QuetiapineNursing considerations

Side effects by what to assess

Sources: [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]

Blood glucose

Why

Hyperglycemia and diabetes

When

Fasting glucose at baseline and periodically with diabetes or risk factors; whenever hyperglycemia symptoms appear

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2]

Blood pressure

Why

Orthostatic hypotension; hypertension in children and teens

When

During titration; at baseline and periodically in children and adolescents

Normal

Below 120/80 mm Hg.

Sources: [1][2][3]

Body weight

Why

Weight gain

When

Regularly during treatment

Sources: [1]

LDL cholesterol

Why

Dyslipidemia

When

Fasting lipids at baseline and periodically

Normal

Below 100 mg/dL in adults 20 and older.

Sources: [1][2][3]

TSH (thyroid-stimulating hormone)

Why

Dose-related drop in thyroid hormone

When

If hypothyroidism is suspected

Normal

0.4 to 4.8 µU/mL.

Sources: [1][2]

White blood cell count

Why

Leukopenia, neutropenia, agranulocytosis

When

Frequently in the first few months for patients with prior low WBC or drug-induced neutropenia

Act on

Stop if neutrophils fall below 1000/mm³, or at the first WBC decline without another cause

Normal

4,500 to 11,000 per microliter.

Sources: [1][2]

High-alert status

Oral antipsychotics are not on the ISMP acute care high-alert list.

Sources: [1]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Boxed warning

Older adults with dementia-related psychosis treated with antipsychotics have a higher risk of death; quetiapine is not approved for them. Antidepressants raised suicidal thoughts and behavior in children, teens, and young adults; monitor all patients for worsening or suicidality. Not approved under age 10.

Sources: [1]

Antidote or reversal

No specific antidote. Overdose causes drowsiness, sedation, tachycardia, hypotension, and anticholinergic toxicity, with QT prolongation reported. Secure the airway and breathing, start continuous ECG monitoring at once, and give supportive care.

Sources: [1]

Patient teaching

• Rise slowly from sitting or lying to prevent dizziness and falls, especially in the first days
• Do not drive or use machinery until you know how drowsy it makes you; limit alcohol
• Watch for new or worse depression, agitation, or thoughts of suicide; families should watch daily
• Report fever, stiff muscles, or confusion right away
• Expect checks of weight, blood sugar, and cholesterol; report extreme thirst, frequent urination, or hunger
• Avoid overheating and dehydration
• Do not stop suddenly; talk to the prescriber first

Sources: [1][2][3][4]

Sound-alike and look-alike names

• QUEtiapine and OLANZapine
• SEROquel and SEROquel XR
• SEROquel and Serzone
• SEROquel and SINEquan

Sources: [1]

Adult dose

Schizophrenia

Day 1: 25 mg twice daily; increase by 25 to 50 mg on days 2 and 3 to 300 to 400 mg by day 4. Usual 150 to 750 mg/day; maximum 750 mg/day.

Bipolar mania (alone or with lithium or divalproex)

Total daily dose of 100, 200, 300, then 400 mg on days 1 to 4, given twice daily; then up to 800 mg/day by day 6. Usual 400 to 800 mg/day; maximum 800 mg/day.

Bipolar depression

Once at bedtime: 50 mg day 1, 100 mg day 2, 200 mg day 3, 300 mg day 4. Target and maximum 300 mg/day.

Bipolar I maintenance (with lithium or divalproex)

400 to 800 mg/day in two doses, usually the dose that stabilized the patient.

Sources: [1]

Renal adjustment

No specific dose adjustment is given; clinical experience in renal impairment is limited.

Sources: [1]

Hepatic adjustment

Start at 25 mg/day and increase daily by 25 to 50 mg/day as tolerated. Levels are higher because quetiapine is mostly cleared by the liver.

Sources: [1][2]

Mechanism

The exact mechanism is unclear; efficacy may come from combined dopamine D2 and serotonin 5HT2 antagonism. Its active metabolite norquetiapine also blocks muscarinic receptors. Strong histamine H1 and alpha-1 adrenergic binding explains sedation and orthostatic hypotension. It is cleared mainly by liver metabolism through CYP3A4, with a half-life of about 6 hours.

Sources: [1][2][3][4][5]