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Aktivní složka: Quetiapin
Značka (y): Seroquel, Qutan

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Quetiapine Drug Recommendation

Within the occasion of psychosis with out agitation, give an antipsychotic based mostly on the reason for the psychosis, efficacy, negative effects and type of administration. Give a benzodiazepine if agitation prevails. If this isn’t potential, give the mixture haloperidol and promethazine. Remedy-resistant psychosis will be handled with clozapine after successive use of two totally different antipsychotics. Intensive monitoring is indicated, resembling leukocyte monitoring due to the chance of agranulocytosis. 

Bipolar dysfunction is handled by or in session with a specialist group. For a extreme manic episode, haloperidol, olanzapine, quetiapine or risperidone are the medication of first selection. For a extreme depressive episode, quetiapine or the mixture of olanzapine and fluoxetine (SSRI) are the medication of first selection. Think about lithium or valproic acid as monotherapy for each forms of episodes.

Quetiapine Indications

  • Remedy of schizophrenia.
  • Remedy of reasonable to extreme manic episode and extreme depressive episode in bipolar dysfunction.
  • Prevention of a recurrent manic or depressive episode in sufferers with bipolar dysfunction, who beforehand responded nicely to quetiapine.

Solely the managed launch pill:

  • adjunctive remedy of main depressive episode in sufferers with unipolar melancholy who don’t reply adequately to monotherapy with an antidepressant; take into account security profile earlier than beginning.

Co byste měli před použitím tohoto léku prodiskutovat se svým lékařem

  • Být těhotná
    • Teratogenesis: In people, inadequate information. Indications of harmfulness in animals.
    • Pharmacological impact: Antipsychotics could cause extrapyramidal problems when used within the third trimester and withdrawal signs within the neonate when used for a very long time till partus.
    • Advice: Can most likely be used safely within the 1st and 2nd trimester. When utilized in 3E trimester, the new child ought to be monitored for extrapyramidal signs and/or withdrawal signs.
    • Different: Failure to adequately deal with a pregnant lady with psychosis or mania can have critical penalties for each mom and youngster. Instantly stopping or switching an antipsychotic throughout being pregnant will increase the chance of a relapse. Due to this fact, if potential, swap antipsychotics earlier than conception.

  • Laktace
    • Transition into breast milk: Sure. Restricted expertise doesn’t recommend any hostile results on the toddler. The quantity handed into breast milk and the relative toddler dose look like low.
    • Advice: Can most likely be used safely. Intention for monotherapy on the lowest potential dose. Monitor the toddler for drowsiness or irritability, apnoea, dry mouth, failure to get up for feedings, poor consuming, weight acquire or extrapyramidal signs.

Quetiapine Drug Interactions

Contraindicated is the concomitant use of a powerful CYP3A4 inhibitor:

  • klarithromycin
  • erythromycin
  • ketokonazol
  • itrakonazol
  • posaconazole
  • HIV protease inhibitors as a consequence of a major inhibition of quetiapine degradation.

Consuming grapefruit juice throughout remedy just isn’t really helpful. Concomitant use of robust CYP3A4 inducers:

  • karbamazepin
  • rifampicin
  • St. John’s wort and phenytoin solely when strictly vital, as a consequence of accelerated degradation of quetiapine.

Warning is suggested in case of concomitant use of alcohol or centrally performing medication, anticholinergics and with medication that disrupt electrolyte stability or lengthen QT interval. Uncomfortable side effects (extrapyramidal signs, drowsiness, weight acquire) are extra frequent together with lithium. Together with valproic acid, leukopenia and neutropenia happen extra regularly.

Quetiapine Dosage

  1. Schizophrenia:
    • Dospělí:
      • Pill: divide each day dose over 2 doses; when beginning, construct up the dose in 4 days:
        • day 1: 50 mg,
        • day 2: 100 mg,
        • day 3: 200 mg,
        • day 4: 300 mg. Thereafter, titrate to a upkeep dosage of 300-450 mg per day; most 750 mg per day.
      • Regulated launch tablets: titrate to the standard dosage of 400-800 mg not less than 1 hour earlier than a meal 1×/day;
        • day 1: 300 mg;
        • day 2: 600 mg each day;
        • upkeep dosage: 600 mg/day, if vital as much as 800 mg/day.

  2. Manic episode:
    • Dospělí:
      • Pill: each day dose divided over 2 doses;
        • day 1: 100 mg,
        • day 2: 200 mg,
        • day 3: 300 mg,
        • day 4: 400 mg, if vital enhance by max. 200 mg/day to 800 mg/day on day 6. Thereafter, escalate to upkeep dosage of 200-800 mg/day based mostly on scientific response; normally 400-800 mg/day.
      • Regulated launch tablets: titrate to the standard dose of 400-800 mg not less than 1 hour earlier than a meal as soon as each day;
        • day 1: 300 mg;
        • day 2: 600 mg each day;
        • upkeep dose: 600 mg/day, as much as 800 mg/day if vital.

  3. Bipolar melancholy:
    • Dospělí:
      • Regulated and unregulated launch tablets: 1×/day dosing at bedtime;
        • day 1: 50 mg,
        • day 2: 100 mg,
        • day 3: 200 mg,
        • day 4: 300 mg; really helpful dose: 300 mg/day, titrating to 600 mg/day if vital on the premise of response. In scientific research, 600 mg/day was no simpler than 300 mg/day. Doses > 300 mg ought to solely be initiated by physicians skilled within the remedy of bipolar dysfunction. If tolerance issues are anticipated, a dose discount to a each day dose of not less than 200 mg could also be thought-about.

  4. Prevention of relapse of bipolar dysfunction:
    • Dospělí:
      • Proceed the identical dosage as within the acute remedy. Inside the dose vary of 300-800 mg/day, intention for the bottom potential dose in response to response and tolerability.

  5. As an adjunct to antidepressants for depressive episodes in unipolar melancholy:
    • Dospělí:
      • Regulated-release pill: 1×/day dosing earlier than bedtime;
        • day 1-2: 50 mg,
        • day 3-4: 150 mg; provided that vital then enhance to 300 mg/day, as a consequence of elevated threat of negative effects with greater doses.
    • Aged individuals:
      • Day 1-3: 50 mg, day 4: 100 mg/day; additional enhance to 150 mg/day on day 8; provided that vital then enhance to a most of 300 mg/day from day 22.

  6. Basic dávkování suggestion for the aged: if vital, decelerate dosage in 50 mg steps per day; begin with 50 mg per day. The required upkeep dosage is normally decrease. Additionally titrate extra slowly in sufferers with heart problems.
  7. Decreased liver operate:
    • Beginning dose pill: 25 mg/day
    • managed launch pill: 50 mg/day
    • enhance each day by 25-50 mg till an efficient dose is reached
  8. Snížená funkce ledvin: není nutná úprava dávky.

Příznaky předávkování

  • ospalost
  • sedace
  • kóma
  • laboured respiration
  • delirium
  • záchvaty
  • stojící epileptik
  • tachykardie
  • hypotenze
  • anticholinergní výsledky
  • zadržování moči
  • rabdomyolýza
  • loss of life

Quetiapine Precautions

  1. Metabolic threat: Monitor the metabolic profile earlier than the beginning and recurrently throughout remedy due to potential modifications in these parameters; significantly in diabetes mellitus. Deal with any deterioration of the metabolic threat profile.

  2. Neutropenia: If neutrophil rely < 1.0 × 10 9/l, discontinue remedy. Observe indicators and signs of an infection and monitor neutrophil rely till it reaches > 1.5 × 109 /l. If an infection or fever happens, take into account neutropenia. Sufferers ought to report signs of an infection, decide leukocyte differentiation in them instantly.

  3. Suicide: The elevated threat of suicide in melancholy and bipolar dysfunction within the early levels of restoration might proceed to extend. In sufferers < 25 years of age the chance of suicide-related occasions is elevated. Mixed with different antidepressants, quetiapine will increase the chance of self-harm and suicide in sufferers aged 25-64 years with no historical past of self-harm. Abuse has been reported. Use warning in sufferers with a historical past of alcohol or drug abuse.

  4. Extrapyramidal results: If indicators of tardive dyskinesia happen throughout use, cut back the dose or discontinue remedy. After discontinuation, these signs might quickly worsen and even happen. If acathisia happens throughout the first weeks of remedy, growing the dose could also be dangerous. With the intention to keep away from acute withdrawal signs, discontinue remedy steadily over a interval of not less than 1-2 weeks.

  5. Neuroleptic malignant syndrome (NMS): If indicators of NMS seem, discontinue administration instantly.

  6. Sleepiness: When extreme sleepiness happens within the remedy of bipolar melancholy, extra frequent remedy contacts are vital; take into account discontinuing remedy.

  7. Dementia: Attributable to a tripling of the chance of cerebrovascular hostile occasions and elevated mortality in aged sufferers with dementia when utilizing some atypical antipsychotics, administration just isn’t really helpful in dementia sufferers with a historical past of CVA/TIA, hypertension or diabetes. Use with warning in extreme natural cerebral problems, epilepsy and Lewy-body dementia.

  8. Parkinson’s illness: Within the remedy of melancholy, sufferers > 65 years of age with Parkinson’s illness have a better threat of loss of life; due to this fact, warning ought to be exercised within the aged with Parkinson’s illness.

  9. Anticholinergic results: In urinary retention, prostatic hypertrophy, intestinal obstruction, elevated intraocular strain and narrow-angle glaucoma, as a result of reasonable to robust anticholinergic exercise of norquetiapine.

  10. Critical pores and skin reactions: Within the occasion of indicators and signs of extreme pores and skin reactions, quetiapine ought to be discontinued instantly.

  11. Comorbidity: Warning ought to be exercised in circumstances of aspiration pneumonia, sleep apnoea (threat elements), QT prolongation within the household historical past, cardio- or cerebrovascular illness or different elements predisposing to hypotension, threat elements for venous thromboembolism and convulsions within the historical past. In heart problems take into account a slower titration.

  12. Laboratory assessments: Enzyme immunoassay use of quetiapine might result in false constructive outcomes for methadone and tricyclic antidepressants; if doubtful, verify outcomes with an applicable chromatography approach.

  13. Analysis information: Extra negative effects (extrapyramidal signs and irritability) have been reported in youngsters and the long-term security implications on development, maturation, cognitive and behavioural improvement are unknown. The long-term security and efficacy if add-on remedy in unipolar melancholy has not been established. Security and efficacy haven’t but been established in youngsters < 18 years of age, nor in sufferers > 65 years of age with depressive episodes within the context of bipolar melancholy. When utilized in a manic episode, there are few information on comedication with lithium and valproic acid as much as six weeks of use.

Quetiapine Side Effects

  • ospalost
  • suchá ústa
  • závrať
  • bolest hlavy
  • extrapyramidové znaky
  • nabrat na váze
  • withdrawal signs after discontinuation
  • enhance in serum triglycerides and complete ldl cholesterol (primarily LDL)
  • lower in HDL
  • hyperprolaktinémie
  • lower in complete and free T4
  • lower in complete T3
  • enhance in TSH
  • zvýšená chuť k jídlu
  • irregular goals
  • noční můry
  • suicidal ideas and behavior
  • podrážděnost
  • pyrexia
  • dysarthria
  • hypersensitivity (together with allergic pores and skin response)
  • Prodloužení QT

Elevated blood strain can be quite common in youngsters aged 10-17 years. Additionally extra frequent than in adults are elevated urge for food, hyperprolactinemia and extrapyramidal signs.

Zřeknutí se odpovědnosti

Information concerning psychotic disorders, included within the review of Quetiapine, is used for the informative features exclusively as well as should not be thought-about to alternative to licensed healthcare or referral of the well being treatment distributor.

 

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Často kladené otázky

  • What is Quetiapine?

    Quetiapine is used alone or together with other medicines to treat bipolar disorder (depressive and manic episodes) and schizophrenia. Quetiapine extended-release tablet is also used together with other antidepressants to treat major depressive disorder.

  • Co dělat, když vynecháte dávku?

    If you miss a dose of Quetiapine, take it as quickly as potential. However, whether it is virtually time to your subsequent dose, skip the missed dose and return to your common dosing schedule. Do not double doses.

  • What if u take too much Quetiapine?

    Pokud dojde k předávkování, pojmenujte svého lékaře nebo zavolejte do nejbližší nemocnice. Možná máte naléhavou lékařskou péči. Můžete se také obrátit na správu jedů ve vaší místní nemocnici.

  • How to store Quetiapine?

    Store at room temperature (15-25ºC)

  • What Should I Avoid While Taking Quetiapine?

    Avoid consuming alcohol or utilizing unlawful medicine when you are taking Quetiapine. They might lower the advantages (e.g. worsen your confusion) and improve hostile results (e.g. sedation) of the remedy.

  • Jaké jsou vedlejší účinky kvetiapinu?

    The most common side effects include chills, cold sweats, confusion, dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position and sleepiness or unusual drowsiness.


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