Seroquel is a brand of quetiapine, an atypical antipsychotic used to treat schizophrenia, bipolar disorder (mania and depression), and as an add-on for major depressive disorder. It helps balance dopamine and serotonin activity in the brain, easing psychosis, stabilizing mood, improving sleep, and reducing agitation. Available as immediate-release (IR) and extended-release (XR) tablets, Seroquel is typically taken in the evening due to its sedating properties. While effective, it carries important risks like weight gain, metabolic changes, and drowsiness, so ongoing monitoring and individualized dosing are crucial. Always use under the guidance of a licensed clinician and never stop abruptly without medical advice.
Seroquel is prescribed for adults with schizophrenia to reduce hallucinations, delusions, disorganized thinking, and agitation. Many patients find it improves sleep and decreases anxiety related to psychotic symptoms, which can enhance daily functioning when combined with therapy and social support.
In bipolar I disorder, Seroquel treats acute manic or mixed episodes and the depressive phase. It can be used alone or in combination with mood stabilizers such as lithium or valproate. For bipolar depression, quetiapine has specific evidence at lower doses than those used for mania, helping with low mood, sleep disturbance, and anxiety.
As an adjunct in major depressive disorder (MDD), Seroquel XR may be added when standard antidepressants do not provide adequate relief. This augmentation can reduce residual symptoms like insomnia and anxiety, though careful monitoring of sedation and metabolic effects is essential.
Clinicians sometimes consider off-label uses (for example, severe generalized anxiety or treatment-resistant insomnia), but these decisions require individualized risk–benefit assessment. Seroquel is not approved for and should not be used in elderly patients with dementia-related psychosis due to increased mortality risk.
Seroquel comes as immediate-release (IR) tablets taken two or three times daily and extended-release (XR) tablets taken once nightly. Your prescriber tailors the dose based on diagnosis, response, and tolerability. Never change your dose or schedule without medical guidance.
Typical adult dosing ranges: Schizophrenia (IR): start 25 mg twice daily; increase over several days to 300–400 mg/day in divided doses; some may require 150–750 mg/day. Schizophrenia (XR): titrate to 400–800 mg once nightly. Bipolar mania: 400–800 mg/day (IR divided or XR once nightly), alone or with mood stabilizers. Bipolar depression: 300 mg once nightly (XR commonly used). MDD adjunct: 150–300 mg once nightly (XR).
Elderly or medically fragile patients often start at 25 mg once daily and increase slowly to reduce orthostatic dizziness, excessive sedation, and falls. In hepatic impairment, start low and titrate cautiously. For XR tablets, take in the evening, without food or with a light meal (about 300 calories). Do not crush or chew XR; IR may be taken with or without food.
If therapy is interrupted for several days or longer, your clinician may retitrate to minimize hypotension and sedation. Combining medication with psychotherapy, sleep hygiene, exercise, and nutrition strategies generally improves outcomes.
Boxed warnings: Increased mortality in elderly patients with dementia-related psychosis; Seroquel is not approved for this population. Antidepressants and certain antipsychotics can increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults—close monitoring is critical, especially at initiation and dose changes.
Metabolic effects: Seroquel can cause weight gain, increased appetite, elevated blood sugar, and lipid abnormalities. Baseline and periodic checks of weight/BMI, waist circumference, fasting glucose or A1C, and fasting lipid panel are recommended, along with counseling on nutrition and activity.
Cardiovascular and blood pressure: Orthostatic hypotension, dizziness, and tachycardia may occur, especially early in treatment or after dose increases. Rise slowly from sitting or lying positions. Use caution in patients with cardiovascular disease, dehydration, or those on antihypertensives.
Sedation and cognition: Somnolence is common. Avoid alcohol, cannabis, and other CNS depressants. Do not drive or operate machinery until you know how Seroquel affects you. Falls are a concern in older adults.
Movement and rare reactions: Though lower risk than some antipsychotics, tardive dyskinesia (involuntary movements) and neuroleptic malignant syndrome (fever, muscle rigidity, confusion, autonomic instability) can occur; both require urgent medical attention. Seizure risk may increase in predisposed individuals.
Other cautions: Possible QT prolongation (use caution with cardiac risk factors or QT-prolonging drugs), leukopenia/neutropenia (consider CBC monitoring in at-risk patients), elevated liver enzymes, hypothyroidism, and rare priapism. Historical labeling suggested periodic lens exams due to cataract risk; discuss eye monitoring with your clinician.
Pregnancy and lactation: Use only if benefits outweigh risks. Third-trimester exposure to antipsychotics may cause neonatal withdrawal or extrapyramidal symptoms. Quetiapine passes into breast milk in low amounts; weigh maternal benefit against potential infant risk with a pediatric specialist.
Absolute contraindication: Known hypersensitivity to quetiapine or any tablet component (for example, severe rash or anaphylaxis). Seroquel is not indicated for dementia-related psychosis. Use extreme caution or alternative treatments in patients with uncontrolled cardiovascular disease, history of severe leukopenia, significant QT prolongation, or recurrent neuroleptic malignant syndrome.
Common: Drowsiness, dizziness, dry mouth, constipation, increased appetite, weight gain, fatigue, orthostatic hypotension, tachycardia, and nasal congestion. Many of these diminish as your body adjusts; taking the dose at night can help manage sedation.
Metabolic: Hyperglycemia, new-onset diabetes or worsening control, elevated triglycerides and LDL cholesterol, reduced HDL cholesterol. Report increased thirst, frequent urination, or unexplained fatigue promptly. Regular lab monitoring is advised.
Neurologic/psychiatric: Restlessness (akathisia), tremor, headache, anxiety, or insomnia in some. Rarely, tardive dyskinesia or seizures. If you notice persistent, involuntary facial or limb movements, notify your prescriber immediately.
Serious but uncommon: Neuroleptic malignant syndrome (high fever, muscle rigidity, confusion, sweating, blood pressure changes), severe allergic reactions, marked leukopenia/neutropenia (fever, infection), significant QT prolongation/arrhythmias, pancreatitis, or liver injury. Seek urgent care for chest pain, fainting, severe constipation with abdominal pain, or signs of infection.
CYP3A4 inhibitors can raise quetiapine levels and side effects. Avoid strong inhibitors such as ketoconazole, itraconazole, ritonavir, cobicistat, clarithromycin, and certain azoles unless your prescriber adjusts dosing and monitors closely.
CYP3A4 inducers can reduce effectiveness. Drugs like carbamazepine, phenytoin, rifampin, and St. John’s wort may require alternative therapy or careful dose changes. Never start or stop these without medical input.
Other cautions: Alcohol, benzodiazepines, opioids, antihistamines, and sleep aids can intensify sedation and respiratory depression. Antihypertensives may compound low blood pressure. QT-prolonging agents (for example, certain antiarrhythmics, macrolides, fluoroquinolones, methadone) increase arrhythmia risk. Grapefruit and grapefruit juice may elevate Seroquel levels—avoid unless cleared by your clinician.
If you miss a dose of Seroquel, take it when you remember unless it is close to the time for your next dose. Do not double up to “catch up.” For XR taken at bedtime, skip the missed dose if it is already the next day and resume your usual schedule that night.
If you have missed several days, contact your prescriber; a lower re-initiation dose and gradual titration may be needed to reduce dizziness, sedation, and blood pressure changes. Consistency helps optimize benefits and minimize side effects.
Symptoms of overdose can include marked drowsiness, confusion, agitation, rapid heartbeat, low blood pressure, fainting, and QT prolongation, with rare reports of coma or fatal outcomes—especially with mixed overdoses. If overdose is suspected, call emergency services or Poison Control (1-800-222-1222 in the U.S.) immediately.
Medical teams provide supportive care: airway protection, cardiac and blood pressure monitoring, IV fluids, and treatment of complications. Do not attempt to self-treat. Keep all medications in child-resistant containers and out of reach of children and vulnerable adults.
Store Seroquel at room temperature (68–77°F or 20–25°C), protected from moisture, heat, and direct light. Keep tablets in the original container with the lid tightly closed. Do not use if the seal is broken or tablets are damaged.
Do not crush or chew Seroquel XR. Use a pill organizer only if it preserves the integrity of the tablets and keeps them dry. Dispose of unused or expired medication through take-back programs; do not flush unless specifically instructed.
In the United States, Seroquel (quetiapine) is a prescription-only medication. There is no lawful way to purchase Seroquel without a valid prescription from a licensed clinician after an appropriate medical evaluation. Be wary of websites or ads promising “no-Rx” sales; these sources are often unsafe, counterfeit, or illegal.
A legal, structured path to treatment does not bypass clinical oversight—it provides it. HealthSouth Rehabilitation Hospital of Tallahassee offers compliant care pathways: patients can be evaluated by licensed professionals who determine whether Seroquel is appropriate, discuss benefits and risks, and, if indicated, issue a legitimate prescription with coordinated pharmacy fulfillment. This approach supports safety, continuity of care, and insurance/financial navigation where available.
If you do not have an established prescriber, the hospital can help connect you with in-network clinicians or telehealth appointments for timely assessment. This ensures medication decisions are individualized, documented, and aligned with federal and state regulations. Always use accredited pharmacies and keep regular follow-up to monitor response and labs.
Note: This article is informational and not a substitute for professional medical advice. For personalized recommendations, consult a qualified healthcare professional who can review your history, medications, and treatment goals.
1 Seroquel, the brand name for quetiapine, is an atypical antipsychotic used to treat schizophrenia, bipolar disorder (mania, mixed episodes, and bipolar depression), and as adjunct therapy for major depressive disorder (MDD) in adults. It may be used off-label for certain anxiety or sleep issues under careful medical supervision.
2 Seroquel blocks dopamine D2 and serotonin 5-HT2A receptors and also affects histamine, alpha-adrenergic, and other serotonin receptors. This mix helps with psychosis, mood stabilization, and sleep, but also explains sedating and metabolic side effects.
3 Common effects include drowsiness, dizziness, dry mouth, constipation, increased appetite, weight gain, and orthostatic hypotension (lightheadedness when standing). Some people notice blurred vision, increased cholesterol or triglycerides, and mild tremor.
4 Serious risks include tardive dyskinesia, neuroleptic malignant syndrome, severe low blood pressure, high blood sugar/diabetes, high lipids, significant weight gain, QT prolongation and arrhythmias, seizures, and increased suicidal thoughts in young people. In elderly patients with dementia-related psychosis, antipsychotics increase the risk of death and stroke; Seroquel is not approved for this use.
5 Sedation can occur with the first doses. Anxiety and sleep may improve in days. For mania, some benefits often appear within a week. For bipolar depression and schizophrenia, fuller effects may take 2–6 weeks, with continued gains over several months.
6 IR (immediate-release) is taken 2–3 times daily and peaks faster, often more sedating. XR (extended-release) is taken once daily, usually in the evening, with a smoother level over 24 hours and potentially fewer daytime peaks and dips.
7 Dosing is individualized and titrated slowly. Typical adult target ranges: schizophrenia 300–800 mg/day, bipolar mania 400–800 mg/day, bipolar depression 300 mg/day, MDD adjunct 150–300 mg/day. Always follow your prescriber’s plan; do not change the dose on your own.
8 Some clinicians use low-dose quetiapine off-label for insomnia or anxiety, mainly due to its sedating antihistamine effects. However, risks like weight gain, metabolic effects, and movement disorders make it a non-first-line option; safer sleep or anxiety treatments are usually preferred.
9 Yes, weight gain is common and may be significant, especially at moderate to high doses or with long-term use. It can also raise cholesterol, triglycerides, and blood sugar. Diet, exercise, and regular monitoring help, and dose adjustments or alternative medications may be considered.
10 Seroquel is often sedating, particularly at lower doses due to histamine blockade. Many people take it in the evening to minimize daytime drowsiness. If excessive sedation persists, discuss dose timing, formulation (XR), or alternatives with your clinician.
11 Strong CYP3A4 inhibitors (like ketoconazole, clarithromycin, ritonavir) can raise quetiapine levels; strong inducers (like carbamazepine, phenytoin, rifampin, St. John’s wort) can lower them. Combining with other sedatives, alcohol, or QT-prolonging drugs increases risks. Avoid grapefruit/grapefruit juice, which inhibits CYP3A4.
12 It’s best to avoid alcohol. Both alcohol and Seroquel cause sedation and impair coordination and judgment, increasing the risk of falls, accidents, and respiratory depression.
13 Safety depends on individual risk-benefit. Some data suggest quetiapine may be among the more studied atypical antipsychotics in pregnancy, but risks like gestational diabetes and neonatal adaptation symptoms exist. It is present in breast milk at low levels. Decisions should be made with your obstetric and psychiatric clinicians.
14 Take it when you remember unless it’s close to the next dose—then skip the missed dose. Do not double up. If you miss doses for several days, contact your prescriber before restarting, as you may need to retitrate.
15 Taper gradually under medical supervision to lower the risk of relapse and discontinuation symptoms (insomnia, nausea, headache, irritability, rebound anxiety). Abrupt cessation is discouraged unless there’s a serious adverse reaction.
16 Seroquel is not considered addictive and does not cause classic drug cravings. However, sudden stopping can cause discontinuation symptoms and a return of underlying illness, which is why a slow taper is recommended.
17 Baseline and periodic checks of weight/BMI, waist circumference, blood pressure, fasting glucose or A1c, and lipids are recommended. Some patients need ECG monitoring, especially if they have cardiac risk or take other QT-prolonging drugs. Eye exams may be considered with long-term use.
18 Seroquel can prolong the QT interval and cause orthostatic hypotension. Risk is higher with electrolyte abnormalities, preexisting heart disease, high doses, or interacting drugs. Report palpitations, fainting, or chest pain promptly.
19 Yes, quetiapine XR is approved as adjunctive therapy for MDD, and clinicians often combine it with SSRIs/SNRIs. Watch for additive side effects such as sedation, weight gain, and QT prolongation, and monitor mood closely.
20 People with dementia-related psychosis, severe cardiovascular disease, uncontrolled sleep apnea, a history of severe metabolic issues, glaucoma risk, or seizure disorders require special caution. Always review your full medication list and medical history with your prescriber.
21 Seroquel is generally more sedating due to histamine blockade, making it helpful for nighttime dosing. Abilify is activating for some, with less sedation and lower metabolic risk, but can cause akathisia (restlessness) more often.
22 Both can cause significant weight gain and metabolic changes, but olanzapine tends to have the highest risk in class. Seroquel also raises weight, cholesterol, and glucose but often to a slightly lesser degree than olanzapine.
23 Risperidone more commonly elevates prolactin (causing menstrual changes, sexual dysfunction, breast changes). It also has higher rates of extrapyramidal symptoms at moderate to high doses. Seroquel has lower prolactin and EPS risk but more sedation.
24 Ziprasidone is generally weight-neutral and metabolically friendlier but has a higher risk of QT prolongation and must be taken with food for absorption. Seroquel is more sedating, more likely to cause weight/metabolic changes, and has a somewhat lower QT risk than ziprasidone.
25 Both have strong evidence for bipolar depression. Lurasidone is often chosen for its relatively favorable metabolic profile and daytime tolerability, though it can cause akathisia. Seroquel is effective and sedating, which may help sleep but can cause more weight gain and daytime grogginess.
26 Clozapine is reserved for treatment-resistant schizophrenia or recurrent suicidality due to superior efficacy, but it requires REMS monitoring for agranulocytosis and carries significant metabolic and cardiac risks. Seroquel is used earlier lines for schizophrenia and bipolar disorder with fewer monitoring burdens but also less potent antipsychotic efficacy than clozapine.
27 Paliperidone (active metabolite of risperidone) can significantly raise prolactin and has long-acting injectable forms. Seroquel has lower prolactin impact and more sedation. Choice hinges on side-effect priorities and adherence; injectables can improve consistency.
28 Both treat bipolar mania; both have evidence in bipolar depression (Vraylar at certain doses). Vraylar often has lower sedation and metabolic burden but higher akathisia risk. Seroquel is more sedating and metabolically heavier yet reliably effective for bipolar depression.
29 Both are approved as adjuncts for MDD. Rexulti tends to be less sedating and may have lower metabolic impact than Seroquel but can cause akathisia. Seroquel’s sedation can aid sleep but may limit daytime functioning.
30 Asenapine is sublingual with a bitter taste and requires no food or drink for 10 minutes after dosing; it’s less sedating and more weight-neutral than Seroquel for many. Seroquel is oral, more sedating, and more likely to cause metabolic changes.
31 Lumateperone generally shows a favorable metabolic profile (minimal weight and lipid changes) and low EPS rates. Seroquel is more sedating and carries higher risks of weight gain and dyslipidemia but may better aid sleep and anxiety.
32 Both are effective; Abilify often suits patients who want less sedation and fewer metabolic effects but may experience akathisia. Seroquel may be preferable when sedation or mood calming is desired. Individual response varies; side-effect tolerance drives choice.
33 Latuda is usually less sedating and can support clearer daytime functioning if taken with a meal. Seroquel commonly causes morning grogginess, particularly at sleep-promoting doses or with IR formulation.
34 Both can act relatively quickly for acute mania or agitation. Zyprexa may have brisk antimanic effects but carries high metabolic risk. Seroquel also helps rapidly, with prominent sedation that can be useful at night but may impair daytime alertness.
35 The active ingredient is the same. Most patients do equally well on generic quetiapine. In rare cases, fillers or release characteristics feel different; if you notice a change after switching, discuss with your prescriber or pharmacist.
36 If QT prolongation risk is paramount, clinicians may favor Seroquel over ziprasidone because ziprasidone has a more pronounced QT effect. However, any antipsychotic can affect QT, so ECG and electrolyte monitoring may still be needed.
37 Invega often raises prolactin substantially, which can cause sexual dysfunction and menstrual changes. Seroquel has a lower risk of prolactin elevation, making it a better option for patients sensitive to this effect.
38 If fatigue and oversedation are problematic, Vraylar may be preferable due to less sedation. If insomnia and anxiety are prominent, Seroquel’s calming effect can be advantageous despite the metabolic trade-offs.
39 Rexulti tends to be less sedating and may cause less cognitive dulling than Seroquel. If daytime clarity is a priority, Rexulti could be favored; if nighttime sleep is needed, Seroquel may help.
40 Seroquel has no long-acting injectable form. Risperidone and paliperidone offer multiple LAI options to improve adherence. If missed doses are a concern, an LAI may be more appropriate despite prolactin/EPS considerations.