Quetiapine is indicated for the treatment of Acute and chronic psychoses, including schizophrenia, Bipolar Disorder including: treatment of manic episodes satisfying DSM-IV criteria for mania associated with bipolar  disorder, treatment of depressive episodes associated with bipolar disorder, maintenance treatment of bipolar I disorder, in combination with a mood stabilizer, for the prevention of recurrence of manic, depressive or mixed episodes.

Pharmaceutical Name

Pharmacology

The mechanism of action of Quetiapine, as with other drugs having efficacy in the treatment of schizophrenia and acute manic episodes associated with bipolar disorder, is unknown. However, it has been proposed that this drug’s efficacy in schizophrenia is mediated through a combination of dopamine type 2 (D2 ) and serotonin type 2 (5HT2) antagonism. Antagonism at receptors other than dopamine and 5HT 2 with similar receptor affinities may explain some of the other effects of Quetiapine. Quetiapine’s antagonism of histamine H1 receptors may explain the somnolence observed with this drug. Quetiapine’s antagonism of adrenergic α1 receptors may explain the orthostatic hypotension observed with this drug.

Administration & Dosage of Tocef 200

Acute and chronic psychoses, including schizophrenia: Quetiapine should be administered twice daily, with or without food. The total daily dose for the first four days of therapy is 50 mg (Day 1), 100 mg (Day 2), 200 mg (Day 3) and 300 mg (Day 4). From Day 4 onwards, the dose should be titrated to the usual effective dose range of 300-450 mg/day. However, this may be adjusted, depending on the clinical response and tolerability of the individual patient, within the range 150 to 750 mg/day.

Manic episodes associated with bipolar disorder: Quetiapine should be administered twice daily, with or without food. The total daily dose for the first four days of therapy is 100 mg (Day 1), 200 mg (Day 2), 300 mg (Day 3) and 400 mg (Day 4). Further dosage adjustments up to 800mg/day by Day 6 should be in increments of no greater than 200 mg/day. The dose may be adjusted depending on clinical response & tolerability of the individual patient, within the range of 200 to 800 mg/day. The usual effective dose is in the range of 400 to 800mg/day.Depressive episodes associated with bipolar disorder: Quetiapine should be administered once daily at bedtime, with or without food. The usual dose is 300 mg/day. The daily dose for the first four days of therapy is 50 mg (Day 1), 100 mg (Day 2), 200 mg (Day 3) and 300 mg (Day 4). Quetiapine can be titrated to 400 mg on Day 5 and up to 600mg by Day 8. Antidepressant efficacy was demonstrated with Quetiapine at 300mg and 600 mg, however no additional benefit was seen in the 600mg group during short term treatment.

Maintenance treatment of bipolar I disorder in combination with mood stabilizers: Patients who have responded to Quetiapine in combination therapy with a mood stabiliser for acute treatment of bipolar disorder should continue on Quetiapine therapy at the same dose. Quetiapine dose can be re-adjusted depending on clinical response and tolerability of the individual patient. Efficacy was demonstrated with Quetiapine (administered twice daily totalling 400mg to 800mg a day) as combination therapy with a mood stabilizer.

Interaction of Tocef 200

Caution should be exercised when Quetiapine is used concomitantly with medicines known to cause electrolyte imbalance or to increase QT interval. Co-administration of Quetiapine and thioridazine or carbamazepine caused increases in the clearance of Quetiapine. Co-administration of Quetiapine with another microsomal enzyme inducer, phenytoin, also caused increases in the clearance of Quetiapine.

Contraindications

Quetiapine is contra-indicated in patients who are hypersensitive to it.

Side Effect of Tocef 200

The most commonly reported Adverse Drug Reactions (ADRs) with Quetiapine are somnolence, dizziness, dry mouth, withdrawal (discontinuation) symptoms, elevations in serum triglyceride levels, elevations in total cholesterol (predominantly LDL cholesterol), decreases in HDL cholesterol, weight gain, decreased haemoglobin and extrapyramidal symptoms.

Pregnancy & Lactation

The safety and efficacy of Quetiapine during human pregnancy have not been established. Therefore, Quetiapine should only be used during pregnancy if the benefits justify the potential risks and the administered dose and duration of treatment should be as low and as short as possible. The degree to which Quetiapine is excreted into human milk is unknown. Women who are breast-feeding should therefore be advised to avoid breast-feeding while taking Quetiapine.

Precautions & Warnings

Suicide/suicidal contemplations or clinical compounding: Discouragement is related with an expanded chance of self-destructive considerations, self-harm and suicide (suicide-related occasions). This chance holds on until noteworthy reduction happens. Concomitant Ailment: Quetiapine ought to be utilized with caution in patients with known cardiovascular infection, cerebrovascular infection, or other conditions inclining to hypotension. Quetiapine may actuate orthostatic hypotension particularly amid the beginning dose-titration period. Seizures: As with other antipsychotics, caution is prescribed when treating patients with a history of seizures. Tardive Dyskinesia and Extrapyramidal Indications (EPS): On the off chance that signs and side effects of tardive dyskinesia show up, dosage lessening or suspension of Quetiapine ought to be considered. Neuroleptic Dangerous Disorder: This disorder has been related with antipsychotic treatment. Quetiapine ought to be ceased and suitable therapeutic treatment given.QT Prolongation: As with other antipsychotics, caution ought to be worked out when Quetiapine is endorsed in patients with cardiovascular malady or family history of QT prolongation. Neutropenia: Extreme neutropenia (<0.5×109/L) has been exceptionally detailed in Quetiapine clinical trials. Most cases of serious neutropenia have happened inside the primary two months of beginning treatment with Quetiapine. Hyperglycemia & diabetes mellitus: Increments in blood glucose and hyperglycaemia, and incidental reports of diabetes, have been watched in clinical trials with Quetiapine.

Therapeutic Class

Atypical neuroleptic drugs

Storage Conditions

Protect from light and moisture by storing below 30°C. Keep the medicine out of children’s reach.