Initially, 50 mg/day PO in the evening. The dosage should be increased in increments of 50 mg/day depending upon individual response and tolerability. Dose range for manic episodes with or without mixed features in younger adults: 400 mg/day to 800 mg/day PO as monotherapy or as an adjunct to lithium or divalproex. Maximum: 800 mg/day PO. Consider slower titration and a lower target dose for debilitated patients and those at risk for hypotension. Coadministration of certain drugs may need to be avoided or dosage adjustments may be necessary; review drug interactions. Efficacy as monotherapy maintenance treatment has not been formally evaluated; therefore the recommended maintenance dose range is 400 mg/day to 800 mg/day as an adjunct to lithium or divalproex. Generally, continue on the same dose on which stabilized during the acute phase of treatment. RE-INITIATION OF TREATMENT: If therapy is discontinued for less than 1 week and subsequently re-initiated, the same dose/schedule may be used without titration. If therapy has been discontinued for more than 1 week, follow the initial titration schedule.
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Monitor all patients for the emergence of agitation, irritability, clinical worsening, and other unusual changes in behavior, as well as the emergence of suicidality, especially during the initial few months of therapy or at times of dose changes. Monitor patients for symptoms of hyperglycemia. Perform fasting glucose testing in patients who develop hyperglycemia during treatment. Ensure that patients with risk factors for diabetes undergo fasting blood glucose testing at the start of therapy and periodically thereafter. Monitor patients with established diagnosis of diabetes mellitus regularly for worsening of glucose control. Perform eye exam at initiation of therapy to detect cataract formation and at 6-mo intervals during long-term treatment. Monitor patients requiring antipsychotic drug treatment after recovery from NMS for recurrence of NMS if quetiapine therapy is reintroduced. Baseline and periodic follow-up lipid evaluations are recommended for patients on quetiapine. Monitor WBC frequently during the first few months of therapy in patients with a preexisting low WBC or history of drug-induced leukopenia/neutropenia. Carefully monitor patients with neutropenia for fever or other symptoms or signs of infection. When treating children for any indication, assess weight gain against that expected for normal growth; measure BP at the beginning of therapy and periodically during therapy.