Seroquel pills 25mg №60

Film Coated Tablets

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60 pcs.

Mechanism of action

Antipsychotic drug (neuroleptic). Shows higher affinity for serotonin 5HT₂-receptors (compared to dopamine D₁- and D₂-receptors) in the brain. It also has a high affinity for histamine and a₁-adrenoreceptors and less active in relation to a₂-adrenoreceptors. Does not possess affinity to m-cholinergic receptors and benzodiazepine receptors.
Showed antipsychotic activity in standard tests.
The results of the study of extrapyramidal symptoms in animals revealed that Quetiapine causes only weak catalepsy when exposed to a dose that effectively blocks dopamine D₂receptors. Quetiapine selectively reduces the activity of mesolimbic A₁₀dopaminergic neurons compared to A₉-nigrostrial neurons involved in motor function.
Clinical studies (using Seroquel in doses of 75-750 mg / day) did not reveal differences between Seroquel and placebo in the frequency of occurrence of extrapyramidal symptoms and the concomitant use of anticholinergic drugs.
Seroquel does not cause a prolonged increase in the level of prolactin in the blood plasma. In numerous studies with a fixed dose did not reveal differences in the level of prolactin when using Seroquel or placebo.
In clinical studies, Seroquel has shown efficacy in treating the positive and negative symptoms of schizophrenia.
Effects of Quetiapine on 5HT₂- and D₂-receptors last up to 12 hours after taking the drug.

Indications and usage

Acute and chronic psychosis (including schizophrenia).

Contraindications

Hypersensitivity, pregnancy, lactation.

Pregnancy and Breastfeeding

Safety and efficacy of Seroquel in pregnant women have not been established. Therefore, during pregnancy, Seroquel can only be used if the expected benefit to the mother outweighs the potential risk to the fetus.
The degree of elimination of quetiapine with human milk is not known. Women should be advised to avoid breastfeeding while taking Seroquel.

Dosage and administration

Seroquel should be taken 2 times / day, regardless of the meal.
For adultstreatment of acute and chronic psychosis, including schizophrenia, The daily dose for the first 4 days of therapy is: 1st day - 50 mg, 2nd day - 100 mg, 3rd day - 200 mg, 4th day - 300 mg.
Starting from the 4th day, the dose should be adjusted to the effective dosage, usually ranging from 300 mg to 450 mg / day. Depending on the clinical effect and individual tolerance of the patient, the dose can vary from 150 mg to 750 mg / day. The maximum daily dose is 750 mg.
Fortreatment of manic episodes in the structure of bipolar disorder Seroquel is used as monotherapy or as adjuvant therapy to stabilize mood.
The daily dose for the first 4 days of therapy is: 1st day - 100 mg, 2nd day - 200 mg, 3rd day - 300 mg, 4th day - 400 mg. In the future, by the 6th day of therapy, the daily dose of the drug can be increased to 800 mg. The increase in the daily dose should not exceed 200 mg / day.
Depending on the clinical effect and individual tolerance, the dose can vary from 200 mg to 800 mg / day. Usually, the effective dose ranges from 400 mg to 800 mg / day. The maximum daily dose is 800 mg.

Special notes

Care should be taken when prescribing Seroquel to patients with cardiovascular and cerebrovascular diseases or other conditions predisposing to arterial hypotension, as well as to elderly patients, with hepatic insufficiency, convulsive fits in history.
Seroquel can cause orthostatic hypotension, especially in the initial period of dose selection (in older patients it is observed more often than in younger patients).
With the abrupt cancellation of high doses of antipsychotic drugs, the following acute reactions (withdrawal syndrome) may occur - nausea, vomiting; rarely - insomnia.
Cases of exacerbation of psychotic symptoms and the appearance of involuntary movement disorders (akathisia, dystonia, dyskinesia) have been reported. In this connection, it is recommended to discontinue the drug gradually.
The occurrence of ZNS may be associated with ongoing antipsychotic treatment. Clinical manifestation of the syndrome includes: hyperthermia, altered mental status, muscular rigidity, instability of the autonomic nervous system, increased levels of CPK. In such cases, Seroquel should be canceled and appropriate treatment carried out.
There were no differences in the incidence of seizures in patients taking Seroquel or placebo. However, caution is advised when treating patients with convulsive seizures in history.
No relationship was found between quetiapine intake and an increase in the QT interval._c. However, when quetiapine is given at the same time as drugs that prolong the QT interval_c, care must be taken, especially in the elderly.
Considering that quetiapine mainly affects the central nervous system, Seroquel should be used with caution in combination with other drugs that have a depressant effect on the central nervous system, or alcohol.
Influence on ability to drive motor transport and control mechanisms
Seroquel can cause drowsiness, so patients are not recommended to work with mechanisms that are dangerous, including not recommended to drive a car and other moving vehicles.

Drug Interactions

With the simultaneous appointment of drugs with a strong inhibitory effect on the CYP3A4 isoenzyme (such as antifungals of the azoles group and macrolide antibiotics), plasma quetiapine concentration may increase. In such cases, lower doses of Seroquel should be used. Special attention should be paid to elderly and debilitated patients. It is necessary to individually assess the ratio of risk and benefit for each patient.
The simultaneous appointment of Seroquel with drugs that induce the enzyme system of the liver, such as Carbamazepine, may decrease the plasma concentration of the drug, which may require an increase in the dose of Seroquel, depending on the clinical effect. In the study of the pharmacokinetics of quetiapine when used in different doses, with its appointment before or simultaneously with carbamazepine (an inducer of hepatic enzymes), a significant increase in clearance of quetiapine is possible. This increase in clearance of quetiapine reduced the AUC by an average of 13% compared with the use of quetiapine without carbamazepine.
The simultaneous administration of Seroquel with another inducer of microsomal liver enzymes (phenytoin) also led to an increase in clearance of quetiapine.With the simultaneous appointment of Seroquel and phenytoin (or other inducers of liver enzymes, such as barbiturates, rifampicin), it may be necessary to increase the dose of Seroquel. It may also be necessary to reduce the dose of Seroquel when canceling phenytoin or carbamazepine or another inducer of the liver enzyme system or replacing it with a drug that does not induce microsomal liver enzymes (for example, sodium valproate).
The pharmacokinetics of lithium preparations do not change with the simultaneous appointment of Seroquel.
No clinically significant changes in the pharmacokinetics of valproic acid and quetiapine were observed when co-administered with sodium divalproex (sodium valproate and valproic acid in a 1: 1 molar ratio) and Seroquel (quetiapine).
Quetiapine did not induce hepatic enzyme systems involved in the metabolism of antipyrine.
The pharmacokinetics of quetiapine does not change significantly when administered concurrently with the antipsychotic drugs Risperidone or Haloperidol. However, concomitant use of Seroquel and thioridazine led to an increase in clearance of quetiapine.
CYP3A4 isoenzyme is a key enzyme involved in cytochrome P₄₅₀-mediated quetiapine metabolism. The pharmacokinetics of quetiapine does not change significantly with simultaneous use of cimetidine, which is an inhibitor of cytochrome P₄₅₀.
The pharmacokinetics of quetiapine did not change significantly with the simultaneous administration of imipramine antidepressant (CYP2D6 inhibitor) or Fluoxetine (CYP3A4- and CYP2D6 inhibitor). However, it is recommended to use caution while using Seroquel and systemic administration of strong inhibitors of the CYP3A4 isoenzyme (such as antifungal agents of the azole group and macrolide antibiotics).
CNS depressant drugs and ethanol increase the risk of side effects of Seroquel.

Data on overdose of Seroquel is limited. There have been cases of taking Seroquel at a dose of more than 20 g, without fatal consequences and with full recovery, but there are reports of extremely rare cases of Seroquel overdose, leading to death or coma.
Symptoms: The symptoms noted were mainly due to the enhancement of the known pharmacological effects of the drug, such as drowsiness and excessive sedation, tachycardia and a decrease in blood pressure.
Treatment: There are no specific antidotes for Quetiapine.In cases of severe intoxication, it is necessary to consider the possibility of symptomatic therapy and it is recommended to carry out activities aimed at maintaining the function of respiration, the cardiovascular system, ensuring adequate oxygenation and ventilation. Medical control and monitoring should be continued until the patient is fully cured.

The drug should be stored out of the reach of children at a temperature below 30 ° C.