Precautions. The use of quetiapine should be avoided in combination with drugs known to increase QT interval, and caution should be exercised when quetiapine is used in combination with drugs known to cause electrolyte imbalance [see Warnings and Precautions Quetiapine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. Aggravation of diabetes mellitus has been reported. Coadministration of pazopanib and quetiapine, a CYP3A4 substrate, may cause an increase in systemic concentrations of quetiapine. In a study conducted by the manufacturer, concurrent use of 60 mg/day of fluoxetine and 300 mg twice daily of quetiapine did not alter the pharmacokinetics of quetiapine. Vemurafenib: (Major) Concomitant use of vemurafenib and quetiapine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Co-administration of quetiapine with sedating H1-blockers may result in additive effects. Midostaurin: (Major) Concomitant use of quetiapine and midostaurin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Muscarinic antagonism of norquetiapine contributes to the anticholinergic effects observed when quetiapine is used clinically, during concurrent use of quetiapine with other anticholinergic medications, or following quetiapine overdose. When used in combination with chronic lumacaftor; ivacaftor treatment (i.e., more than 7 to 14 days), titrate the quetiapine dosage based on clinical response and tolerability. If these agents must be used together, monitor closely for movement disorders and additive CNS effects. 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. Saxagliptin: (Moderate) Monitor blood glucose during concomitant atypical antipsychotic and dipeptidyl peptidase-4 (DPP-4) inhibitor use. When rifabutin is discontinued, the dose of quetiapine should be reduced to the original level within 7 to 14 days. Additive drowsiness or other CNS effects may occur. Possible mechanisms include atypical antipsychotic-induced insulin resistance or direct beta-cell inhibition. Key facts Quetiapine does not work straight away. 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. Intestinal obstruction has been reported with quetiapine, including fatal cases in patients who were receiving multiple concomitant medications that decrease intestinal motility. Dosage not established. Limited data, including some case reports, suggest that quetiapine may also be associated with a significant prolongation of the QTc interval in rare instances. Both quetiapine and perphenazine may be associated with QT prolongation. 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. Not having enough dopamine may contribute to feeling unhappy, unmotivated, mood swings, sleep problems and other symptoms. Butorphanol: (Moderate) Concomitant use of butorphanol with quetiapine can potentiate the effects of butorphanol on CNS and/or respiratory depression. Possible mechanisms include atypical antipsychotic-induced insulin resistance or direct beta-cell inhibition. Data sources include IBM Watson Micromedex (updated 3 July 2023), Cerner Multum (updated 10 July 2023), ASHP (updated 10 July 2023) and others. Case reports have indicated that the level of quetiapine in breast milk ranges from undetectable to 170 mcg/L; the estimated infant dose ranged from 0.09% to 0.43% of the weight-adjusted maternal dose. Also monitor patients for the emergence of serotonin syndrome. Common Seroquel side effects may include: This is not a complete list of side effects and others may occur. In addition, efavirenz may induce the CYP3A4 metabolism of quetiapine, and thus, decrease the serum concentration of quetiapine. (Moderate) Monitor blood glucose during concomitant atypical antipsychotic and metformin use. Mefloquine: (Major) Concomitant use of quetiapine and mefloquine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Lovastatin: (Moderate) In a published case, it has been hypothesized that the combination of lovastatin and quetiapine resulted in prolongation of the QTc interval. Clonidine: (Moderate) Monitor blood pressure and for unusual drowsiness and sedation during coadministration of clonidine and quetiapine. Siponimod: (Major) Concomitant use of siponimod and quetiapine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). However, because up to one-third of human breast cancer cases may be prolactin dependent (based on in vitro studies), quetiapine should be used with caution in women with breast cancer. Flecainide: (Major) Concomitant use of flecainide and quetiapine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Acetaminophen; Caffeine; Dihydrocodeine: (Major) Concomitant use of opioid agonists with quetiapine may cause excessive sedation and somnolence. Quetiapine is a CYP3A substrate, and lesinurad is a weak CYP3A inducer. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. 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. Coadministration may increase the risk for QT prolongation and torsade de pointes. High doses or long-term use of quetiapine can cause a serious movement disorder that may not be reversible. Sibutramine has not been systematically evaluated in combination with antipsychotic medications. If concomitant use is necessary, reduce the dose of quetiapine to one-sixth the original dose and consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring. Quetiapine may be associated with a significant prolongation of the QTc interval in rare instances. Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Major) Coadministration of rifampin, a potent CYP3A4 inducer, with quetiapine, a CYP3A4 substrate, may result in decreased exposure to quetiapine. Apomorphine: (Major) Avoid use of quetiapine and apomorphine if possible due to an increased risk for QT prolongation and sedation. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Fluphenazine: (Moderate) Concurrent use of quetiapine and fluphenazine should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). Report any new or worsening symptoms to your doctor. Lansoprazole; Amoxicillin; Clarithromycin: (Major) Avoid concurrent use of quetiapine and clarithromycin due to the potential for additive effects on the QT interval and torsade de pointes (TdP) and the potential for greatly increased quetiapine exposure. 7 Methadone In addition, co-administration of quetiapine with phenothiazines may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. In one evaluation, concurrent use of eszopiclone and olanzapine reduced psychomotor function as measured by the Digit Symbol Substitution Test (DSST). In addition, co-administration of quetiapine with olanzapine may increase the risk of adverse effects such as drowsiness, dizziness, orthostatic hypotension, anticholinergic effects, extrapyramidal symptoms, neuroleptic malignant syndrome, or seizures. These effects may be potentiated during concurrent use of thiothixene and other antipsychotics. Cetirizine: (Moderate) Monitor for unusual drowsiness and sedation during coadministration of atypical antipsychotics and cetirizine due to the risk for additive CNS depression. Maximum: 800 mg/day PO. If apalutamide is discontinued, reduce the quetiapine dose to the original level in 7 to 14 days. Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: (Moderate) Somnolence is a commonly reported adverse effect of quetiapine. Generic name: quetiapine [kwe-TYE-a-peen] If you are a Mayo Clinic patient, this could Amoxicillin; Clarithromycin; Omeprazole: (Major) Avoid concurrent use of quetiapine and clarithromycin due to the potential for additive effects on the QT interval and torsade de pointes (TdP) and the potential for greatly increased quetiapine exposure. Additive drowsiness or other CNS effects may occur. Also monitor patients for the emergence of serotonin syndrome. Sevoflurane: (Major) Concomitant use of quetiapine and halogenated anesthetics increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Diphenoxylate; Atropine: (Moderate) Monitor for unusual drowsiness or excess sedation and for signs or symptoms of anticholinergic toxicity during concomitant quetiapine and atropine use. In one large comparison trial (n = 612) for patients with major depressive disorder (MDD), quetiapine XR 150 mg/day PO, quetiapine XR 300 mg/day PO, and duloxetine 60 mg/day PO showed significant improvement in the primary outcome, change in Montgomery-Asberg Depression Rating Scale (MADRS), compared to placebo; however, only the quetiapine XR 300 mg/day group and the duloxetine group were superior to placebo in MADRS remission rates (absolute score 8 or less). The manufacturer of quetiapine recommends a quetiapine dose reduction to one-sixth the original dose during concurrent administration of CYP3A4 inhibitors, such as cobicistat. Limited data, including some case reports, suggest that quetiapine may be associated with a significant prolongation of the QTc interval in rare instances. Quetiapine is a sensitive CYP3A4 substrate and rifapentine is a strong CYP3A4 inducer. Concomitant use may result in additive anticholinergic adverse effects. Atypical antipsychotic therapy may aggravate diabetes mellitus. Quetiapine is extensively metabolized in the liver. If atazanavir is discontinued, increase the quetiapine dose by 6-fold. Due to mutually opposing effects on dopamine, atypical antipsychotics and levodopa may interfere with the effectiveness of each other. According to the manufacturer of quetiapine, other drugs having an association with QT prolongation should not be used with quetiapine. Limited data, including some case reports, suggest that quetiapine may also be associated with a significant prolongation of the QTc interval in rare instances. Perampanel: (Moderate) Co-administration of perampanel with CNS depressants, including ethanol, may increase CNS depression. Careers. The effectiveness of CNS medications such as quetiapine could theoretically be decreased. Atypical antipsychotic therapy may aggravate diabetes mellitus. Usual dose: 400 to 800 mg/day. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Concomitant use may result in additive anticholinergic adverse effects. Discontinue all serotonergic agents and initiate symptomatic treatment if serotonin syndrome occurs. Atazanavir; Cobicistat: (Major) Avoid concurrent use of quetiapine and anti-retroviral protease inhibitors, such as atazanavir. According to the manufacturer, since iloperidone may prolong the QT interval, it should be avoided in combination with other agents also known to have this effect, such as quetiapine. 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. Dronedarone: (Contraindicated) Concomitant use of dronedarone and quetiapine is contraindicated. If delavirdine is discontinued, increase the quetiapine dose by 6-fold. 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. Also, somnolence is a commonly reported adverse effect of quetiapine; coadministration of quetiapine with barbiturates may result in additive sedative effects. Foscarnet: (Major) Concomitant use of quetiapine and foscarnet increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Reversal of effects generally occurs after discontinuation of the drug. The manufacturer of quetiapine recommends a reduced dosage during concurrent administration of CYP3A4 inhibitors. Adjust the dose based on patient response and tolerability. 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. Avoid prescribing opioid cough medication in patients taking quetiapine. information highlighted below and resubmit the form. If concurrent use is necessary, reduce initial dosage and titrate to clinical response; use the lowest effective doses and minimum treatment durations. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Co-administration of quetiapine with sedating H1-blockers may result in additive effects. Limit the use of opioid pain medications with quetiapine to only patients for whom alternative treatment options are inadequate. Also monitor patients for the emergence of serotonin syndrome. Atypical antipsychotics have been associated with metabolic changes, including hyperglycemia, diabetic ketoacidosis, hyperosmolar, hyperglycemic states, and diabetic coma. The plasma concentrations of quetiapine may be elevated when administered concurrently with ritonavir. National Library of Medicine Avoid concomitant use if possible, especially in patients with additional risk factors for TdP.
Gallery Crawl Pittsburgh,
Ravenswood Vintners Blend,
Planet Fitness Arapahoe Crossing,
Manitoulin Farmers Forum Posts,
Articles Q