Neutapin

Schizophrenia. Moderate to severe manic episodes & major depressive episodes in bipolar disorder. Prevention of recurrence of manic or depressed episodes in patients w/ bipolar disorder w/ previous quetiapine treatment.

Adult Schizophrenia Administer bid. Total daily dose: 50 mg on Day 1, 100 mg on Day 2, 200 mg on Day 3 & 300 mg on Day 4. Dose range from Day 4 onwards: 300-450 mg daily. May be adjusted to 150-750 mg daily. Moderate to severe manic episodes in bipolar disorder Administer bid. Total daily dose: 100 mg on Day 1, 200 mg on Day 2, 300 mg on Day 3 & 400 mg on Day 4. May be adjusted up to 800 mg daily by Day 6 in increments of no >200 mg daily. Dose range: 200-800 mg daily. Major depressive episodes in bipolar disorder Administer once daily at bedtime. Total daily dose: 50 mg on Day 1, 100 mg on Day 2, 200 mg on Day 3 & 300 mg on Day 4. Recommended daily dose: 300 mg (600 mg in some). Prevention of recurrence in bipolar disorder Dose range: 300-800 mg daily as bid. Hepatic impairment Initially 25 mg daily. May be increased w/ 25-50 mg daily increments.

May be taken with or without food.

Hypersensitivity. Concomitant use w/ cytochrome P450 3A4 inhibitors eg, HIV PIs, azole antifungals, erythromycin, clarithromycin, nefazodone.

Discontinue use if tardive dyskinesia or NMS occur; in patient w/ neutrophil count <1 x 10⁹/L. Increased risk of suicidal thoughts & suicide-related events. Increased incidence of extrapyramidal symptoms. Patients w/ hyperglycaemia & DM; somnolence; CV or cerebrovascular disease or other conditions predisposing to hypotension; preexisting low WBC count; congenital long QT syndrome, CHF, heart hypertrophy, hypokalaemia or hypomagnesaemia; risk factors of stroke; acute moderate to severe manic episodes; constipation & intestinal obstruction; pancreatitis. Risk factors for stroke; aspiration pneumonia. Current diagnosis or prior history of urinary retention, prostatic hypertrophy, intestinal obstruction or related conditions, increased IOP or narrow angle glaucoma. History of seizure disorder; of or at risk for sleep apnea; drug-induced neutropenia; QT prolongation; alcohol or drug abuse. Galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Gradual w/drawal over a period of at least 1-2 wk. Concomitant use w/ carbamazepine, phenytoin; medications having anticholinergic effects; drugs known to increase QT interval; divalproex or lithium. May affect ability to drive & use machines. Hepatic impairment. Pregnancy (3rd trimester). Lactation. Not recommended in childn & adolescents <18 yr. Elderly >65 yr w/ Parkinson's disease/parkinsonism.

Decreased Hb; elevated serum triglyceride levels & total cholesterol (predominantly LDL cholesterol), decreased HDL cholesterol, wt gain; dizziness, somnolence, headache, extrapyramidal symptoms; dry mouth; w/drawal (discontinuation) symptoms. Leucopenia, decreased neutrophil count, increased eosinophils; hyperprolactinaemia, decreased total T₄, free T₄ & total T₃, increased TSH; increased appetite, blood glucose increased to hyperglycaemic levels; abnormal dreams & nightmares, suicidal ideation & behaviour; dysarthria; blurred vision; tachycardia, palpitations; orthostatic hypotension; dyspnoea; constipation, dyspepsia, vomiting; elevated ALT & γ-GT levels; mild asthenia, peripheral oedema, irritability, pyrexia. SJS, TEN, erythema multiforme, DRESS. Childn 10-17 yr: Increased BP; vomiting. Syncope; rhinitis; irritability.

Increased AUC w/ ketoconazole. Concomitant use w/ CYP3A4 inhibitors; grapefruit juice; medicinal products causing electrolyte imbalance or increased QT interval. Increased clearance w/ carbamazepine, phenytoin & thioridazine. Higher incidence of extrapyramidal events, somnolence & wt gain w/ lithium. False +ve in enzyme immunoassays for methadone & TCAs.

Antipsychotics

N05AH04 - quetiapine ; Belongs to the class of diazepines, oxazepines and thiazepines antipsychotics.

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