Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Quetiapine is an oral antipsychotic drug
used for treating schizophrenia and bipolar disorder. Although the mechanism of
action of quetiapine is unknown, like other anti-psychotics, it inhibits
communication between nerves of the brain. It does this by blocking receptors on
the nerves for several neurotransmitters, the chemicals that nerves use to
communicate with each other. It is thought that its beneficial effect is due to
blocking of the dopamine type 2 (D2) and serotonin type 2 (5-HT2) receptors.
PRESCRIPTION: Yes
GENERIC AVAILABLE: No
PREPARATIONS: Tablets: 25, 50, 100, 200, 300, and 400 mg
STORAGE: Tablets should be stored at room temperature, 15-30°C
(59-86°F).
PRESCRIBED FOR: Quetiapine is used alone or in combination with other
drugs to treat schizophrenia and
bipolar disorder.
DOSING:
Quetiapine usually is taken
two or three times daily. The dose usually is increased slowly over several days
or weeks to achieve the desired effect. Quetiapine can be taken with or without
food.
The initial dose for bipolar disorder is 50 mg twice daily (100 mg/d). The dose
can be increased by 100 mg/d to a daily dose of 400 mg/d. Most patients respond
to 400-800 mg/d. Doses greater than 800 mg/d have not been studied.
The initial dose for schizophrenia is 25 mg twice daily (50 mg/d). The dose
can be increased by 25-50 mg two or three times daily. The target dose is
300-400 mg/d in two or three doses. Patients respond to 150-750 mg/d, and doses
greater than 800 mg/d have not been evaluated.
DRUG INTERACTIONS: Phenytoin (Dilantin) and thioridazine (Mellaril)
markedly decrease the amount of quetiapine that is absorbed from the intestine
and thereby reduces its effectiveness. Therefore, patients taking phenytoin or
thioridazine may require higher doses of quetiapine.
Quetiapine can cause hypotension (low blood pressure) and therefore increase
the blood pressure lowering effects of antihypertensive drugs.
Quetiapine can increase the sedating effects of other drugs that sedate. Such
drugs include narcotic pain relievers [for example, oxycodone and acetaminophen
(Percocet, Roxicet, Tylox, Endocet)], barbiturates, sedatives
such as alprazolam (Xanax) and clonazepam (Klonopin),
ethanol, and blood pressure drugs that can cause orthostatic hypotension, such
as prazosin
(Minipress) and terazosin (Hytrin).
Quetiapine is eliminated from the body by an enzyme in the liver called
cytochrome P450 3A. There is a concern that drugs that strongly interfere with
the enzyme, for example, ketoconazole (Nizoral), itraconazole (Sporanox), fluconazole
(Diflucan), and erythromycin, clarithromycin (Biaxin), nefazodone (Serzone),
verapamil (Calan, Isoptin, Verelan), or diltiazem (Cardizem, Tiazac, Dilacor)
may cause elevated and toxic levels of quetiapine.
PREGNANCY: There are no
adequate studies of quetiapine in pregnant women. Studies in animals are inconsistent. Some studies suggest effects on the
fetus and others show no effects. Quetiapine should only be used in pregnancy if
the physician feels that it is absolutely necessary and that the potential
benefits justify the unknown risks.
NURSING MOTHERS: Quetiapine is excreted in the milk of animals during
lactation. Although it is not known if it is excreted in
human milk, it is
recommended that women taking quetiapine not breast feed.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Schizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. Symptoms of psychosis appear in men in their late teens and early 20s and in women in their mid-20s to early 30s. With treatment involving the use of antipsychotic medications and psychosocial treatment, schizophrenia patients can lead rewarding and meaningful lives.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Psychotic disorders are a group of serious illnesses that affect the mind. Different types of psychotic disorders include schizophrenia, schizoaffective disorder, schizophreniform disorder, brief psychotic disorder, shared psychotic disorder, delusional disorder, substance-induced psychotic disorder, paraphrenia, and psychotic disorders due to medical conditions.
Fragile X syndrome is the most common inherited form of mental retardation. It's caused by a mutation on the X chromosome. People with Fragile X syndrome suffer from physical, social, emotional, speech, language, sensory, intelligence, and learning impairments. There is no definitive treatment for Fragile X, though there are ways to minimize the symptoms.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Brief psychotic disorder is a short-term mental illness that features psychotic symptoms. There are three forms of brief psychotic disorder. The first occurs shortly after a major stress, the second has no apparent trauma that triggers the illness, and the third is associated with postpartum onset. Symptoms include hallucinations, delusions, unusual behavior, disorientation, changes in eating and sleeping, and speech that doesn't make sense. Treatment typically involves medication and psychotherapy.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Depressive disorders have been with mankind since the beginning of recorded history. In the Bible, King David, as well as Job, suffered from this affliction. Hippocrates referred to depression as melancholia, which literally means black bile. Black bile, along with blood, phlegm, and yellow bile were the four humors (fluids) that described the basic medical physiology theory of that time. Depression, also referred to as clinical depression, has been portrayed in literature and the arts for hundreds of years, but what do we mean today when we refer to a depressive disorder? In the 19th century, depression was seen as an inherited weakness of temperament. In the first half of the 20th century, Freud linked the development of depression to guilt and conflict. John Cheever, the author and a modern sufferer of depressive disorder, wrote of conflict and experiences with his parents as influencing his development of depression.
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