Second-generation (atypical) antipsychotic

Quetiapine

Seroquel, Seroquel XR
FDA-Approved Indications
  • Schizophrenia
  • Bipolar I disorder (manic and depressive episodes)
  • Major depressive disorder (adjunctive)
Common Off-Label Uses
  • Insomnia
  • Generalized anxiety
  • Agitation in dementia (with significant caveats)

Side Effects Worth Knowing

Metabolic syndrome

Weight gain, hyperglycemia, dyslipidemia. Present at all doses due to H1 blockade. Requires monitoring: fasting glucose, lipid panel, weight, and waist circumference. This applies even at 25mg, a point many prescribers underappreciate.

Orthostatic hypotension

Alpha-1 blockade. Most significant during initiation and dose increases. Higher risk in elderly patients and those on antihypertensives.

Sedation

H1 blockade. Most prominent at lower doses and early in treatment. Many patients develop tolerance to the sedating effect over weeks (the brain upregulates histamine receptors), which is why insomnia may return after initial improvement.

QTc prolongation

Dose-dependent. Requires ECG monitoring in patients with cardiac risk factors or those on other QTc-prolonging medications.

Black box warning

Like all antipsychotics, quetiapine carries the FDA boxed warning for increased mortality in elderly patients with dementia-related psychosis. This applies to the entire antipsychotic class.

See This Medication in Action

These case studies show how quetiapine decisions play out in real clinical scenarios:

PsychopharmacologyThe Patient Who Gained 30 PoundsMood DisordersBipolar II. Maintenance Phase DecisionsMood DisordersThe College Student Who Can't SleepSide Effect RecognitionAkathisia: The Side Effect That Looks Like the DiseaseMedication ManagementThe Messy Med List

References & Further Reading

This page synthesizes information from standard clinical references. Consult primary sources for all prescribing decisions.

Test your Quetiapine knowledge

Review flashcards on dosing, side effects, and interactions, or build a custom quiz with board-style questions.

Study FlashcardsBuild a Quiz
For learning and board prep — not a prescribing reference. Dosing and safety information change. Always verify against current FDA labeling and your institution’s protocols before prescribing.