Atypical antipsychotic drug Seroquel (Quetiapine): experience of using the drug in children, adolescents and general psychiatric practice

In the treatment of psychiatric diseases, it is often impossible to do without pharmacotherapy, and in some cases, drugs - antipsychotics - are the main way to cope with complications.

The line of such antipsychotics has recently been supplemented with a new generation of atypical antipsychotics. These drugs suppress the negative symptoms of mental disorders and show positive results on the patient. In addition, they do not cause at all or almost no extrapyramidal (motor function disorders), hyperprolactinemia (increased levels of the hormone prolactin in the blood), that is, unwanted side effects.

A prominent representative of modern atypical antipsychotics is a drug called Seroquel, which contains the active component quetiapine. The developers recommended this remedy for the treatment of schizophrenia. In the Russian Federation, its use has been approved for the treatment of psychosis and other mental disorders since 1999, and it is also widely used for the same purposes in another seventy countries around the world. The most detailed information about Seroquel and the experience of its use is discussed in the scientific work of psychiatrist (psychotherapist and child and adolescent psychiatrist) Victoria Valerievna Krasavina, on whose material we will rely in this article.

Compound

The chemical composition of the drug Seroquel or Seroquel Prolong depends primarily on the form of release of the drug. One tablet of the above-mentioned drugs may contain 25, 50, 100, 150, 200, 300 or 400 mg. quetiapine (active substance).
The drug Seroquel also contains such auxiliary compounds as: calcium hydrogen phosphate, povidone, carboxymethyl starch, microcrystalline cellulose, lactose monohydrate, sodium carboxymethyl starch and magnesium stearate .

The film coating of the tablets contains macrogol 400, titanium dioxide , as well as hypromellose , and some dosage forms of the drug contain dyes, for example, yellow or red iron oxide.

In addition to the active compound quetiapine, contains such auxiliary components as: lactose monohydrate, microcrystalline cellulose, sodium dihydrate, magnesium stearate , and hypromellose . The film coating of the tablets contains titanium dioxide, macrogol, yellow or red iron oxide and hypromellose.

Release form

Seroquel film-coated tablets differ not only in the amount of the drug compound they contain, but also in color. The manufacturer produces pink tablets - 25 mg each. quetiapine (10 pieces in a blister, 3 or 6 blisters in a package), yellow - 100 mg. quetiapine (10 pieces in a blister, 3,6 or 9 blisters in a package) and white - 200 mg each. quetiapine (10 pieces per blister, 3,6 or 9 blisters per package).

In addition, one package of a medicinal product may contain a combination of different forms of release of the drug, i.e. contains 6 tablets of 25 mg each, 3 tablets of 100 mg each. and 1 – 200 mg. One side of the tablets is engraved, which indicates the amount of the medicinal compound contained in one or another form of the drug - Seroquel 25, Seroquel WO and Seroquel 200.

The drug Seroquel Prolong is also available in tablet form. Depending on the dosage form, the special film-coated oblong and biconvex tablet of this medicine may be engraved, which corresponds to the amount of quetiapine , for example, XR50, XR150, XR200, XR300 and XR400. As a rule, one blister contains 10 tablets of the drug, and one cardboard package contains 6 blisters.

The nineties of the last century were marked by the emergence of a new group of antipsychotic drugs - atypical neuroleptics (ANL; Fig. 1). The introduction of these drugs, which lack most of the disadvantages of traditional antipsychotics, into clinical practice has become a big step in psychopharmacotherapy. Traditionally, ANL refers to drugs characterized by a low risk of developing extrapyramidal side effects. During the study of their action, other features of ANL were identified, allowing us to speak about the advantages of these drugs over typical antipsychotics: reduction of secondary and, to a lesser extent, primary negative symptoms, reduction in the severity of manifestations of cognitive deficits, impact on comorbid affective disorders, lack of influence or minimal effect on the level of prolactin in the blood. In addition, ANLs are often effective in cases of resistance to traditional antipsychotics [9].

Quetiapine fumarate is a compound from the dibenzothiazepine group and is structurally similar to the reference ANL clozapine, due to which it has a number of pharmacological properties similar to the latter (Fig. 2). Under the trade name Seroquel, the drug is produced by AstraZeneca in dosages of 25, 100 and 200 mg.

Quetiapine has affinity for D1, D2, 5-HT1A, 5-HT2A, alpha1 and alpha2 adrenergic receptors. The drug has pronounced antihistamine properties, somewhat less - the ability to block alpha1-adrenergic, 5-HT2A-serotonergic and alpha2-adrenergic receptors. With D2-dopaminergic,

Quetiapine interacts weakly with 5-HT1A-serotonergic and D1-dopaminergic receptors. It practically does not bind to cholinergic receptors of the M1 type [5, 11]. The receptor binding properties of quetiapine make it possible to prescribe it for a single dose per day, although most recommendations suggest twice a day [11, 17].

Clinical use of Seroquel

S. Stahl (1999) identifies the following features of Seroquel that are relevant for clinical use, distinguishing it from other ANLs [17]:

• Patients who have demonstrated resistance to previous courses of ANL therapy often experience improvement with Seroquel therapy;
• the drug is successfully used not only for chronic schizophrenia, but also for bipolar and schizoaffective disorders;
• Seroquel affects behavior disorders within psychodic conditions, such as aggression, cognitive impairment and mood symptoms;
• During therapy with Seroquel, disorders such as extrapyramidal disorders or hyperprolactinemia are practically not observed.

Data on the effectiveness of Seroquel are quite numerous, they allow us to conclude that the overall effectiveness of this drug in the treatment of various psychotic conditions is not inferior to that of standard antipsychotics and other representatives of the ANL class. These conditions include:

• schizophrenia (at the stage of active and maintenance therapy);
• schizoaffective psychoses [3, 4];
• manic and manic-delusional states in bipolar disorder [10, 13];
• psychotic disorders of late age [5].

It is also worth mentioning the positive results of studying the effectiveness of Seroquel for neurosis-like disorders in low-grade schizophrenia, including:

• somatization disorders (senestoipochondriacal states) [1];
• anxiety-phobic disorders and obsessive-compulsive (“schizo-obsessive”) states [4].

The action profile of quetiapine has now been determined through studies of its effectiveness in various disorders (Fig. 3).

The most characteristic of Seroquel is traditionally considered to be a pronounced sedative effect . Among other ANLs, it is second only to the effect of clozapine and is due to high tropism for alpha1 and alpha2 adrenergic receptors and blockade of H1 histamine receptors [5, 8], which makes it preferable for use in acute psychotic conditions that occur with agitation and anxiety.

No less important is the ability of the drug to have an anti-aggressive effect . This property allows a number of authors to recommend Seroquel for a wide range of conditions, including acute schizophrenic psychoses occurring with psychomotor agitation, hostility and aggression, psychoses of late age, psychopathic states with impulsive behavior [2, 5]. It is noted that in this capacity the drug has a pronounced “socializing effect” that regulates behavior: even with persistent hallucinatory-delusional symptoms, the effect of Seroquel on disorganized behavior quickly manifested itself.

The antimanic effect is currently being actively studied [3]. Its effectiveness in acute manic states has been established at a level not different from the level of the reference drug (haloperidol), with a virtual absence, unlike the latter, of adverse events, including extrapyramidal disorders, hyperprolactinemia, etc.

It is indicated that the choice of Seroquel in these cases often allows one to avoid the prescription of concomitant therapy with benzodiazepines to relieve psychomotor agitation. A comparison of the antimanic effect of Seroquel with that of other atypical antipsychotics is shown in Fig. 4.

Among the additional effects of Seroquel, first of all, attention should be paid to the antidepressant effect noted by many authors [4, 5, 7], which is manifested by a decrease not only in affective disorders themselves, but also in the level of anxiety, tension and a number of negative disorders.

Considering that up to 60% of patients suffering from schizophrenia experience depression during the course of the disease (including postpsychotic and so-called pharmacogenic depression), it is important to note that the use of Seroquel in this category of patients allows, in some cases, to avoid the prescription of concomitant antidepressant therapy.

G.E. Mazo (2003) believes that the antidepressant and anxiolytic effect of Seroquel is “fast and immediate,” which allows it to be recommended as the drug of choice in the treatment of patients with schizophrenia and depression [7].

The question of the possibility of using Seroquel for low-grade schizophrenia with obsessions is quite relevant, due to the well-known resistance of these conditions to pharmacotherapy. In contrast to the pronounced anxiolytic effect, the anti-obsessive effect of Seroquel is less pronounced (total improvement - 41.5%), and, according to the authors who studied its effectiveness, an increase in the daily dosage of the drug to 600–800 mg was often required [4].

According to the results of a comparative study of the effectiveness of ANL and haloperidol in 150 patients, S.N. the speed of onset as a distinctive characteristic of Seroquel [9]. After the first week of therapy with Seroquel at an average dosage of 410 mg, the reduction in the total PANSS score was 24.3 ± 2.4, which exceeded the effects of all other drugs used during the first four weeks of treatment (Fig. 5).

Therapeutic resistance in schizophrenia

RA Emsley et al. (2000) compared the effects of Seroquel (600 mg/day) and haloperidol (20 mg/day) in 288 patients with schizophrenia with signs of therapeutic resistance (no therapeutic response or partial response to fluphenazine therapy at a dose of 20 mg/day) [12]. The results of treatment during 8-week courses of therapy with these drugs are presented in Fig. 6.

Noteworthy is the pronounced overall therapeutic effect of Seroquel, superior to that of haloperidol (52.2 versus 38% of responders, respectively), and its effect on negative disorders. This allows us to conclude that in order to overcome therapeutic resistance that has formed after courses of therapy with typical antipsychotics, the appointment of Seroquel is more preferable than haloperidol.

Seroquel dosing

S. Stahl (1999) provides recommendations for dosing of Seroquel [17]:

• the effective dosage of the drug varies between 75–400 mg twice a day (in elderly patients 25–75 mg twice a day);
• in some clinical studies, a dosage regimen of Seroquel was used in 3 doses, but in clinical practice, 2 doses per day are more often used, which in cases of using small dosages for maintenance therapy (< 400 mg / day) can be replaced with a single dose;
• with increasing dosages, the drug can be effectively used for the treatment of acute psychotic conditions, including those occurring with agitation, including cases of drug resistance;
• Therapeutic dosages of 300–400 mg/day are recommended to be achieved around the fifth day of Seroquel therapy, starting with a dosage of 50 mg on the first day.

M. Smith et al. (2005) studied the possibility of rapid dose escalation during Seroquel therapy [16]. It was noted that increasing the therapeutic dosage to 400 mg/day on the third and even on the second day of therapy is not associated with a noticeable increase in the number of side effects and can be recommended for patients who need to quickly achieve a therapeutic effect.

Side effects of Seroquel

One of the most extensive materials available to judge the safety and tolerability of quetiapine is a premarketing study conducted on a large sample of patients (n = 1710). In this study, 5% of patients discontinued quetiapine therapy early due to the development of adverse events. The most common side effects are shown in the table.

Among the listed undesirable effects, the most common is drowsiness during the day, accompanied by a feeling of dizziness and orthostatic symptoms. The manifestation of these disorders occurs in the first few days of therapy with Seroquel and most often becomes the reason for patients’ refusal to continue therapy (1.4% of all patients).

Of interest are the data of PT Pollack and K. Zbuk (2000) on a case of quetiapine overdose (single dose of 30 tablets of 100 mg) [14]. The main observed disorders consistent with similar observations of overdose were hypotension, prolonged tachycardia (in the absence of other arrhythmias) and somnolence. These phenomena were reduced within 24 hours.

Pharmacoeconomic aspects of the use of Seroquel

It is known that the choice of an antipsychotic for long-term preventive therapy after psychosis is largely determined by its price.

S. Stahl (1999) notes that at dosages below 400 mg/day, quetiapine may be the most acceptable ANL in terms of the cost of the course of therapy.

E.B. Lyubov et al. (2005) present the results of a pharmacoeconomic study comparing the cost indicators of anti-relapse treatment for ANL in patients with schizophrenia [6]. According to these data, the cost of a daily dose of Seroquel (450 mg/day) is 197.5 rubles. and practically does not differ from the cost of a daily dose of risperidone (6 mg/day) – 176.33 rubles, but significantly lower than the cost of a daily dose of olanzapine (15 mg/day) – 286 rubles. However, this indicator is only part of the cost of treatment. It is known that the side effects of antipsychotics necessitate more frequent visits to the doctor, as well as appropriate therapy. Thus, calculating the full cost of treatment with a particular antipsychotic drug should take into account the overall level of costs for medical care, the cost of additional prescriptions, etc. The authors indicate that the share of the cost of the drug in the total cost of treatment when using Seroquel is 70% compared to 57% for risperidone and 77% for olanzapine. As a result, it turned out that the daily cost of treatment is 256.5 rubles. for Seroquel, 309.4 rubles. for risperidone and 371.4 rubles. for olanzapine. It was concluded that Seroquel, taking into account the total cost of treatment, dominates among the ANLs available in Russia.

The use of Seroquel at various stages of antipsychotic therapy

When conducting antipsychotic therapy, there are 3 stages [9]:

1. Relieving or active therapy (acute treatment), aimed at quickly eliminating psychotic symptoms. Duration – 4–12 weeks.
2. Aftercare, stabilizing or maintenance therapy (maintenance treatment), aimed at suppressing residual productive symptoms, correcting negative disorders, restoring social and labor adaptation and preventing or treating early relapses. At this stage, dosages are gradually reduced in order to reduce the sedative effect of the antipsychotic. Duration – 3–9 months.
3. Anti-relapse or preventive therapy (prophylactic treatment) is carried out to prevent the development of new attacks and slow down the rate of progression of the disease. It lasts indefinitely, but not less than 1–2 years.

Each of these stages imposes its own requirements on the prescribed antipsychotic. If at the first stage of active therapy the severity of the antipsychotic effect and the speed of onset of the therapeutic effect are decisive, then at the second stage the ability of the drug to influence negative symptoms and the possibility of smoothly changing dosages come to the fore. Additional therapeutic effects of the drug also play a significant role, allowing one to avoid combinations with other drugs to combat comorbid disorders. For the third stage of antipsychotic therapy, the most important are the positive safety and tolerability profiles of the drug, as well as pharmacoeconomic factors. Taking into account the data presented above, we can conclude that the unique properties of Seroquel allow it to be successfully used at all stages of antipsychotic therapy, which is confirmed by the positive results of a number of studies.

Pharmacodynamics and pharmacokinetics

Since both drugs belong to the group of atypical antipsychotic drugs , they exhibit a high affinity for serotonin receptors of the 5HT2 class , in comparison with the brain dopamine receptors D1 and D2 . The drugs show similar properties in relation to adrenoreceptors and histamine receptors .

During scientific studies, the affinity of both drugs for benzodiazepine and cholinergic muscarinic receptors was not identified. When performing standard medical tests, the drugs show their antipsychotic properties. Seroquel Prolong, like Seroquel, causes mild catalepsy , which entails blocking dopamine D2 receptors.

Next, there is a selective decrease in the activity of dopaminergic mesolimbic neurons A10 in comparison with nigrostriatal neurons . When using both drugs, prolactin levels in the blood do not increase. As a result of research, experts discovered the ability of these medications to combat the symptoms and manifestations of schizophrenia .

When taking drugs orally, the medicinal compounds included in their composition are quickly absorbed into the stomach and then actively metabolized through the liver . It is worth noting that the bioavailability of quetiapine is not affected by food, so both drugs can be taken regardless of meals.

Both Seroquel Prolong and Seroquel are excreted from the human body in feces as well as urine .

Pharmacological properties of the drug Seroquel

An atypical antipsychotic drug that interacts with various types of neurotransmitter receptors. Quetiapine exhibits a higher affinity for serotonin receptors (5HT2) than for dopamine D1 and D2 receptors in the brain, as well as a high affinity for histamine and α1-adrenergic receptors and a lower affinity for α2-adrenergic receptors. It has no affinity for M-cholinergic receptors and benzodiazepine receptors, and exhibits antipsychotic activity. When studying extrapyramidal symptoms in an experiment, it was found that quetiapine causes only mild catalepsy when used in a dose that effectively blocks dopamine D2 receptors. Quetiapine causes a selective reduction in the activity of mesolimbic A10-dopaminergic neurons compared to A9-nigrostriatal motor neurons and has minimal effects on muscle tone in neuroleptic-sensitive monkeys. Quetiapine does not cause an increase in serum prolactin levels. The drug effectively eliminates both positive and negative symptoms of schizophrenia. When taken orally, it is well absorbed and actively metabolized. Food intake does not have a significant effect on the bioavailability of quetiapine. The main metabolites do not have pronounced pharmacological activity. The half-life is about 7 hours. Approximately 83% of quetiapine is bound to plasma proteins. Effective when taken 2 times a day. The effect of quetiapine on 5HT2 and D2 receptors lasts up to 12 hours, which is confirmed by positron emission tomography data. The pharmacokinetics of quetiapine is linear; there are no differences in the pharmacokinetics of the drug in men and women. The average clearance of quetiapine in elderly patients is 30–50% lower than in patients aged 18–65 years. Quetiapine clearance is reduced by 25% in patients with severe renal impairment (creatinine clearance less than 30 ml/min/1.73 m2) and in patients with liver damage (compensated alcoholic cirrhosis), but individual clearance levels are within the range corresponding to healthy people . Less than 5% of quetiapine is not metabolized and is excreted unchanged in urine or feces. Approximately 73% of quetiapine is excreted in urine and 21% in feces. The key enzyme in the metabolism of quetiapine is CYP 3A4, mediated by cytochrome P450. Quetiapine and some of its metabolites have a weak inhibitory effect on the enzymes cytochrome P450, 1A2, 2C9, 2C19, 2D6 and 3A4, but only at concentrations 10–50 times higher than the concentrations achieved when used at the usual dose (300–450 mg/day). In vitro , the ability of quetiapine to cause significant inhibition of the activity of cytochrome P450 and to influence the metabolism of other drugs mediated by it has not been established.

Indications for use

These drugs are indicated for:

• schizophrenia;
• chronic psychoses;
• manic states;
• depression;
• bipolar disorders.

Seroquel Prolong is also used for preventive purposes, for example, to prevent relapses of schizophrenic seizures in stable patients, as well as bipolar disorders

in patients who have previously successfully completed courses of treatment
with quetiapine . In addition, the drug is often included in the complex treatment of patients with a suboptimal response to monotherapy using antidepressants .

Child and adolescent therapy

At this time, few descriptions of the practical use of Seroquel in child and adolescent psychiatry can be found in the specialized literature. But they describe in sufficient detail the specifics of using the drug for this category of patients.

Due to good treatment results and mild side effects, experts suggest more active use of the drug in child and adolescent psychiatry. Already at 3-6 weeks, minor patients with schizophrenia taking Quetiapine in doses from 100 to 800 mg per day demonstrated a decrease in the symptoms of this disease, “extinguishing” hyperactivity and aggression.

Some patients experienced dry mouth, mild tremor, dizziness and hypotension as side effects. However, there were only a few such patients, and such manifestations were very weak. The usual strong increase in body weight after taking atypical antipsychotics was not observed, as well as disturbances in the endocrine system and problems with motor functions.

Also safe for children and adolescents is treatment with Quetiapine for bipolar and schizoactive disorders, antisocial behavior, psychopathy, Gilles de la Tourette syndrome and generalized tics, and other mental disorders. At the same time, experts warn about the danger of an overdose of the drug, which can cause tachycardia, hypotension, and agitation.

Contraindications

Both drugs are contraindicated if patients have an individual intolerance to certain components included in the chemical composition of the drugs, as well as lactase deficiency or galactose intolerance , or glucose-galactose malabsorption.

In addition, both medications are contraindicated in children under 18 years of age. Seroquel Prolong, like Seroquel, should be taken with extreme caution by elderly patients, people suffering from cerebrovascular and cardiovascular ailments or prone to hypotension , as well as those categories of patients whose history describes the risks of developing seizures, liver failure, aspiration pneumonia and stroke .

Structure and receptor activity of the drug

Chemically, Seroquel (quetiapine) is a derivative of dibenzothiazepine. This atypical antipsychotic interacts with many neuroreceptors, so its spectrum of therapeutic effects is very wide. The drug blocks H1 receptors according to the following scheme: H1 >α>α1>5-HT 2a>α2>D2>5-HT1a>D1>M1. Due to this binding of quetiapine and blockade of α1 and α2 receptors, a nonspecific sedative effect occurs, and anxious affect and arousal are eliminated.

The absence of side effects (hyperprolactinemia and minor extrapyramidal effects) is explained by the weak effect on 5-HT2a and D2 receptors.

Side effects of Seroquel

Among the most common side effects of Seroquel and Seroquel Prolong are the following:

• dizziness;
• drowsiness;
• dispersion;
• constipation;
• tachycardia;
• dry mouth;
• orthostatic hypotension;
• increased levels of triglycerides, liver enzymes, and insulin in the blood.

Patients often gain weight in the first weeks of using medications. Quite rarely, however, when taking these medications, side effects such as convulsions, priapism, neuroleptic syndrome, impaired consciousness, dystonia, vegetative-vascular disorders, neutropenia, akathisia, and leukopenia . , tardive dyskinesia may develop .

Side effects of the drug Seroquel

The most frequently reported side effects were drowsiness, dizziness, dry mouth, asthenia, constipation, tachycardia, orthostatic hypotension, and dyspepsia. As with treatment with other antipsychotic drugs, neuroleptic malignant syndrome, leukopenia, and peripheral edema were noted when using Seroquel. The incidence of side effects associated with the use of Seroquel is presented in the table.

1 See SPECIAL INSTRUCTIONS. 2 Drowsiness may develop in the first 2 weeks of treatment and, as a rule, disappears with prolonged use of the drug. 3 Occur, as a rule, at the beginning of treatment. 4 Asymptomatic increases in serum transaminase activity (ALT, AST, or gamma-glutaryltransferase) developed only in some patients taking Seroquel. These changes resolved with prolonged treatment. 5 Like other antipsychotic drugs with α-adrenergic blocking activity, Seroquel can cause the development of orthostatic hypotension, which is manifested by dizziness, tachycardia and, in some patients, loss of consciousness (especially at the beginning of treatment). 6 In placebo-controlled monotherapy studies in patients with baseline neutrophil counts ≥1.5 × 109/L, the incidence of at least one episode of neutrophil count ≤1.5 × 109/L was 1.72% in patients taking quetiapine. compared with 0.73% in patients taking placebo. In all clinical studies (placebo-controlled, open-label, active comparator; patients with baseline neutrophil count ≥1.5 x 109/L), the incidence of at least one episode of neutrophil count decline ≤1.5 x 109/L was 0.21% in patients treated with quetiapine and 0% in patients treated with placebo; incidence of ≥0.5–≤1×109/L was 0.75% in patients treated with quetiapine and 0.11% in patients treated with placebo. who used placebo. 7 At least 1 episode of glucose ≥126 mg/dL or fasting glucose ≥200 mg/dL.

Seroquel therapy was sometimes accompanied by a slight dose-dependent decrease in the level of thyroid hormones in the blood (total T4 and unbound T4). The maximum decrease in total and unbound T4 was observed during the first 2-4 weeks of quetiapine therapy, without further decrease in hormone levels with prolonged treatment. In almost all cases, cessation of treatment resulted in normalization of total T4 and free T4 levels, regardless of the duration of treatment. A slight decrease in the level of total T3 was noted only when using the drug in a high dose. The level of thyroxine-binding globulin did not change, and no increase in the level of thyroid-stimulating hormone was noted. No signs of hypothyroidism were noted while taking Seroquel. Very rarely, the development of hyperglycemia and decompensation of diabetes mellitus has been reported during treatment with quetiapine. As with other antipsychotic drugs, quetiapine therapy may be accompanied by weight gain, mainly in the first weeks of treatment. Like other antipsychotic drugs, quetiapine may cause an increase in the QTc on the ECG, but in clinical studies there was no relationship between the use of the drug and a persistent increase in QTc .

Instructions for use Seroquel Prolonga (Method and dosage)

Seroquel Prolong should be taken on an empty stomach; the tablets should not be chewed or broken. The dosage and duration of treatment with the drug depends on the type and severity of the disease, and, in addition, the health status of the patients should be taken into account. When treating schizophrenia , as well as bipolar disorders, this medicine should be taken according to the following plan:

• 300 mg each. on the first day;
• 600 mg each. over the next two days.

The optimal recommended daily dosage of the drug is 600 mg. may be increased to 800 mg. in case of urgent medical need.

During the treatment of depressive conditions, Seroquel Prolong is taken according to the following regimen:

• 50 mg each. on the first day;
• 100 mg each. on the second day;
• then 200 mg. during the third day;
• then 300 mg. throughout the fourth day.

The recommended daily dosage of the drug is 300 mg. may be increased to 600 mg. for medical reasons and in case of normal tolerability of the drug by patients. For preventive purposes, Seroquel Prolong is taken at night within a dose range of 300-800 mg.

As part of complex therapy, when have a suboptimal response to treatment with antidepressants, the drug is taken at a dose of 50 mg. the first two days, and then 150 mg. for another four days.

In accordance with the instructions for Seroquel, the drug is taken twice a day. The medication regimen, as well as the duration of the course of treatment, depends on the type of disease and the patient’s health condition.

When treating schizophrenia, as well as psychosis, the drug is taken:

• 50 mg each. first day;
• 100 mg each. on the second day;
• 200 mg each. on the third day;
• 300 mg each. on the fourth day.

The recommended daily dosage of the drug can vary from 150 to 750 mg.

When treating biopolar disorders , as well as manic-depressive states, Seroquel is taken according to the following regimen:

• 100 mg each. first day;
• 200 mg each. on the second day;
• 300 mg each. on the third day;
• 400 mg each. on the last fourth day.

Gradually, the therapeutic dose of the drug is increased and by the sixth day it can reach 800 mg.

Seroquel in general psychiatry

At the moment, there is a significant amount of data on the practical use of Quetiapine, accumulated by specialists over the past five years. As already mentioned, this atypical antipsychotic has been introduced as a treatment for schizophrenia. Its long-term use leads to an increase in the general activity of patients, a decrease in autistic manifestations, and an improvement in social adaptation. In this case, hyperprolactinemia and extrapyramidal disorders are not observed.

Seroquel has a positive effect on cognitive function in people with schizophrenia:

• after 3 months of use, attention improves significantly;

• after six months to a year, the quality of executive function and verbal productivity improves.

It should be clarified that this effect is achieved at an average dose of 517.9 mg/day of the drug per day. Long-term use of the drug is not dangerous, as it is well tolerated. Among other things, it reduces suicidal risks.

Experts who have used the atypical antipsychotic in practice indicate its positive results for depressive symptoms. It has a stronger antipsychotic effect than haloperidol, surpassing it and other drugs in antidepressant, anti-anxiety and anti-manic properties.

Such abilities of Quetiapine made it possible to use it and prove its effectiveness in the treatment of:

• anxiety states;

• affective disorders;

• behavioral disorders;

• bipolar disorders, etc.

The drug has also been successfully used to relieve hostility and aggression, in acute mania, and to reduce psychotic symptoms.

The following positive points can be mentioned:

1. Thanks to Seroquel, monotherapy has become possible, that is, treatment of mental disorders with excellent results without side effects is available using only one, maximum two drugs.

2. If we talk about obsessive-compulsive disorders, then Seroquel has also been tried to treat patients with strong resistance to antipsychotics such as selective serotonin reuptake inhibitors. However, a small dose of the drug in monotherapy was ineffective. But, in cases of combination of Quetiapine with SSRIs, patients experienced significant improvement in their condition.

3. They tried to use an atypical antipsychotic in the treatment of post-traumatic stress disorder. 18 war veterans with this problem took Seroquel for 6 weeks, 25-300 mg per day. By the end of therapy, the patients' condition improved significantly; no deterioration in neurological parameters or negative changes in internal organs were recorded. As a result, it was decided to expand research on the use of the drug in the treatment of this disorder.

4. There is evidence of success with this antipsychotic in elderly patients with psychotic symptoms, Parkinson's disease and Alzheimer's disease. Elderly patients had improved quality of life, motor functions, decreased behavioral disorders, and improved sleep. The attending physicians clarify that to achieve a positive effect, you should start with small doses of the drug and not increase them much.

5. There are isolated cases of effective use of Quetiapine for a patient with a mental illness aggravated by drug addiction and alcoholism.

Overdose

It is worth noting that if you follow the recommendations for taking both medications, cases of drug overdose are quite rare. However, in some cases, the consequences of an overdose were so incompatible with the lives of patients that they led to death or coma.

If daily doses of drugs are exceeded, symptoms such as drowsiness, decreased blood pressure, excessive sedation , and, in addition, tachycardia may be observed. In case of severe intoxication , symptomatic treatment is carried out, as well as measures aimed at maintaining the cardiovascular and respiratory systems of the human body.

Seroquel overdose, symptoms and treatment

Data on drug overdose are limited. Cases of taking the drug at a dose higher than 20 g have been described; no deaths have been recorded; symptomatic therapy is effective. After the widespread introduction of the drug into practice, there were isolated reports of cases of Seroquel overdose leading to coma or death. Symptoms of an overdose of quetiapine - sedation, tachycardia and hypotension were, as a rule, a consequence of increased pharmacological effects of the drug. There is no specific antidote. In cases of serious intoxication, multidirectional intensive care is recommended, including restoration and control of the upper airway, ensuring adequate oxygenation and ventilation, monitoring and support of the cardiovascular system. Careful medical supervision and monitoring should be carried out until the patient recovers completely.

Interaction

An increase in the concentration of quetiapine , and, consequently, an increase in the effectiveness of both drugs, can occur when Seroquel Prolong and Seroquel are taken simultaneously with antibiotics belonging to the macrolide , as well as with azole antifungals . Drug dosage adjustments may also be required when using drugs concomitantly with drugs that contain phenytoin or are designed to induce liver enzymes , such as carbamazepine.

Drug interactions Seroquel

Seroquel should be used with caution in combination with other drugs that act on the central nervous system. In this regard, during treatment it is necessary to avoid drinking alcohol. The pharmacokinetics of lithium with simultaneous administration of quetiapine does not change. The pharmacokinetics of sodium valproate and quetiapine do not change when used simultaneously. The pharmacokinetics of quetiapine did not change significantly when administered concomitantly with risperidone or haloperidol. Concomitant use of quetiapine and thioridazine resulted in increased clearance of quetiapine. The simultaneous administration of quetiapine and carbamazepine (an inducer of microsomal liver enzymes) led to an increase in the clearance of quetiapine. Co-administration of quetiapine and phenytoin (or other hepatic enzyme inducers such as barbiturates, rifampicin) may significantly reduce the systemic exposure of quetiapine; therefore, it may be necessary to increase the dose of quetiapine used concomitantly with hepatic enzyme inducers to maintain control of psychotic symptoms. The dose of quetiapine may be reduced when phenytoin, carbamazepine or other liver enzyme inducers are discontinued or replaced with a drug that does not have an inducing effect on liver microsomal enzymes (for example, sodium valproate). CYP 3A4 is a key enzyme involved in the cytochrome P450-mediated metabolism of quetiapine. The pharmacokinetics of quetiapine does not change significantly when used simultaneously with cimetidine, which is a cytochrome P450 inhibitor. Co-administration of quetiapine and the antidepressant imipramine (CYP 2D6 inhibitor) or fluoxetine (CYP 3A4 and CYP 2D6 inhibitor) does not cause significant changes in the pharmacokinetics of quetiapine. Co-administration of ketoconazole resulted in an increase in the mean maximum concentration and AUC of quetiapine by 235 and 522%, respectively, and a decrease in clearance by 84%. The mean half-life of quetiapine increased from 2.6 to 6.8 hours, but the mean time to reach maximum concentration remained unchanged. Caution is recommended during concomitant use of quetiapine and potential inhibitors of CYP 3A4 (azole antifungals and macrolide antibiotics), and a possible dose reduction of quetiapine should be considered.

special instructions

When transferring patients from Seroquel to Seroquel Prolong, the same daily dosage is used, although the number of medication doses is reduced. However, in some cases, adjustments to the dosage as well as the pill plan may be necessary. When using both drugs in the treatment of elderly patients, a reduced daily dose (25 mg) should be started.

Since the side effects of both drugs include drowsiness , you should not drive a vehicle or work with potentially dangerous units and mechanisms during treatment with these drugs.

Seroquel analogs

Level 4 ATX code matches:
Lakvel

Leponex

Zalasta

Quentiax

Closasten

Ketilept

Zyprexa

Clozapine

Quetiapine

Azaleptin

It is worth noting that the main analogue of Seroquel is Seroquel Prolong and vice versa. However, the list of similar drugs that are similar in their structure and mechanism of action to both drugs includes:

• Hedonin;
• Victoel;
• Quetiapine;
• Quentiax;
• Quetiapine fumarate;
• Quentiapin Stada;
• Quentiapine hemifumarate;
• Ketilept;
• Lakvel;
• Ketiap;
• Kutipin;
• Servitel;
• Nantharid.

During pregnancy (and lactation)

As a rule, experts do not recommend taking both drugs during pregnancy , since the effects of quetiapine . However, in cases where the expected benefit outweighs the possible risk, drugs are used in therapeutic treatment under strict medical supervision.

While taking medications, breastfeeding should be stopped.

Reviews of Seroquel

On the forums you can find various reviews of those taking the drugs Seroquel and Seroquel Prolong, as people’s opinions are divided. Some praise these medications, while others, on the contrary, speak negatively about their effectiveness and cost.

Therefore, although many patients leave positive reviews about Seroquel Prolong and Seroquel, a considerable number of patients note an extensive list of side effects, as well as a too “calm” and absolutely inactive state when using them, as a negative side of both drugs.

Seroquel price, where to buy

You can buy both drugs in pharmacies with a doctor's prescription. It is worth noting that these drugs are not cheap, for example, the average price of Seroquel Prolonga 300 mg. (60 tablets in one package) reaches 1100 rubles.

• Online pharmacies in RussiaRussia
• Online pharmacies in UkraineUkraine

LuxPharma* special offer

• Seroquel Prolong tablet.
  400 mg No. 60 RUR 10,500 order

ZdravCity

• Seroquel tab. p.p.o. 200 mg n60AstraZeneca Pharmaceutical Co., Ltd./AstraZeneca UK Limited

  RUB 1,839 order

• Seroquel tab. p.p.o. 100 mg n60AstraZeneca Pharmaceutical Co., Ltd./AstraZeneca UK Limited

  RUB 1,183 order

• Seroquel tab. p.p.o. 25mg n60AstraZeneca Pharmaceutical Co., Ltd./AstraZeneca UK Limited

  RUB 855 order

• Seroquel Prolong tab. prolong d-i p/o captivity. 0.3g 60pcs AstraZeneca Pharmaceuticals LP/LLC AstraZeneca Industries

  RUR 3,086 order

• Seroquel Prolong tab prolong. valid p/o captivity. 0.2g 60pcsAstraZeneca Pharmaceuticals LP/LLC AstraZeneca Industries

  RUB 1,772 order

Pharmacy Dialogue

• Seroquel (tablet p/o 25 mg No. 60)Astra Zeneca/ZIO Zdorovye

  RUB 774 order

• Seroquel (tablet p/o 200 mg No. 60)Astra Zeneca/ZIO Zdorovye

  1608 rub. order

• Seroquel (tablet p/o 100 mg No. 60)Astra Zeneca/ZIO Zdorovye

  1011 rub. order

• Seroquel (tab.p.pl/vol. 25 mg No. 60)Astra Zenesa/AstraZeneca Industries

  RUR 943 order

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Pharmacy24

• Seroquel XR 50 mg No. 60 tablets Astra Zeneca UK Limited, UK
  810 UAH.order
• Seroquel XR 200 mg N60 tablets Astra Zeneca UK Limited, UK

  1579 UAH. order