Headache quetiapine

Quetiapine (Seroquel). Another atypical antipsychotic, quetiapine has also been approved by the FDA for the treatment of acute mania. It is usually administered twice daily at doses of 150-750mg/day. Like its counterparts, quetiapine is a well-tolerated medication. Its common side effects are drowsiness, dizziness, and headache. It causes less weight gain than olanzapine or clozapine but more than ziprasidone or aripiprazole. Quetiapine also does not cause agranulocytosis nor does it increase the risk of seizures. It can occasionally cause mild changes in liver function tests, but these usually return to normal even if the patient continues taking quetiapine. 

A 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation was treated as an out-patient with lamotrigine 400 mg/day, clonazepam 0.5 mg tds, and quetiapine 100 mg/day. She gained 9 kg in 6 months and was advised to reduce the dose of quetiapine to 50 mg/day. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude normal daily activities. She was instructed to take quetiapine 75 mg/day, but her symptoms continued and only resolved when she took 100 mg/day. Slower reduction in the dose of quetiapine (by 12.5 mg/day every 5 days) with an antiemetic, ondansetron, also failed. On a third attempt, prochlorperazine successfully reduced her withdrawal symptoms, although moderate nausea persisted for 2 days after complete withdrawal. 

A 3-week, double-blind, placebo-controlled trial of quetiapine monotherapy in children and adolescents with mania was reported [202 ]. The most common adverse events associated with quetiapine were somnolence, sedation, dizziness and headache most events were mild to moderate in intensity. Potentially clinically relevant increases in total cholesterol, LDL-cholesterol and triglyceride concentrations were more frequent and numericdly larger with quetiapine mean weight gain at end point (observed cases) was 1.7kg for both quetiapine doses and 0.4kg for placebo. 

Reviews A review of quetiapine for the treatment of acute bipolar mania, mixed episodes and maintenance therapy reported the most common adverse events in acute trials were somnolence, sedation, dry mouth, weight gain, dizziness, asthenia, pharyngitis and postural hypotension [210 ]. In the maintenance trials, the most common adverse events were somnolence, upper respiratory tract infection, nasopharyngitis and headache. 

A review of quetiapine XR in the treatment of schizophrenia and bipolar disorder is reported to possess similar side effects to quetiapine IR, with the most common being sedation, dry mouth, somnolence, dizziness and headache [21V],... 

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