Quetiapine

Your doctor will advise you on how long it is best to keep taking your medication. This may vary depending on what you’re taking it for and how many times you’ve been unwell.

If it is prescribed for psychotic symptoms or schizophrenia, it is recommended that you take this medication for at least six months to two years after your first episode of illness. It may be appropriate to continue for longer if you had more than one episode of illness.

If you are taking quetiapine to treat bipolar mania or depression, then you will need to discuss long-term medicines for your bipolar disorder with your doctor. This is to help stop the illness coming back.

For bipolar disorder, it is important to remain on medicines in the long term because every time you become ill, there is more chance of you becoming ill again. Quetiapine can be used as a long-term medicine, but there are other choices too. You should discuss your options with your doctor.

For schizoaffective disorder, it is probably best to keep taking quetiapine for several years to reduce the chances of the illness coming back. We know less about schizoaffective disorder, but it has some similarities to bipolar disorder and some similarities to schizophrenia.

If you are taking quetiapine to help with feelings and emotions, like severe agitation, irritability or aggression, your doctor will review your medication with you regularly.

You will get most benefit from your quetiapine if you take it every day at the dose prescribed by your doctor.

You will start with a low dose that your doctor will increase slowly to a dose that is effective for you. This may take several days or weeks.

You will usually take your dose once or twice a day.

It doesn’t matter what time you take it each day but try to take it at about the same time each day. Choose a time that you can always remember. This could be a mealtime or when you brush your teeth.

You can take the ordinary tablets with or without food and they should be swallowed with a drink of water – the tablets have an unpleasant bitter taste if chewed.

The prolonged-release (long-acting) tablets should not be broken as they have a special system in them to deliver the medicine into your body slowly over a few hours.

You should take the prolonged-release (long-acting) tablets by swallowing them whole with a glass of water on an empty stomach one hour before food, or two hours after food. Do not chew or crush the tablets.

The liquid comes with an oral syringe and dosing cup to help you measure the correct dose. Shake the bottle well before use. The liquid should be stored in a fridge. It has an expiry date of 28 days after you open the bottle.

If you remember later during the day, take it as soon as possible.

If you forget to take it by your next dose, just take the next dose at the correct time. Do not try to catch up on missed doses by taking a double dose.

If you forget to take your tablets for a few days, you may start getting your old symptoms back or some withdrawal symptoms. Talk to your doctor if this happens.

Regularly forgetting to take your medication can increase the risk of you becoming ill again and may mean that your symptoms could be worse if you become unwell again.

If you are struggling to remember to take your medication regularly as prescribed by your doctor, speak to your pharmacist and doctor for advice to help you.

Stopping quetiapine too soon after you have recovered may increase your risk of becoming unwell again. Discuss stopping your medication with your doctor. Planning and support are important to stopping quetiapine successfully.

Quetiapine is not addictive, but if stopped suddenly, or the dose you are taking is reduced too much at once, you may experience withdrawal symptoms. These are caused by the receptors and levels of chemical transmitters in your brain readjusting after you reduce or stop your medication. Your brain can take a while to adapt to this change.

Some of the symptoms you get may be like symptoms you had when you were unwell, so understandably, you might feel anxious or upset that your illness could be returning.

Withdrawal symptoms usually start within a few days of stopping (or sometimes reducing) your medication. A wide range of symptoms have been reported. You may experience a few or a range of these:

• difficulty getting to sleep or disturbed sleep
• low mood, feeling anxious or agitated or restless
• dizziness or light-headedness
• headaches
• reduced concentration or feeling confused
• feeling sick or being sick, diarrhoea
• flu-like symptoms
• tense or jerky muscles and slow movements
• uncontrollable movement of face or body
• hallucinations, intrusive thoughts (you may experience these even if your medication wasn’t prescribed to treat psychosis)

It is not possible to predict if you will experience withdrawal symptoms, or how bad they will be if you do experience them. If you do experience symptoms, they are usually mild and don’t last long, but for some these could be severe enough to make you feel very unwell and last longer (two to three months or more). Arrange an appointment with your doctor to discuss your symptoms and seek advice if you are concerned or unable to tolerate them.

Some people have thoughts about harming themselves or taking their own lives soon after they stop this medicine. If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help. You may have discussed what to do if you got these thoughts with your doctor when starting this medicine and created a safety plan. Reading this may also be helpful to remind you about who to contact for support and what you can do to help you cope.

You can stop taking quetiapine safely with your doctor’s help. Planning a gradual withdrawal together can help to minimise or prevent the withdrawal symptoms you experience.

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

• feeling sleepy or tired
• unusual body movements you can’t control
• problems standing and walking
• feeling dizzy (due to low blood pressure)
• uneven heartbeat
• seizures or fits

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

While taking quetiapine you may have thoughts about hurting yourself or taking your own life. These thoughts could be caused by mental illness or maybe a side effect of your medicine. They have been reported during treatment with quetiapine or soon after stopping treatment.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Quetiapine can sometimes cause serious side effects, including allergic reactions.

Stop taking quetiapine and go to a hospital straight away if you get any of the following symptoms:

• difficulty breathing
• an allergic reaction or allergy (including symptoms such as swelling of your face, eyelids, lips, tongue or throat so that you cannot swallow or breathe, or really bad itching of the skin with raised lumps)
• fever, muscle stiffness, sweating or reduced consciousness (these symptoms could be caused by neuroleptic malignant syndrome)
• seizures or fits
• a painful erection (priapism) that lasts longer than three hours

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking quetiapine, if you get any of the following symptoms:

• movements of the tongue, mouth and face that you cannot control (this could be a condition called tardive dyskinesia)
• tensing or contraction of muscles that you are not able to control (this could affect any muscle, including your eyes, mouth, tongue or jaw)
• any unusual bleeding or bruising
• sudden fever, sore throat or mouth ulcers
• swelling, pain, and redness in the leg (this could be a blood clot and may lead to chest pain and difficulty breathing)
• yellowing of the skin or whites of the eyes (these may be signs of hepatitis)
• a sudden change in your mental state, or difficulty with your memory
• severe abdominal pain and feeling sick
• develop new symptoms including needing to drink a lot, needing to pee a lot, feeling weak or increased appetite and feeling hungry (these might indicate your body is not processing sugar very well)

Feeling a little dizzy or sleepy is common, particularly at the start of treatment. This usually passes, but if you feel very dizzy or excessively sleepy, contact your doctor.

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects are more common when you first start taking quetiapine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

Very common side effects of quetiapine (affecting more than one in ten people) include:

• dizziness, which may lead to falls
• headache
• dry mouth
• feeling sleepy
• weight gain
• unusual muscle movements

Common side effects of quetiapine (affecting up to one in ten people) include:

• feeling like your heart is pounding, racing or skipping beats
• indigestion or constipation (having difficulty pooing)
• feeling weak
• swelling of the arms or legs
• high blood sugar
• blurred vision
• unusual dreams or nightmares
• increased appetite
• disturbances in speech or language
• thoughts of suicide or worsening of your depression
• shortness of breath
• being sick (mainly in older people)

Young people are more likely than adults to get the following side effects:

• having thoughts about hurting themselves or taking their own lives
• increased appetite
• higher blood pressure
• movement disorders
• higher levels of the hormone prolactin in the blood
• feeling irritable

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

You should have your weight, blood sugar, blood fats, prolactin level, blood pressure and pulse measured before you start quetiapine and regularly during early treatment, then at least every six months (if you are under 18) or once a year (if you are over 18) after that.

A blood test will be required to check your blood sugar, blood fats and prolactin level.

Your doctor might also recommend additional monitoring. This might include checking your heart with an electrocardiogram (ECG) and checking your liver and thyroid function. This is done by taking a blood test.

They might also check your height and development. If you have periods, they may ask if there have been any changes to the pattern or frequency of these.

It is very important to go for these checks when you are asked to do so. If you are worried or anxious about the monitoring, talk to your doctor, care team or practice nurse about this for advice and support.

You could take some of these measurements at home (e.g. weight ) and keep a record of the results to share with your doctor when they review your treatment.