"Quetiapine has a wide clinical dose range that extends up to 750mg/day (up to 800 mg/day in the USA and Canada).[21,22] Although administration is usually twice-daily,[23] a pilot study in patients with schizophrenia or schizoaffective disorder found similar levels of clinical efficacy in patients administered quetiapine on a once-or twice-daily basis.[24] Moreover, our clinical experience has suggested that a more rapid initiation schedule than that described in current prescribing information (300 mg/day by Day 4; 300-400 mg/day by Day 4 in the USA and Canada),[21] with a higher target dose, may be more appropriate in hospitalised adult and adolescent patients with an acute exacerbation of schizophrenia in order to achieve rapid control of symptoms. Some evidence supporting this assertion can be found in a poster that described a randomised, multicentre, double-blind, pilot study of hospitalised patients with acute schizophrenia who had their doses of quetiapine (twice-daily oral administration) titrated to 400 mg by Days 2, 3 or 5, without any increased risk of adverse events compared with classic initiation.[25] The overall frequency of adverse events was similar among the three initiation groups and somnolence was experienced by fewer than 15% of patients in each initiation group; indeed, the lowest incidence of somnolence (8%) was observed in the group of patients using the fastest initiation scheme (400 mg by Day 2). Throughout the study, patient vital signs and laboratory values were similar among the three initiation groups. The somnolence observed in these quetiapine-treated patients is likely to be a result of histamine H1 antagonism to which tolerance usually develops over time. Experience has shown that somnolence with quetiapine is not dose-related, most cases are mild and transient (usually dissipating after approximately 2 weeks), and that the incidence of somnolence does not increase over time. These data support our clinical experience of initiating quetiapine at 200mg/day in the inpatient setting and increasing the dose in increments of 200 mg/day."
Dosing of quetiapine and Clinical Global Improvement scores in a small study of patients with schizophrenia, schizoaffective disorder or other psychotic disorders.
Managing Acute Exacerbations of Schizophrenia: Focus on: Influence of Tolerability on Treatment Selection
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