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Atypical Antipsychotic Pregnancy: C

Quetiapine (Elderly — Dementia Caution)

Brand names: Seroquel, Atrolak

Adult dose

Dose: 25–50 mg once or twice daily initially; increase slowly; dementia agitation: 25–50 mg/day
Route: oral
Frequency: once or twice daily
Max: 800 mg/day (schizophrenia); lower doses in elderly — start low, go slow
MHRA: increased risk of CVA and mortality in elderly with dementia — only use if other non-pharmacological measures failed; document consent

Paediatric dose

Route:
Not licensed for dementia-related psychosis in any age group; licensed for schizophrenia and bipolar in ≥13 years

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce dose in hepatic impairment

Clinical pearls

  • MHRA warning: antipsychotics for dementia-related psychosis increase mortality (1.6–1.7x) and stroke risk — document discussion with family
  • CATIE trial: moderate efficacy for Alzheimer's psychosis — short-term use only with clear indication
  • BEERS criteria: avoid in elderly if possible — alternatives include carer support, environmental modification

Contraindications

  • Dementia with concurrent hepatic/renal impairment (cautious use)
  • QT prolongation
  • Concurrent potent CYP3A4 inhibitors

Side effects

  • Sedation
  • Orthostatic hypotension (falls)
  • QT prolongation
  • Metabolic syndrome (dyslipidaemia, hyperglycaemia)
  • EPS (low)
  • Anticholinergic effects

Interactions

  • CYP3A4 inhibitors (ketoconazole — markedly increase levels)
  • Antihypertensives (hypotension)
  • QT-prolonging drugs
  • Alcohol (CNS depression)

Monitoring

  • ECG (QTc)
  • FBC
  • Glucose/HbA1c
  • Lipids
  • Blood pressure (postural)
  • EPDS (falls assessment)

Reference: BNFc; BNF 86; MHRA guidance 2004; NICE NG97; CATIE trial. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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