Adverse Effects of Quetiapine

Common Adverse Effects

Extrapyramidal symptoms (EPS) can occur but are less common than with traditional antipsychotics, according to the American Academy of Child and Adolescent Psychiatry 1, 2
Risk of tardive dyskinesia, though lower than with typical antipsychotics, is noted by the American Academy of Child and Adolescent Psychiatry 2
Weight gain is one of the most significant problems associated with quetiapine use, as reported by the American Academy of Child and Adolescent Psychiatry 1, 3
Metabolic effects with long-term use, including potential for hyperglycemia, are a concern, as indicated by the British Journal of Pharmacology 4
Orthostatic hypotension (4-7% of patients) is a potential risk, according to the American Academy of Child and Adolescent Psychiatry and the Annals of Oncology 1, 5
QT prolongation has been reported, as noted by the Annals of Oncology 5, 6
Risk of leukopenia, though rare, is a potential concern, as reported by the American Academy of Child and Adolescent Psychiatry 1, 3
Elevations in hepatic transaminase levels may occur, according to the American Academy of Child and Adolescent Psychiatry 1, 3
Quetiapine was associated with cataract development in animal studies, though this has not been confirmed in humans, as noted by the American Academy of Child and Adolescent Psychiatry 1, 3
The FDA recommends baseline and 6-month follow-up eye examinations when prescribing quetiapine, as reported by the American Academy of Child and Adolescent Psychiatry 3

Neuroleptic malignant syndrome is a potential risk, as reported by the American Academy of Child and Adolescent Psychiatry 2

Elderly patients are at higher risk of sedation and cognitive impairment, according to the Mayo Clinic Proceedings 7
Elderly patients are also at greater susceptibility to orthostatic hypotension, as noted by the Annals of Oncology 6, 8
Dose reduction is recommended in older patients, as reported by the Annals of Oncology 6, 8

Regular monitoring of weight and metabolic parameters (glucose, lipids) is recommended, as suggested by the American Academy of Child and Adolescent Psychiatry 1, 3
Baseline and periodic liver function tests are advised, according to the American Academy of Child and Adolescent Psychiatry 3
Baseline and 6-month follow-up eye examinations are recommended, as noted by the American Academy of Child and Adolescent Psychiatry 1, 3
ECG monitoring is suggested in patients with cardiovascular risk factors or if using high doses, as reported by the Annals of Oncology 5, 6
Blood pressure monitoring is recommended, particularly when initiating therapy or increasing doses, according to the American Academy of Child and Adolescent Psychiatry and the Annals of Oncology 1, 5

Starting with lower doses in elderly patients and those with hepatic impairment is recommended, as suggested by the Annals of Oncology 6, 8
Avoiding combination with benzodiazepines due to risk of oversedation and respiratory depression is advised, according to the Annals of Oncology 6

Nausea and vomiting are the most common reasons for discontinuation of quetiapine, with overall discontinuation due to adverse effects ranging from 4-12.3% depending on the indication, as reported by the Annals of Internal Medicine 9, 10, 11

The American Academy of Child and Adolescent Psychiatry recommends monitoring for seizures, particularly at higher doses, in patients taking quetiapine 12
The Lancet Psychiatry suggests that quetiapine has high central anticholinergic activity, which may worsen cognitive symptoms, requiring medication review and potential dose reduction within therapeutic range 13

The Lancet Psychiatry recommends a comprehensive metabolic baseline, including BMI, waist circumference, blood pressure, HbA1c, fasting glucose, and lipid panel, before initiating quetiapine treatment 13
The Lancet Psychiatry also recommends hematologic evaluation, including complete blood count and prolactin level, before starting quetiapine 13
The Journal of the American Academy of Child and Adolescent Psychiatry suggests documenting any preexisting abnormal movements before initiating quetiapine treatment 12
The Lancet Psychiatry recommends monitoring fasting glucose at 4 weeks, and BMI, waist circumference, and blood pressure weekly for 6 weeks after initiating quetiapine treatment 13
The Lancet Psychiatry also recommends repeating all baseline measures at 3 months and annually thereafter, including HbA1c, renal function, and liver function 13

The Journal of the American Academy of Child and Adolescent Psychiatry reports that neutropenia risk may be higher in youth taking quetiapine, with five of 21 patients developing significant neutropenia in one study 12
The Journal of the American Academy of Child and Adolescent Psychiatry also reports that seizure risk appears elevated in youth taking quetiapine, with two of 21 youth experiencing seizures in clozapine comparison studies 12