Periodically re-assess the need for continued therapy. Co-administration of trifluoperazine with atypical agents (e.g., lurasidone and others) may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Dantrolene: (Moderate) Simultaneous use of dantrolene and other CNS depressants such as antipsychotics can increase CNS depression (e.g., drowsiness). Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Limit the use of opioid pain medications with quetiapine to only patients for whom alternative treatment options are inadequate. The concomitant use of serotonergic drugs increases the risk of serotonin syndrome. Acetaminophen; Caffeine; Dihydrocodeine: (Major) Concomitant use of opioid agonists with quetiapine may cause excessive sedation and somnolence. Possible mechanisms include atypical antipsychotic-induced insulin resistance or direct beta-cell inhibition. Lens changes have also been observed with long-term therapy in humans, however, a causal relationship has not been established. The manufacturer of quetiapine recommends a reduced dosage during concurrent administration of CYP3A4 inhibitors. We comply with the HONcode standard for trustworthy health information. There also may be additive sedation. Monitor patients on antidiabetic agents for worsening glycemic control. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. The risk of next-day impairment, including impaired driving, is increased if suvorexant is taken with other CNS depressants. Possible mechanisms include atypical antipsychotic-induced insulin resistance or direct beta-cell inhibition. Cobicistat: (Major) The plasma concentrations of quetiapine may be elevated when administered concurrently with cobicistat. Methohexital: (Major) Coadministration of barbiturates, potent CYP3A4 inducers, with quetiapine, a CYP3A4 substrate, may result in decreased exposure to quetiapine. Ivosidenib: (Major) Avoid coadministration of ivosidenib with quetiapine due to an increased risk of QT prolongation. Concomitant use increases the risk for serotonin syndrome and additive hypotension and CNS depression. COMT inhibitors: (Moderate) Monitor for movement disorders, unusual changes in moods or behavior, and diminished effectiveness of the atypical antipsychotic or COMT inhibitor during coadministration. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. The likelihood of pharmacodynamic interactions varies based upon the individual properties of the co-administered antipsychotic agent. Additive drowsiness or other CNS effects may occur. The degree of QT prolongation associated with rilpivirine is not clinically significant when administered within the recommended dosage range; QT prolongation has been described at 3 times the maximum recommended dose. In general, atypical antipsychotics are less likely to interfere with rasagiline than traditional antipsychotics. Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Seroquel only for the indication prescribed. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. Efavirenz: (Major) Limited data, including some case reports, suggest that quetiapine may be associated with a significant prolongation of the QTc interval in rare instances. Butabarbital: (Major) Coadministration of barbiturates, potent CYP3A4 inducers, with quetiapine, a CYP3A4 substrate, may result in decreased exposure to quetiapine. Co-administration of quetiapine with sedating H1-blockers may result in additive effects. Concomitant use of tramadol and quetiapine may increase seizure risk and cause additive CNS depression. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Mitotane is a strong CYP3A4 inducer and quetiapine is a CYP3A4 substrate; coadministration may result in decreased plasma concentrations of quetiapine. (Moderate) Monitor blood glucose during concomitant atypical antipsychotic and metformin use. Atypical antipsychotic therapy may aggravate diabetes mellitus. Concurrent use may result in additive CNS depression. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Atypical antipsychotic therapy may aggravate diabetes mellitus. The degree of QT prolongation associated with rilpivirine is not clinically significant when administered within the recommended dosage range; QT prolongation has been described at 3 times the maximum recommended dose. Quetiapine is used to treat certain mental/mood conditions (such as schizophrenia, bipolar disorder, sudden episodes of mania or depression associated with bipolar disorder). Homatropine; Hydrocodone: (Major) Concomitant use of opioid agonists with quetiapine may cause excessive sedation and somnolence. Metformin; Repaglinide: (Moderate) Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia. (Moderate) Somnolence is a commonly reported adverse effect of quetiapine. Overall, the 150 mg/day dose was associated with more positive secondary efficacy results than 50 mg/day and 300 mg/day versus placebo. 2016;10:259-76. Although the incidence of tardive dyskinesia from antipsychotic combinations has not been established and data are very limited, the risk may be increased during combined use versus use of an antipsychotic alone. Co-administration of quetiapine with sedating H1-blockers may result in additive effects. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Atypical antipsychotic therapy may aggravate diabetes mellitus. Esketamine: (Major) Closely monitor patients receiving esketamine and quetiapine for sedation and other CNS depressant effects. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Reduce the quetiapine dose to 1/6 the original dose in patients also receiving cyclosporine, because the magnitude of this interaction may be increased. If serotonin syndrome occurs, discontinue therapy. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. The likelihood of pharmacodynamic interactions varies based upon the individual properties of the co-administered antipsychotic agent. Avoid prescribing opioid cough medication in patients taking quetiapine. Although the incidence of tardive dyskinesia from combination antipsychotic therapy has not been established and data are very limited, the risk appears to be increased during use of a conventional and atypical antipsychotic versus use of a conventional antipsychotic alone. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Gilteritinib: (Major) Concomitant use of quetiapine and gilteritinib increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Thioridazine: (Contraindicated) Thioridazine, a phenothiazine, is associated with an established risk of QT prolongation and torsade de pointes (TdP) and is contraindicated for use with other drugs that are known to prolong the QT interval, such as quetiapine. Concomitant use may result in additive CNS depression or anticholinergic effects. If coadministration cannot be avoided, the manufacturer of quetiapine recommends reducing the dose of quetiapine to one sixth of the current dose in combination with a potent CYP3A4 inhibitor. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Indications Amiodarone: (Major) Concomitant use of amiodarone and quetiapine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Usual dose: 400 to 600 mg/day. Also monitor patients for the emergence of serotonin syndrome. In general, atypical antipsychotics are less likely to interfere with pramipexole than traditional antipsychotics. The possibility of multiple drug involvement should be considered. Promethazine: (Major) Concomitant use of quetiapine and promethazine increases the risk of QT/QTc prolongation and torsade de pointes (TdP) and additive anticholinergic effects, CNS depression, and serotonin syndrome. Usual dose: 400 to 800 mg/day. Lemborexant: (Moderate) Monitor for excessive sedation and somnolence during coadministration of lemborexant and atypical antipsyhotics. [1] FDA-approved Indications Schizophrenia if the patient is over the age of 13 years Bipolar I disorder, for acute treatment of manic or mixed episodes. There may be a slightly increased risk of serious, possibly fatal side effects (such as stroke, heart failure, fast/irregular heartbeat, pneumonia) when this medication is used by older adults with. RE-INITIATION OF TREATMENT: If therapy is discontinued for less than 1 week and subsequently re-initiated, the same dose/schedule may be used without titration. Lithium: (Major) Concomitant use of lithium and quetiapine increases the risk of QT/QTc prolongation and torsade de pointes (TdP) as well as an encephalopathic syndrome that may be similar to or the same as neuroleptic malignant syndrome. Caution is also advised since both drugs act on the CNS. Anticholinergic effects observed during therapeutic use of quetiapine are thought to be associated with norquetiapine, an active metabolite of quetiapine which has demonstrated a moderate to strong in vitro binding affinity for several muscarinic receptor subtypes. Nelfinavir: (Major) Avoid concurrent use of quetiapine and nelfinavir. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Also monitor patients for the emergence of serotonin syndrome. The bioavailability of the formulations is comparable. There are no adequate and well-controlled studies of quetiapine in pregnant women; therefore, quetiapine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. This includes prescription and over-the-counter medicines, vitamins, and herbal products. The dose of quetiapine should be increased by up to 5-fold when combined with chronic administration (7 to 14 days) of a potent CYP3A4 inducer. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. During concomitant use of strong CYP3A4 inhibitors (e.g., ketoconazole, ritonavir), reduce the quetiapine dose to one-sixth of the previous dose. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. Meglitinides: (Moderate) Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia. Co-administration of quetiapine with sedating H1-blockers may result in additive effects. Acetaminophen; Chlorpheniramine: (Moderate) Somnolence is a commonly reported adverse effect of quetiapine. Federal government websites often end in .gov or .mil. Intestinal obstruction has been reported with quetiapine, including fatal cases in patients who were receiving multiple concomitant medications that decrease intestinal motility. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. Dabrafenib is a moderate CYP3A4 inducer and quetiapine is a sensitive CYP3A4 substrate. Possible mechanisms include atypical antipsychotic-induced insulin resistance or direct beta-cell inhibition. Alfentanil: (Major) Concomitant use of opioid agonists with quetiapine may cause excessive sedation and somnolence. The likelihood of these pharmacodynamic interactions varies based upon the individual properties of the co-administered antipsychotic agent. Consider the patient's use of alcohol or illicit drugs. Taking antipsychotic medication during the last 3 months of pregnancy may cause problems in the newborn, such as withdrawal symptoms, breathing problems, feeding problems, fussiness, tremors, and limp or stiff muscles. The Beers Criteria recognize quetiapine and clozapine as exceptions to the general recommendation to avoid all antipsychotics in older adults with Parkinson's disease. Additive drowsiness or other CNS effects may occur. Therefore, extended-release quetiapine should be administered without food or with a light meal only. Lumacaftor; Ivacaftor: (Major) Lumacaftor; ivacaftor may reduce the efficacy of quetiapine by decreasing its systemic exposure. Swallow whole. Monitor patients for signs and symptoms of serotonin syndrome during concomitant use, particularly during treatment initiation and dosage increases. Also, quetiapine and apomorphine may reduce the effectiveness of each other through opposing effects on dopamine. Letermovir: (Moderate) Caution is advised when administering quetiapine with letermovir, as taking these drugs together may increase quetiapine concentration and risk for adverse events. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Possible mechanisms include atypical antipsychotic-induced insulin resistance or direct beta-cell inhibition. Although the incidence of tardive dyskinesia from combination antipsychotic therapy has not been established and data are very limited, the risk appears to be increased during use of a conventional and atypical antipsychotic versus use of a conventional antipsychotic alone. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Chlordiazepoxide: (Moderate) Somnolence is a commonly reported adverse effect of quetiapine; coadministration of quetiapine with anxiolytics, sedatives, and hypnotics, or other CNS depressants may result in additive sedative effects. Maximum: 800 mg/day PO. Quetiapine is not approved for the treatment of major depressive disorder (MDD) in pediatric patients less than 18 years of age. Selegiline: (Moderate) Monitor for loss of selegiline efficacy, signs and symptoms of serotonin syndrome, particularly during treatment initiation and dosage increase, and unusual drowsiness and sedation during concomitant atypical antipsychotic and selegiline use. Atypical antipsychotic therapy may aggravate diabetes mellitus. If a centrally acting medication needs to be used with butorphanol, use the smallest effective dose and the longest dosing frequency of butorphanol. The exact mechanism of action of quetiapine in treating schizophrenia has not been determined. If antipsychotic use is necessary in geriatrics with a history of falls or fractures, consider reducing the use of other CNS depressants and implement other fall risk strategies. Quetiapine is a CYP3A substrate and ketoconazole is a strong CYP3A inhibitor. 2017 Oct;27(10):959-969. Concomitant use may result in additive CNS depression or anticholinergic adverse effects. 25 mg PO twice daily for 1 day, then 50 mg PO twice daily, initially. Consider a slow rate of dose titration and a lower target dose in debilitated patients or patients at risk for hypotension. Avoid prescribing opioid cough medication in patients taking quetiapine. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. The increase in QTc is approximately 10 milliseconds at doses of 400 mg twice daily (the FDA-approved dose) and up to 25 milliseconds at doses of 1600 mg twice daily. PDF Reference ID: 3397413 - Food and Drug Administration Limited data, including some case reports, suggest that quetiapine may be associated with a significant prolongation of the QTc interval in rare instances. All trademarks used are the properties of their respective owners. The risk of these adverse effects may be increased during concurrent use of lurasidone with other antipsychotics. If apalutamide is discontinued, reduce the quetiapine dose to the original level in 7 to 14 days. The concomitant use of opioids with other drugs that affect the serotonergic neurotransmitter system has resulted in serotonin syndrome. Tolterodine has been associated with dose-dependent prolongation of the QT interval, especially in poor CYP2D6 metabolizers. Intestinal obstruction has been reported with quetiapine, including fatal reports in patients who were also receiving multiple medications that decrease intestinal motility. Albiglutide: (Moderate) Monitor blood glucose during concomitant atypical antipsychotic and incretin mimetic use. Also monitor patients for the emergence of serotonin syndrome. CrCl 10 mL/minute and above: No dosage adjustment is needed. Atypical antipsychotic therapy may aggravate diabetes mellitus. When the potent CYP3A4 inducer is discontinued, the quetiapine dose should be reduced to the original dose within 1 to 2 weeks. If delavirdine is discontinued, increase the quetiapine dose by 6-fold. Additive drowsiness or other CNS effects may occur. to a friend, relative, colleague or yourself. Identify the importance of interprofessional communication regarding the adverse effects of quetiapine. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Possible mechanisms include atypical antipsychotic-induced insulin resistance or direct beta-cell inhibition. The atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. When rifabutin is discontinued, the dose of quetiapine should be reduced to the original level within 7 to 14 days. Voriconazole has also been associated with rare cases of torsades de pointes, cardiac arrest, and sudden death. According to the manufacturer, use of quetiapine should be avoided in combination with drugs known to increase the QT interval, such as efavirenz. Darunavir may inhibit the CYP3A4 metabolism of quetiapine, resulting in elevated quetiapine plasma concentrations. Separate multiple email address with a comma. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Pioglitazone; Metformin: (Moderate) Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia. Aprepitant, when administered as a 3-day oral regimen (125 mg/80 mg/80 mg), is a moderate CYP3A4 inhibitor and inducer and may increase plasma concentrations of quetiapine. If therapy has been discontinued for more than 1 week, follow the initial titration schedule. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Data sources include IBM Watson Micromedex (updated 3 July 2023), Cerner Multum (updated 10 July 2023), ASHP (updated 10 July 2023) and others. Monitor for gastrointestinal adverse reactions related to hypomotility, unusual drowsiness and sedation, and signs and symptoms of serotonin syndrome during concomitant use, particularly during treatment initiation and dosage increases. Review/update the Because of the frequency and severity of adverse effects with antipsychotics, it is advisable to reserve the use of quetiapine for patients refractory to traditional therapies for depression and whose severity of illness outweighs the long-term risks of treatment with an antipsychotic. Max: 750 mg daily. and transmitted securely. The efficacy of SEROQUEL XR in manic or mixed episodes Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma.