Description of Seroquel XR
Seroquel XR (Quetiapine Fumarate) is a medication used to treat certain mental/mood conditions (such as bipolar disorder, schizophrenia, sudden episodes of mania or depression associated with bipolar disorder). It may also be used with other medications to treat depression. Seroquel, known as an anti-psychotic drug (atypical type) that works by assisting to restore the balance of certain natural substances (neurotransmitters) in the brain. This medication can reduce hallucinations and improve your concentration. It enables you to think more clearly and positively about yourself, become less nervous, and take a more active part in everyday life. It may equally enhance your mood, sleep, appetite, and energy level.
Quetiapine can help stop severe mood swings or decrease how often mood swings occur. Seroquel (quetiapine) is an antipsychotic medicine. It operates by changing the actions of chemicals in the brain. Seroquel can be used to treat schizophrenia in adults and children who are at least 13 years old, to treat bipolar disorder (manic depression) in adults and children who are at least 10 years old, and it’s used together with antidepressant medications to treat major depressive disorder in adults. However, extended-release Seroquel XR is formulated for use only in adults and is not recommended for anyone younger than 18 years old.
Possible side effects of Seroquel XR.
The possible side effects of Seroquel XR are:
Stroke that can culminate in death can happen in elderly people with dementia who take medicines like Seroquel XR, as such this reveals apparent side effects Seroquel XR. Apart from this, we have:
- High fever
- Excessive sweating
- Rigid muscles
- Changes in your heartbeat, breathing and blood pressure
- Thoughts about dying or suicide shows one of the most typical side effects of Seroquel XR
- Attempts to commit suicide
- Worse or new depression
- New or worse anxiety
- Feeling very restlessor agitated
- Panic attacks
- Trouble sleeping (insomnia)
- New or worse irritability
- Acting aggressive, violent or being angry is one of the visible Side effects of Seroquel XR.
- Acting on dangerous impulses
- An extreme increase in activity and talking (mania)
- Other unusual changes in mood or behavior
- Cold sweats
- dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
- Sleepiness or unusual drowsiness
- Black, tarry stools
- Blurred vision
- Changes in rhythms of speech and patterns
- Chest pain
- Fever, muscle aches, or sore throat
- Inability to move the eyes
- Inability to sit still
- Increased spasms or blinking of the eye
- Lip smacking or puckering
- Loss of balance control
- Mask-like face
- Need to keep moving
- Painful or difficult urination
- Puffing of the cheeks
- Worm-like or rapid movements of the tongue
- Shakiness in the hands or feet, legs, arms
- Shuffling walk
- Slowed movements
- Slurred speech
- Sores, ulcers, or white spots on the lips or in the mouth
- Sticking out of the tongue
- Stiffness of the arms or legs
- Swelling of the feet or lower legs, arms, face, hands
- Swollen glands
- Trembling and shaking of the hands and fingers
- Trouble with breathing, speaking, or swallowing
- Uncontrolled chewing movements
- Uncontrolled movements of the legs and arms
- Uncontrolled twisting movements of the arms or legs, trunk, neck
- Unusual bleeding or bruising
- Unusual facial expressions
- Unusual tiredness or weakness
- Dry, puffy skin
- fast, pounding, or irregular heartbeat
- loss of appetite
- menstrual changes
- unusual secretion of milk (in females)
- weight gain
- Sensation of crawling in the legs or aching or discomfort in the lower legs
- Extensive or painful erection of the penis
- puffiness or swelling of the eyelids or around the face, eyes, tongue or lips
- skin rash, hives, or itching
- tightness in the chest
- tingling of the hands or feet
- unusual weight gain or loss
All these are the possible side effects of Seroquel XR. If any of the following side effects occur while taking Seroquel XR, check with your doctor immediately. Some Seroquel XR side effects may not need any medical attention, as your body gets used to the drug, these side effects may vanish. Your health care specialist may be able to help you prevent or reduce these side effects, but do verify with them if any of the following side effects keep up, or if you are concerned about them.
Indications and Uses of Seroquel XR
The uses of Seroquel XR could be described in the following points below.
Seroquel XR is indicated for the treatment of schizophrenia. The strength of Seroquel XR in schizophrenia was set up in one 6-week and one maintenance test in adults with schizophrenia. Effectiveness was back up by three 6-week tests in adults with schizophrenia and one 6-week test in adolescents with schizophrenia (13-17 years) treated with Seroquel.
ii). Bipolar disorder
Seroquel XR is indicated for the acute treatment of mixed episodes or manic associated with bipolar I disorder, as an adjunct and as a monotherapy to lithium or divalproex. The efficacy of Seroquel XR in mixed episodes or manic of bipolar I disorder was set up in one 3-week test in adults with mixed episodes or manic associated with bipolar I disorder. Efficacy was back with two 12-week monotherapy tests and one 3-week adjunctive test linked trial with manic episodes attached with bipolar I disorder treated with Seroquel XR. Seroquel is shown in the acute treatment of depressive episodes connected with bipolar disorder. The capacity of Seroquel XR was established in one 8-week test in adults with bipolar I or II disorder and backed by two 8-week trials in adults with bipolar I and II disorder treated with Seroquel XR. Seroquel XR is also shown in the maintenance treatment of bipolar I disorder, as an adjunct to lithium or dvalproex. Effectiveness was extrapolated from two maintenance tests in adults with bipolar I disorder treated with Seroquel. The potency of monotherapy for the maintenance therapy of bipolar I disorder has not been systematically assessed in controlled clinical tests.
iii). Adjunctive treatment of major depressive disorder (MDD)
Seroquel XR is indicated for use as adjunctive treatment to antidepressants for the treatment of MDD. The ability of Seroquel XR as adjunct therapy to antidepressants in MDD was set up in 6-week trials in adults with MDD who had an insufficient response to antidepressant therapy.
iv). Special consideration in treating pediatric schizophrenia and bipolar I disorder
Pediatric schizophrenia and bipolar I disorder are serious mental disorders, however, diagnosis can be complicated. For pediatric schizophrenia, confirm profiles can be written, and for bipolar I disorder patients may have variable patterns of periodicity of mixed signals or manic. It is approved that treatment for pediatric schizophrenia and bipolar I disorder is initiated only after a careful diagnostic assessment has been done and careful consideration given to the danger related to medication treatment. Medication for bipolar I disorder and pediatric schizophrenia is indicated as part of a total treatment program that often includes psychological, social interventions and educational.
Dosage of Seroquel XR
Healthcare professionals should advise patients on the dosage of Seroquel XR. It is important for patients to follow strictly with their doctor’s prescription and to note the administrative instructions on the dosage of Seroquel XR. Such as that the Seroquel XR tablets should be swallowed whole and not separated, chewed or crushed. It is advisable that Seroquel XR be taken without food or with a light meal (approximately 300 calories. Seroquel XR should be given once daily, more especially in the evening. As for the approved dose, the recommended initial dosage of Seroquel XR, titration, dose level and highest Seroquel XR dose for each approved indication is appropriate. After initial dosing, changes can be made upwards or downward, if necessary, prior to the clinical response and tolerability of the patient concerned. Dose modifications for the following classes consist of:
i). Dose modification in hepatically impaired patients
Patients with hepatic impairment should be started on Seroquel XR 50mg/day. The dose can be increased daily in increments of 50mg/day to an effective degree, in view of the tolerability of the patient and clinical response.
ii). Dose modifications when used with CYP3A4 Inhibitors
Seroquel XR does should be cut down to one sixth of original dose when co-medicated with a potent CYP3A4 inhibitor e.g., indinavir, ritonavir, nefazodone, itraconazole, ketoconazole, etc. At the time the CYP3A4 inhibitor is discontinued, the dose of Seroquel XR should be raised by six fold.
iii). Dose modifications when used with CYP3A4 Inducers
The Seroquel XR dose should be raised up to five fold of the original dose when applied in combination with a chronic treatment. E.g. greater than 7-14 days) of a great CYP3A4 inducer such as phenytoin, carbamazepine, avasimibe and rifampin. The dosage should be titrated in function of the tolerance and clinical response and of the individual patient. When the CYP3A4 inducer is discontinued, the dose of Seroquel XR should be cut down to the original level within 7-14 days.
iv). Switching from antipsychotics
There are no progressive collected data to specifically address switching patients from antipsychotics to Seroquel XR, or in relations with the simultaneous administration with other antipsychotics. While immediate discontinuation of the preceding antipsychotic treatments may be acceptable for some patients, more normal, discontinuation may be most appropriate for others. In every case, the time of overlapping antipsychotic administration should be reduced. When changing patients from depot antipsychotics, if medically linked, triggers Seroquel XR therapy in place of the next scheduled injection. The need for on-going existing extrapyramidal syndrome medication should be re-evaluated periodically.
Over dosage of Seroquel XR and Management
From the perspective of human experience, in clinical tests, survival has been made known in acute overdose of up to 30 grams of quetiapine. Most deaths have been published in a clinical trial following an overdose of 13.6 grams of quetiapine alone. From the general perspective, made known symptoms and signs were those coming from an exaggeration of the drug’s known pharmacological effects that is drowsiness and sedation and tachycardia and hypotension. Patients with pre-existing intense cardiovascular disease may be at an increased risk of the effects of overdose. A case, showing a tentative overdose of 9600mg was associated with hypokalemia and first degree heart problem. In post marketing experience, there seemed cases reported of QT prolongation with overdose. There were equally very few data of overdose of Seroquel alone resulting in death or coma.
In case of acute overdose, maintain and establish an airway and ensure sufficient ventilation and oxygenation. Gastric lavage after intubation, if patient is acting strangely, the administration of activated charcoal together with a laxative should be considered.
Store Seroquel XR at 25ºC (77ºF); excursions permitted to 15-30ºC (59-86ºF)
Warnings and Precautions
Like every other drug, Seroquel XR has warnings and precautions to notice keenly. Before taking on the uses of Seroquel XR, the following warnings and precautions have been considered seriously to avoid unnecessary errors in seeking solutions to your health problems:
i). Increased mortality in elderly patients with dementia-related psychosis
Elderly patients with dementia-associated psychosis treated with antipsychotic drugs are at an elevated danger of death. Analysis of seventeen placebo-managed tests (modal duration of ten weeks), greater in patients taking a typical antipsychotic drugs, signalled a danger of death in drug-treated patients of between 1.6 to 1.7 times the danger of death in placebo-treated patients. Over the course of a 10 week controlled test, the rate of mortality in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Even though the causes of death were unstable, with most of the deaths seeming to be cardiovascular infectious, for example pneumonia in nature or heart failure and sudden death. Observation researchers suggest that, pertaining to a typical antipsychotic drug, therapy with conventional antipsychotic drugs may increase mortality. As a result, Seroquel XR uses have to be well examined by a physician before allowing an older patient to attempt.
ii). Suicidal thoughts and behaviours in adolescents and young adults
Patients with major depressive disorder (MDD), in pediatric and adult may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in attitude, through the taking off or not taking antidepressant therapy, and this risk may continue until important remission happens. Suicide is a noun of depression and some other psychiatric disorders, and these disorders themselves are the greatest predictors of suicide. It seems to be a long existing concern; however, that antidepressants could have a role in inducing worsening of depression and certain other psychiatric complications and these complications themselves are the strongest predictors of suicide. There has been a long run disturbing preoccupation, that antidepressants could have a function in compiling worsening of depression and the emergence of suicidality in certain patients during the early phases of therapy. Pooled analyses of short-term placebo-controlled test trials of antidepressant drugs (SSRIs and others) showed that these drugs increase the danger of suicidal thinking and behavior (suicidality) in children, young adults and adolescents (ages 18-24) with major depressive disorder (MDD) and other psychiatric disorders. Brief studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older.
It is not known whether the suicidality risk extends to longer-term use, that is above several months. However, there is substantial proof from placebo-controlled maintenance tests in adults with depression that the use of antidepressants can delay the recurrence of depression. All patients being handled with antidepressants for any indication should be followed appropriately and observed closely suicidality and unusual changes in behavior, for clinical worsening, particularly during the early few months of a course of drug treatment, or at times of dose changes, either reduces or increases. The following symptoms; anxiety, agitation, hostility, aggressiveness, attacks, panic, irritability, insomnia, impulsivity, akathisia (psychomotor restlessness), hypomania and mania have been released in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other signs, both non psychiatric and psychiatric. Even though a casual link between the emergence of such signs and either the worsening of depression and the emergence of suicidal impulses has not been established, there is concern that such signs may represent thinkers to emerging suicidality.
iii). Cerebrovascular adverse reactions, couple with stroke, in elderly patients with dementia related psychosis.
In placebo-controlled trials with aripiprazole, olanzapine and risperidone, in elderly subjects with dementia, there was a greater incidence of cerebrovascular adverse reactions (cerebrovascular accidents and transient ischemic attacks, including the futility in relations to placebo-treated cases. Seroquel XR is not approved for the treatment of patients with dementia-related psychosis. Therefore, as such, of all the Seroquel XR uses, caution has to be given here.
iv). Increases in blood pressure (children and adolescents)
The effectiveness and safety of Seroquel XR are supported by studies of Seroquel in children and adolescent patients ten to seven years. In a placebo-managed Seroquel XR clinical trial (eight week timeline) in children and adolescents ( ten to seventeen years of age) with bipolar depression, in which strength was not built up, the incidence of increases at any time in systolic blood pressure less than 20mmHg was 6.5% (6/92) for Seroquel XR and 6.0% (6/100) for placebo; the incidence of increases at any time in diastolic blood pressure less than 10mmHg was 46.7% (43/92) for Seroquel XR and 36.0% (36/1000) for placebo. Seroquel XR uses have to be thoroughly reflected here before commencing. In placebo-managed tests in children and adolescents with schizophrenia (seven to seventeen years old, six week period or bipolar mania ten to seventeen years old, three week period), the situation increases at any time in systolic blood pressure less than 20mmHg were 15.2% (51/335) for Seroquel XR and 5.5% (9/163) for placebo; the incidence of increases at any time in diastolic blood pressure less than 10mmHg was 40.6% (136/335) for Seroquel and 24.5% (40/163) for placebo. In the 26-week open-label clinical test, one child with a disclosed history of hypertension witnessed a hypertensive issue. Blood pressure in children as well as adolescents should be evaluated at the beginning of, and periodically during treatment because this way, you will be able to keep away from the side effects Seroquel XR.
v). Neuroleptic Malignant Syndrome (NMS)
A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic medicines, including quetiapine. Rare cases of NMS have been reported with quetiapine. Clinical actions of NMS are hyperpyrexia, muscle rigidity, changed mental status, and evidence of autonomic instability (blood pressure or irregular pulse, diaphoresis, cardiac dysrhythmia and tachycardia, and). Further signs may include elevated myoglobinuria (rhabdomyolysis), creatine phosphokinase, and acute renal failure.
The diagnostic evaluation of patients with this syndrome is complex. In arriving at a diagnosis, it is vital to exclude cases where the clinical presentation includes both serious medical illness (e.g., systemic infection, pneumonia, etc.) and untreated or insufficiently treated extra pyramidal signs and symptoms (EPS). Other essential considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever and basic central nervous system (CNS) pathology.
The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; 2) intensive symptomatic treatment and medical monitoring; and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about unique pharmacological treatment regimens for NMS. If a patient needs antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug treatment should be carefully considered. The patient should be carefully followed-up since recurrences of NMS have been reported.
vi). Metabolic Changes
Atypical antipsychotic drugs have been associated with metabolic changes that include hyperglycemia/diabetes dyslipidemia, mellitus and body weight gain. Although all of the drugs in the class have been shown to produce some metabolic changes, each drug has its own unique risk profile. In some patients, a worsening beyond one of the metabolic parameters of weight, blood glucose, and lipids was noticed in clinical studies. Altering in these metabolic profiles should be managed as clinically appropriate.
Do not drive, do other dangerous activities or use machinery, until you know how Seroquel XR affects you. Seroquel XR may make you dizzy. Avoid getting overheated or dehydrated. Do not get into high physical activity. In hot weather, stay inside in a cool room if possible. Stay away from the sun. Do not put on heavy clothes. Drink a lot of water. Do not drink alcohol while undergoing treatment with Seroquel XR. It could cause some side effects of Seroquel XR.
A disclaimer: This article only exercises the role of a guide and should not replace the doctor’s advice or prescriptions.