Precautions and Warnings With Quetiapine
An awareness of precautions and warnings with quetiapine can help ensure a safe treatment process. Although the drug is not an antidepressant, it does carry the FDA's special warning for that type of medication, so it's important to watch for signs of suicidal behavior. Precautions and warnings with quetiapine also extend to those with diabetes, epilepsy, or dementia, as well as those who are allergic to any components of the drug.
Quetiapine: What Should I Tell My Healthcare Provider?You should talk with your healthcare provider prior to taking quetiapine fumarate (Seroquel®) if you have:
- Alzheimer's disease or other forms of dementia
- Low thyroid (hypothyroidism)
- Low blood pressure (hypotension)
- Heart disease, congestive heart failure (CHF), or other heart problems
- Any allergies, including allergies to food, dyes, or preservatives.
Also let your healthcare provider know if you:
- Are pregnant or thinking of becoming pregnant
- Are breastfeeding
- Drink alcohol.
You should also be sure to tell your healthcare provider about all of the medicines you take, including prescription and non-prescription medicines, vitamins, and herbal supplements.
Specific Precautions and Warnings With QuetiapineWarnings and precautions to be aware of prior to taking quetiapine include the following:
- The U.S. Food and Drug Administration (FDA) has issued a special warning (a "black box warning") about the use of quetiapine in elderly people with psychosis or dementia (a condition involving confusion; disorientation; and a loss of memory, intellect, and judgment). Elderly people with dementia (Alzheimer's disease is the most common form) who are treated with antipsychotics -- including quetiapine -- are more likely to die of various causes than those who were not treated with those medications. Quetiapine is not approved to treat dementia or dementia-related psychosis, and caution should be used before giving the medication to elderly people with this condition.
- Even though quetiapine is not classified as an antidepressant, the FDA has required the drug to carry the special antidepressant and suicide warning, since it is used to treat bipolar depression. Antidepressants may increase the risk of suicidal thinking or behavior in people taking it (see Depression and Suicide). Therefore, if you notice any changes in symptoms or new symptoms, talk to your healthcare provider immediately. Some of these symptoms may include:
- Extreme hyperactivity
- Suicidal thinking or behavior.
- Quetiapine can cause a life-threatening condition called neuroleptic malignant syndrome (NMS). Symptoms of NMS can include:
- A high fever
- Stiff muscles
- Irregular pulse or blood pressure
- A fast heart rate (tachycardia)
- Irregular heart rhythms (arrhythmias).
Tell your healthcare provider right away if think you might have NMS.
- Quetiapine can cause tardive dyskinesia. This is a condition involving unusual uncontrollable body or face movements. The condition can become permanent (even if quetiapine is stopped). The best way to prevent it from becoming permanent is to tell your healthcare provider right away if you notice any abnormal movements (including abnormal movements of the tongue) while taking the drug.
- Quetiapine can cause an increase in blood sugar levels and can increase the risk of developing diabetes. Tell your healthcare provider if you develop signs of diabetes while taking the drug. Possible signs include increased thirst, urination, and hunger. If you have diabetes, your blood sugar should be monitored carefully and regularly during treatment with quetiapine to make sure that it is not becoming more severe (see Seroquel and Diabetes).
- Quetiapine can cause a drop in blood pressure when going from a sitting or lying-down position to standing (known medically as orthostatic hypotension). This can cause a person to have lightheadedness or dizziness, or to faint. Tell your healthcare provider if you have any of these symptoms when standing. Orthostatic hypotension can be especially dangerous in people with heart disease or congestive heart failure (CHF).
- The medication can cause cataracts (an eye condition). It is recommended that all people taking quetiapine should have their eyes checked for cataracts every six months.
- The medication may increase the risk of seizures. Before starting quetiapine, tell your healthcare provider if you have epilepsy or a history of seizures.
- Quetiapine can cause an underactive thyroid (hypothyroidism), high liver enzymes, high cholesterol, or high triglycerides. It is a good idea to have your thyroid, triglycerides, liver enzymes, and cholesterol checked (using a blood test) regularly while taking the drug.
- Quetiapine can cause a potentially dangerous change in the heart rhythm known as QT prolongation. Combining quetiapine with other QT-prolonging medications increases this risk. People with low blood potassium levels, low blood magnesium levels, congestive heart failure, or certain arrhythmias have a higher risk for this problem.
- Quetiapine can cause high levels of the hormone prolactin. Let your healthcare provider know if you develop signs of high prolactin, such as breast enlargement or breast discharge.
- In rare cases, quetiapine can cause priapism (a painful erection of the penis that does not go away). Since this is a medical emergency, seek medical care immediately to prevent permanent damage to the penis.
- The medication can cause difficulty swallowing, which can lead to inhalation of food (which can cause pneumonia). Tell your healthcare provider if you notice any problems swallowing while taking quetiapine.
- Quetiapine is considered a pregnancy Category C medication. This means that it may not be safe to take while pregnant. Be sure to talk with your healthcare provider about the risks and benefits of using quetiapine during pregnancy (see Seroquel and Pregnancy).
- Quetiapine passes through breast milk. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Seroquel and Breastfeeding).
- Generally, alcohol should be avoided while taking the medication (see Alcohol and Seroquel).
- Quetiapine can interact with certain medications (see Seroquel Drug Interactions).