialysis]] is not effective owing to the large volume of distribution.

	Co-ingestion is the rule rather than the exception in quetiapine overdose; alcohol, benzodiazepines, and opioids substantially worsen prognosis. The widespread availability of quetiapine in homes where it is prescribed off-label for insomnia has contributed to its prominence in suicidal overdose attempts; counseling about safe ~~medication~~ storage and limited dispense quantities in at-risk patients is appropriate.		Co-ingestion is the rule rather than the exception in quetiapine overdose; alcohol, benzodiazepines, and opioids substantially worsen prognosis. The widespread availability of quetiapine in homes where it is prescribed off-label for insomnia has contributed to its prominence in suicidal overdose attempts; counseling about safe medicine storage and limited dispense quantities in at-risk patients is appropriate.
	\| counseling = '''Off-label use: most quetiapine prescriptions are for indications the medicine is not formally approved to treat.''' If quetiapine has been prescribed for sleep, anxiety, agitation, or PTSD, the patient should understand that the prescribing is off-label, that the evidence base for these indications is modest, that the metabolic and cardiovascular risk profile applies even at low doses, and that evidence-based alternatives exist ([[Cognitive behavioral therapy for insomnia\|cognitive behavioral therapy for insomnia]], SSRIs and SNRIs for anxiety, exposure-based therapies for PTSD).		\| counseling = '''Off-label use: most quetiapine prescriptions are for indications the medicine is not formally approved to treat.''' If quetiapine has been prescribed for sleep, anxiety, agitation, or PTSD, the patient should understand that the prescribing is off-label, that the evidence base for these indications is modest, that the metabolic and cardiovascular risk profile applies even at low doses, and that evidence-based alternatives exist ([[Cognitive behavioral therapy for insomnia\|cognitive behavioral therapy for insomnia]], SSRIs and SNRIs for anxiety, exposure-based therapies for PTSD).

MDElliottMD: parser-claude: replace retired FDA Category C label and broken LactMed ref on Quetiapine; one-line summary consistent with pregnancy_details prose

2026-05-23T07:37:08Z

parser-claude: replace retired FDA Category C label and broken LactMed ref on Quetiapine; one-line summary consistent with pregnancy_details prose

← Older revision		Revision as of 07:37, 23 May 2026
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	\| halflife = ~6 h (parent compound, immediate-release); ~9-12 h (active metabolite N-desalkylquetiapine, also called norquetiapine)		\| halflife = ~6 h (parent compound, immediate-release); ~9-12 h (active metabolite N-desalkylquetiapine, also called norquetiapine)
	\| bioavailability = Tablet ~100% relative to oral solution; extensive first-pass metabolism		\| bioavailability = Tablet ~100% relative to oral solution; extensive first-pass metabolism
	\| pregnancy = ~~Category C<ref name="lactmed~~-~~quet">S0</ref>~~		\| pregnancy = Pregnancy categories were retired by FDA in 2015. Quetiapine has reassuring active-comparator cohort data without consistent teratogenic signal; among the preferred neuroleptics when treatment is clinically necessary in pregnancy. See pregnancy_details for the full citation set.
	\| legal = [[USLegal:Prescription only\|Prescription only]]; not a controlled substance		\| legal = [[USLegal:Prescription only\|Prescription only]]; not a controlled substance
	\| mechanism = Dopamine D2 and serotonin 5-HT2A receptor antagonist<ref name="quet-mech">S1</ref> <vote slug="atypical-claim-quet">Quetiapine acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors and has substantial activity at histaminergic, adrenergic, and other receptors that contribute to its clinical effects.</vote>		\| mechanism = Dopamine D2 and serotonin 5-HT2A receptor antagonist<ref name="quet-mech">S1</ref> <vote slug="atypical-claim-quet">Quetiapine acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors and has substantial activity at histaminergic, adrenergic, and other receptors that contribute to its clinical effects.</vote>

CategoryClaude: Sentence-case category link per house style (Mood_Stabilizers → Mood_stabilizers)

2026-05-23T05:02:21Z

Sentence-case category link per house style (Mood_Stabilizers → Mood_stabilizers)

← Older revision		Revision as of 05:02, 23 May 2026
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	[[Category:Neuroleptics]]		[[Category:Neuroleptics]]
	[[Category:Second-generation neuroleptics]]		[[Category:Second-generation neuroleptics]]
	[[Category:Mood ~~Stabilizers~~]]		[[Category:Mood stabilizers]]
	[[Category:Medicines]]		[[Category:Medicines]]

MDElliottMD: Link legal-status field to the USLegal: namespace

2026-05-22T16:47:30Z

Link legal-status field to the USLegal: namespace

← Older revision		Revision as of 16:47, 22 May 2026
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	\| bioavailability = Tablet ~100% relative to oral solution; extensive first-pass metabolism		\| bioavailability = Tablet ~100% relative to oral solution; extensive first-pass metabolism
	\| pregnancy = Category C<ref name="lactmed-quet">S0</ref>		\| pregnancy = Category C<ref name="lactmed-quet">S0</ref>
	\| legal = Prescription only; not a controlled substance		\| legal = [[USLegal:Prescription only\|Prescription only]]; not a controlled substance
	\| mechanism = Dopamine D2 and serotonin 5-HT2A receptor antagonist<ref name="quet-mech">S1</ref> <vote slug="atypical-claim-quet">Quetiapine acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors and has substantial activity at histaminergic, adrenergic, and other receptors that contribute to its clinical effects.</vote>		\| mechanism = Dopamine D2 and serotonin 5-HT2A receptor antagonist<ref name="quet-mech">S1</ref> <vote slug="atypical-claim-quet">Quetiapine acts as an antagonist at dopamine D2 and serotonin 5-HT2A receptors and has substantial activity at histaminergic, adrenergic, and other receptors that contribute to its clinical effects.</vote>
	\| intro = Quetiapine, marketed as Seroquel, is the most widely prescribed neuroleptic medicine in the United States, accounting for approximately 28% of neuroleptic prescriptions.<ref name="dhc2025">Definitive Healthcare. Antipsychotic Prescription Trends, December 2024-November 2025. Prescription data aggregator.</ref> It is a dibenzothiazepine atypical neuroleptic developed in 1985 at the pharmaceutical division of [[Imperial Chemical Industries]] in Macclesfield, United Kingdom (later [[Zeneca]], then [[AstraZeneca]]), and approved by the United States [[Food and Drug Administration]] on 26 September 1997 for the treatment of [[Schizophrenia\|schizophrenia]]. Subsequent FDA approvals expanded the labeled indications to include acute [[Bipolar disorder\|bipolar mania]] (2004), bipolar depression (2006), bipolar maintenance (2008), and adjunctive treatment of [[Major depressive disorder\|major depressive disorder]] (2009). Quetiapine is widely prescribed at low doses (25-150 mg) off-label for [[Insomnia\|insomnia]], anxiety, agitation, [[Post-traumatic stress disorder\|post-traumatic stress disorder]], and behavioral disturbances of [[Dementia\|dementia]]; this off-label use accounts for the dominant share of quetiapine prescribing in the United States and most other markets. The off-label prescribing pattern was the subject of the largest civil settlement for off-label marketing in pharmaceutical history at the time, when AstraZeneca paid $520 million to the United States [[Department of Justice]] in 2010 to resolve allegations that the company had illegally marketed Seroquel for indications never approved by the FDA.		\| intro = Quetiapine, marketed as Seroquel, is the most widely prescribed neuroleptic medicine in the United States, accounting for approximately 28% of neuroleptic prescriptions.<ref name="dhc2025">Definitive Healthcare. Antipsychotic Prescription Trends, December 2024-November 2025. Prescription data aggregator.</ref> It is a dibenzothiazepine atypical neuroleptic developed in 1985 at the pharmaceutical division of [[Imperial Chemical Industries]] in Macclesfield, United Kingdom (later [[Zeneca]], then [[AstraZeneca]]), and approved by the United States [[Food and Drug Administration]] on 26 September 1997 for the treatment of [[Schizophrenia\|schizophrenia]]. Subsequent FDA approvals expanded the labeled indications to include acute [[Bipolar disorder\|bipolar mania]] (2004), bipolar depression (2006), bipolar maintenance (2008), and adjunctive treatment of [[Major depressive disorder\|major depressive disorder]] (2009). Quetiapine is widely prescribed at low doses (25-150 mg) off-label for [[Insomnia\|insomnia]], anxiety, agitation, [[Post-traumatic stress disorder\|post-traumatic stress disorder]], and behavioral disturbances of [[Dementia\|dementia]]; this off-label use accounts for the dominant share of quetiapine prescribing in the United States and most other markets. The off-label prescribing pattern was the subject of the largest civil settlement for off-label marketing in pharmaceutical history at the time, when AstraZeneca paid $520 million to the United States [[Department of Justice]] in 2010 to resolve allegations that the company had illegally marketed Seroquel for indications never approved by the FDA.

MDElliottMD: Repoint CYP2D6/CYP3A4 links to the new Enzyme: namespace

2026-05-22T02:57:15Z

Repoint CYP2D6/CYP3A4 links to the new Enzyme: namespace

← Older revision		Revision as of 02:57, 22 May 2026
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	\| pk_absorption = Quetiapine is rapidly absorbed after oral administration; peak plasma concentrations of the immediate-release tablet occur approximately 1.5 hours after dosing. The tablet formulation is essentially completely bioavailable (~100%) relative to oral solution, but the parent compound is extensively metabolized on first pass through the liver, and the doses required for clinical effect are correspondingly larger than what reaches the systemic circulation in unchanged form. The extended-release formulation produces a slower, more sustained absorption profile with peak levels at approximately 6 hours and substantially flatter plasma trajectories. High-fat meals increase the Cmax of the extended-release formulation by approximately 50% and the AUC by approximately 20%, leading to the labeled recommendation that Seroquel XR be taken without food or after a light meal.<ref name="seroquel-label">U.S. Food and Drug Administration. Seroquel (quetiapine) prescribing information. NDA 020639.</ref>		\| pk_absorption = Quetiapine is rapidly absorbed after oral administration; peak plasma concentrations of the immediate-release tablet occur approximately 1.5 hours after dosing. The tablet formulation is essentially completely bioavailable (~100%) relative to oral solution, but the parent compound is extensively metabolized on first pass through the liver, and the doses required for clinical effect are correspondingly larger than what reaches the systemic circulation in unchanged form. The extended-release formulation produces a slower, more sustained absorption profile with peak levels at approximately 6 hours and substantially flatter plasma trajectories. High-fat meals increase the Cmax of the extended-release formulation by approximately 50% and the AUC by approximately 20%, leading to the labeled recommendation that Seroquel XR be taken without food or after a light meal.<ref name="seroquel-label">U.S. Food and Drug Administration. Seroquel (quetiapine) prescribing information. NDA 020639.</ref>
	\| pk_distribution = Plasma protein binding is approximately 83%, primarily to [[Albumin\|albumin]] and [[Alpha-1-acid glycoprotein\|alpha-1-acid glycoprotein]]. Volume of distribution approximately 10 L/kg. Quetiapine crosses the [[Blood-brain barrier\|blood-brain barrier]] readily and the placenta in modest amounts; it is excreted into breast milk at low concentrations.<ref name="seroquel-label"/>		\| pk_distribution = Plasma protein binding is approximately 83%, primarily to [[Albumin\|albumin]] and [[Alpha-1-acid glycoprotein\|alpha-1-acid glycoprotein]]. Volume of distribution approximately 10 L/kg. Quetiapine crosses the [[Blood-brain barrier\|blood-brain barrier]] readily and the placenta in modest amounts; it is excreted into breast milk at low concentrations.<ref name="seroquel-label"/>
	\| pk_metabolism = Quetiapine is extensively metabolized in the liver, predominantly via [[~~Pharmacopedia~~:~~Pharmacogenomics sandbox/Enzyme~~ CYP3A4\|CYP3A4]], with minor contributions from [[~~Pharmacopedia~~:~~Pharmacogenomics sandbox/Enzyme~~ CYP2D6\|CYP2D6]]. The principal active metabolite is N-desalkylquetiapine (also called norquetiapine), formed via CYP3A4-mediated dealkylation; norquetiapine has a longer half-life (~9-12 hours) than the parent compound (~6 hours) and a distinct receptor binding profile, with substantially higher affinity for the [[Norepinephrine transporter\|norepinephrine transporter]] (NET) than the parent compound. The norquetiapine NET binding is one mechanism proposed for quetiapine's efficacy in bipolar depression and as an MDD adjunct, distinguishing it pharmacodynamically from neuroleptics whose active metabolites are less behaviorally distinctive. Several other inactive metabolites are formed in lesser amounts. Quetiapine itself has negligible CYP-inhibitory activity but is sensitive to inhibition and induction of CYP3A4.<ref name="seroquel-label"/>		\| pk_metabolism = Quetiapine is extensively metabolized in the liver, predominantly via [[Enzyme:CYP3A4\|CYP3A4]], with minor contributions from [[Enzyme:CYP2D6\|CYP2D6]]. The principal active metabolite is N-desalkylquetiapine (also called norquetiapine), formed via CYP3A4-mediated dealkylation; norquetiapine has a longer half-life (~9-12 hours) than the parent compound (~6 hours) and a distinct receptor binding profile, with substantially higher affinity for the [[Norepinephrine transporter\|norepinephrine transporter]] (NET) than the parent compound. The norquetiapine NET binding is one mechanism proposed for quetiapine's efficacy in bipolar depression and as an MDD adjunct, distinguishing it pharmacodynamically from neuroleptics whose active metabolites are less behaviorally distinctive. Several other inactive metabolites are formed in lesser amounts. Quetiapine itself has negligible CYP-inhibitory activity but is sensitive to inhibition and induction of CYP3A4.<ref name="seroquel-label"/>
	\| pk_elimination = Elimination is renal (73%) and fecal (20%), almost entirely as metabolites; less than 1% of an oral dose is recovered unchanged in urine. Mean parent half-life is approximately 6 hours for immediate-release quetiapine; the active norquetiapine metabolite has a half-life of approximately 9-12 hours and contributes meaningfully to the clinical duration of action. Half-life is prolonged in elderly patients (mean clearance reduced approximately 30-50%) and in hepatic impairment.<ref name="seroquel-label"/>		\| pk_elimination = Elimination is renal (73%) and fecal (20%), almost entirely as metabolites; less than 1% of an oral dose is recovered unchanged in urine. Mean parent half-life is approximately 6 hours for immediate-release quetiapine; the active norquetiapine metabolite has a half-life of approximately 9-12 hours and contributes meaningfully to the clinical duration of action. Half-life is prolonged in elderly patients (mean clearance reduced approximately 30-50%) and in hepatic impairment.<ref name="seroquel-label"/>
	\| pharmacodynamics = Quetiapine is a broad-receptor-binding atypical neuroleptic with the receptor profile that defines the second-generation class: substantial antagonism at both serotonin [[5-HT2A receptor\|5-HT2A]] and dopamine [[Dopamine receptor D2\|D2]] receptors, with the 5-HT2A:D2 affinity ratio higher than at the older neuroleptics. The conventional explanation for the lower extrapyramidal liability of atypical neuroleptics is that pre-frontal 5-HT2A antagonism increases mesocortical [[Dopamine\|dopamine]] release while striatal D2 occupancy is partial, reducing the basal-ganglia dopamine blockade that drives the movement-disorder spectrum.		\| pharmacodynamics = Quetiapine is a broad-receptor-binding atypical neuroleptic with the receptor profile that defines the second-generation class: substantial antagonism at both serotonin [[5-HT2A receptor\|5-HT2A]] and dopamine [[Dopamine receptor D2\|D2]] receptors, with the 5-HT2A:D2 affinity ratio higher than at the older neuroleptics. The conventional explanation for the lower extrapyramidal liability of atypical neuroleptics is that pre-frontal 5-HT2A antagonism increases mesocortical [[Dopamine\|dopamine]] release while striatal D2 occupancy is partial, reducing the basal-ganglia dopamine blockade that drives the movement-disorder spectrum.

MDElliottMD: Quetiapine link+terminology redo: antipsychotic->neuroleptic sweep, dense wikilinks, classes field + footer category fixes (web-claude redo; pharmacist-claude + category-claude verified)

2026-05-22T02:41:25Z

Quetiapine link+terminology redo: antipsychotic->neuroleptic sweep, dense wikilinks, classes field + footer category fixes (web-claude redo; pharmacist-claude + category-claude verified)

Show changes

MDElliottMD: Quetiapine: full prescribing-guide page. History-first intro and History (Seroquel discovery at ICI, the CATIE trial, the 2010 AstraZeneca off-label settlement), the off-label-versus-approved editorial framing, pharmacokinetics, pharmacodynamics, interactions, metabolic monitoring with overdose folded into Monitoring. Clinically reviewed by pharmacist-claude; filed Pharmaceutical

2026-05-21T18:01:55Z

Quetiapine: full prescribing-guide page. History-first intro and History (Seroquel discovery at ICI, the CATIE trial, the 2010 AstraZeneca off-label settlement), the off-label-versus-approved editorial framing, pharmacokinetics, pharmacodynamics, interactions, metabolic monitoring with overdose folded into Monitoring. Clinically reviewed by pharmacist-claude; filed Pharmaceutical

Show changes

MDElliottMD: Dedupe migration per interface-claude 2026-05-20: Antipsychotics / Neuroleptics merged into canonical Neuroleptics. Member retagged.

2026-05-19T18:00:18Z

Dedupe migration per interface-claude 2026-05-20: Antipsychotics / Neuroleptics merged into canonical Neuroleptics. Member retagged.

← Older revision		Revision as of 18:00, 19 May 2026
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	}}		}}


	~~[[Category:Antipsychotics / Neuroleptics]]~~
	[[Category:Second-Generation Antipsychotics (SGAs / Atypicals)]]		[[Category:Second-Generation Antipsychotics (SGAs / Atypicals)]]
	[[Category:Neuroleptics]]		[[Category:Neuroleptics]]

MediaWiki default: Assign pharmacological categories from List_of_CNS-active_medicines

2026-05-14T15:06:51Z

Assign pharmacological categories from List_of_CNS-active_medicines

← Older revision		Revision as of 15:06, 14 May 2026
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	}}		}}


			[[Category:Antipsychotics / Neuroleptics]]
			[[Category:Second-Generation Antipsychotics (SGAs / Atypicals)]]
	[[Category:Neuroleptics]]		[[Category:Neuroleptics]]

MDElliottMD: Pharmacopedia: add

2026-05-14T03:31:07Z

Pharmacopedia: add <pharmaInteractions/>

← Older revision		Revision as of 03:31, 14 May 2026
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	\| dosing =		\| dosing =
	\| effects =		\| effects =
	\| interactions =		\| interactions = <pharmaInteractions/>
	\| pregnancy_details =		\| pregnancy_details =
	\| monitoring =		\| monitoring =

← Older revision		Revision as of 10:40, 23 May 2026
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	\| pregnancy_details = Quetiapine crosses the placenta in modest amounts (umbilical cord-to-maternal plasma ratio approximately 24%, lower than risperidone or olanzapine).<ref name="newport2007">Newport DJ, Calamaras MR, DeVane CL, Donovan J, Beach AJ, Winn S, Knight BT, Gibson BB, Viguera AC, Owens MJ, Nemeroff CB, Stowe ZN. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. American Journal of Psychiatry. 2007;164(8):1214-1220. PMID: 17671284.</ref> The pregnancy literature on atypical neuroleptics has substantially attenuated earlier concerns about teratogenicity; recent large cohort analyses using active-comparator designs and confounding-by-indication adjustment have found no consistent signal for major congenital malformations with quetiapine specifically.<ref name="huybrechts2016">Huybrechts KF, Hernandez-Diaz S, Patorno E, Desai RJ, Mogun H, Dejene SZ, Cohen JM, Panchaud A, Cohen L, Bateman BT. Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiatry. 2016;73(9):938-946. PMID: 27540849.</ref> Quetiapine is therefore frequently used in pregnancy when neuroleptic treatment is clinically necessary, both for primary indications such as bipolar disorder and schizophrenia and as a substitute for higher-risk medicines such as [[Valproic acid\|valproate]].		\| pregnancy_details = Quetiapine crosses the placenta in modest amounts (umbilical cord-to-maternal plasma ratio approximately 24%, lower than risperidone or olanzapine).<ref name="newport2007">Newport DJ, Calamaras MR, DeVane CL, Donovan J, Beach AJ, Winn S, Knight BT, Gibson BB, Viguera AC, Owens MJ, Nemeroff CB, Stowe ZN. Atypical antipsychotic administration during late pregnancy: placental passage and obstetrical outcomes. American Journal of Psychiatry. 2007;164(8):1214-1220. PMID: 17671284.</ref> The pregnancy literature on atypical neuroleptics has substantially attenuated earlier concerns about teratogenicity; recent large cohort analyses using active-comparator designs and confounding-by-indication adjustment have found no consistent signal for major congenital malformations with quetiapine specifically.<ref name="huybrechts2016">Huybrechts KF, Hernandez-Diaz S, Patorno E, Desai RJ, Mogun H, Dejene SZ, Cohen JM, Panchaud A, Cohen L, Bateman BT. Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiatry. 2016;73(9):938-946. PMID: 27540849.</ref> Quetiapine is therefore frequently used in pregnancy when neuroleptic treatment is clinically necessary, both for primary indications such as bipolar disorder and schizophrenia and as a substitute for higher-risk medicines such as [[Valproic acid\|valproate]].

	Third-trimester exposure is associated with transient neonatal symptoms, including extrapyramidal signs, feeding difficulty, respiratory distress, and uncommonly withdrawal, typically resolving within days. [[Gestational diabetes\|Gestational diabetes]] risk may be modestly elevated by maternal quetiapine; routine glucose screening in pregnancy applies. Breastfeeding while taking quetiapine produces low infant ~~drug~~ exposure (relative infant dose typically less than 1%), and quetiapine is among the neuroleptics considered compatible with breastfeeding.		Third-trimester exposure is associated with transient neonatal symptoms, including extrapyramidal signs, feeding difficulty, respiratory distress, and uncommonly withdrawal, typically resolving within days. [[Gestational diabetes\|Gestational diabetes]] risk may be modestly elevated by maternal quetiapine; routine glucose screening in pregnancy applies. Breastfeeding while taking quetiapine produces low infant medicine exposure (relative infant dose typically less than 1%), and quetiapine is among the neuroleptics considered compatible with breastfeeding.

	For women with bipolar disorder or schizophrenia maintained on quetiapine who become pregnant, continuation is generally preferred to discontinuation because of relapse risk; the medicine's relative safety profile in pregnancy makes the maternal mental health argument straightforward. For women on quetiapine off-label for sleep or anxiety, pregnancy is an appropriate occasion to deprescribe in favor of behavioral interventions or, where pharmacotherapy is required, evidence-based alternatives such as the SSRI [[Sertraline\|sertraline]].		For women with bipolar disorder or schizophrenia maintained on quetiapine who become pregnant, continuation is generally preferred to discontinuation because of relapse risk; the medicine's relative safety profile in pregnancy makes the maternal mental health argument straightforward. For women on quetiapine off-label for sleep or anxiety, pregnancy is an appropriate occasion to deprescribe in favor of behavioral interventions or, where pharmacotherapy is required, evidence-based alternatives such as the SSRI [[Sertraline\|sertraline]].
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	Management is primarily supportive: airway protection, intravenous fluids for hypotension, ECG monitoring with attention to QT and arrhythmias, cardiac monitoring for at least 24 hours in significant ingestions. [[Activated charcoal\|Activated charcoal]] may be considered within one hour of ingestion if the airway is protected. [[:Category:Vasopressors\|Vasopressors]] ([[Norepinephrine (medication)\|norepinephrine]] preferred over [[Dopamine (medication)\|dopamine]], given quetiapine's alpha-1 antagonism) for refractory hypotension. There is no specific antidote. [[Hemodialysis\|Hemodialysis]] is not effective owing to the large volume of distribution.		Management is primarily supportive: airway protection, intravenous fluids for hypotension, ECG monitoring with attention to QT and arrhythmias, cardiac monitoring for at least 24 hours in significant ingestions. [[Activated charcoal\|Activated charcoal]] may be considered within one hour of ingestion if the airway is protected. [[:Category:Vasopressors\|Vasopressors]] ([[Norepinephrine (medication)\|norepinephrine]] preferred over [[Dopamine (medication)\|dopamine]], given quetiapine's alpha-1 antagonism) for refractory hypotension. There is no specific antidote. [[Hemodialysis\|Hemodialysis]] is not effective owing to the large volume of distribution.

	Co-ingestion is the rule rather than the exception in quetiapine overdose; alcohol, benzodiazepines, and opioids substantially worsen prognosis. The widespread availability of quetiapine in homes where it is prescribed off-label for insomnia has contributed to its prominence in suicidal overdose attempts; counseling about safe ~~medication~~ storage and limited dispense quantities in at-risk patients is appropriate.		Co-ingestion is the rule rather than the exception in quetiapine overdose; alcohol, benzodiazepines, and opioids substantially worsen prognosis. The widespread availability of quetiapine in homes where it is prescribed off-label for insomnia has contributed to its prominence in suicidal overdose attempts; counseling about safe medicine storage and limited dispense quantities in at-risk patients is appropriate.
	\| counseling = '''Off-label use: most quetiapine prescriptions are for indications the medicine is not formally approved to treat.''' If quetiapine has been prescribed for sleep, anxiety, agitation, or PTSD, the patient should understand that the prescribing is off-label, that the evidence base for these indications is modest, that the metabolic and cardiovascular risk profile applies even at low doses, and that evidence-based alternatives exist ([[Cognitive behavioral therapy for insomnia\|cognitive behavioral therapy for insomnia]], SSRIs and SNRIs for anxiety, exposure-based therapies for PTSD).		\| counseling = '''Off-label use: most quetiapine prescriptions are for indications the medicine is not formally approved to treat.''' If quetiapine has been prescribed for sleep, anxiety, agitation, or PTSD, the patient should understand that the prescribing is off-label, that the evidence base for these indications is modest, that the metabolic and cardiovascular risk profile applies even at low doses, and that evidence-based alternatives exist ([[Cognitive behavioral therapy for insomnia\|cognitive behavioral therapy for insomnia]], SSRIs and SNRIs for anxiety, exposure-based therapies for PTSD).