Crushing Seroquel Formulations

Formulation-Specific Guidance

• The American Medical Association, as reported in JAMA, recommends that crushing bictegravir/tenofovir alafenamide/emtricitabine is not recommended, and the same principle applies to extended-release formulations like Seroquel XR, as crushing destroys the controlled-release mechanism and can lead to dose dumping, increased side effects, and loss of therapeutic efficacy 1, 2
• Immediate-release quetiapine tablets can be crushed when medically necessary, particularly for patients experiencing severe mucositis from chemotherapy or those with significant dysphagia, according to JAMA 1

Clinical Considerations When Crushing Is Necessary

• Patients with swallowing disorders can have immediate-release tablets crushed, but consider liquid formulations if available, as suggested by JAMA 1

Common Pitfalls to Avoid

• The FDA, as reported in Mayo Clinic Proceedings, warns that quetiapine should be avoided in elderly patients with dementia due to increased mortality risk 3

Alternative Considerations

• JAMA suggests switching to liquid formulations if available when crushing is frequently needed 1
• Praxis Medical Insights notes that quetiapine has relatively low seizure risk compared to clozapine, making it a reasonable choice when crushing is necessary in patients with seizure history 2