Dosing of Quetiapine in Schizophrenia: How Clinical Practice Differs From Registration Studies
J Clin Psychiatry 2005;66(12):1512-1516
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: A substantial number of
patients with psychosis receive quetiapine in amounts
that are greater than what is recommended in the product labeling approved by drug
regulatory agencies. The purpose of this article is to
review the past and present dosing patterns of
quetiapine for the treatment of schizophrenia.
Method: A PubMed search for the
period January 1, 1990, to July 1, 2005, was
conducted to identify English-language articles related
to quetiapine dose in schizophrenia using the
search terms quetiapine, dose, and schizophrenia. Trends in dosing of quetiapine in a large,
state-operated psychiatric hospital system and the anecdotal
evidence describing the use of quetiapine in
excess of 800 mg/day were also reviewed.
Results: The registration studies of
quetiapine suggest a target dose range of 300 to 500
mg/day for schizophrenia. In contrast, among
inpatients hospitalized in New York State in the period
of April 1, 2004, to June 30, 2004, the mean dose
of quetiapine prescribed was 620 mg/day, with 33.6% receiving doses in excess of 750
mg/day. Patients with nonwhite ethnicity, length of stay
of at least 1 year, or history of prior state
hospital admission were more likely to receive
doses greater than 750 mg/day. Patients receiving
quetiapine as antipsychotic monotherapy or in combination with other antipsychotics were
equally likely to receive doses greater than 750
mg/day. Published anecdotal reports describe the use
of quetiapine in excess of 800 mg/day and up to 2400 mg/day among patients not responding
to lower doses, but currently there are no
published reports from double-blind randomized
clinical trials establishing the utility of this
high-dose treatment strategy.
Conclusions: Dosing of quetiapine in
clinical practice is higher than what has been
established in the registration program for
schizophrenia. Although there is anecdotal evidence
describing the use of quetiapine in excess of 800
mg/day, double-blind randomized clinical trials