Posology : מינונים

4.2   Posology and method of administration
Different dosing schedules exist for each indication. It must therefore be ensured that patients receive clear information on the appropriate dosage for their condition.
Seroquel should be administered twice daily, with or without food.

Adults
For the treatment of schizophrenia: the total daily dose for the first 4 days of therapy is 50 mg (Day 1), 100 mg (Day 2), 200 mg (Day 3) and
300 mg (Day 4).

From Day 4 onwards, the dose should be titrated to the usual effective dose range of 300 to 450 mg/day. Depending on the clinical response and tolerability of the individual patient, the dose may be adjusted within the range 150 to 750 mg/day.
For the treatment of manic episodes associated with bipolar disorder: as monotherapy or as adjunct therapy to mood stabilizers, the total daily dose for the first four days of therapy is 100 mg (Day 1), 200 mg (Day 2), 300 mg (Day 3) and 400 mg (Day 4). Further dosage adjustments up to 800 mg per day by Day 6 should be in increments of no greater than 200 mg per day.

The dose may be adjusted depending on clinical response and tolerability of the individual patient, within the range of 200 to 800 mg per day. The usual effective dose is in the range of 400-800 mg per day.

For the treatment of depressive episodes in bipolar disorder:
Seroquel should be administered once daily at bedtime as this may reduce the likelihood of daytime sedation. The total daily dose for the first four days of therapy is 50 mg (Day 1), 100 mg (Day 2), 200 mg
(Day 3) and 300 mg (Day 4). The recommended daily dose is 300 mg.
Depending on the patient’s response Seroquel may be titrated up to 600 mg daily. Antidepressant efficacy was demonstrated at 300 mg and 600 mg/day, however no additional benefit was seen in the 600 mg group above 300 mg daily during short-term treatment.(see section 5.1)
When treating depressive episodes in bipolar disorder, treatment should be prescribed by physicians experienced in treating bipolar disorder.


Elderly
As with other antipsychotics, Seroquel should be used with caution in the elderly, especially during the initial dosing period.
The rate of dose titration may need to be slower, and the daily therapeutic dose lower, than that used in younger patients, depending on the clinical response and tolerability of the individual patient. The mean plasma clearance of quetiapine was reduced by 30 - 50% in elderly subjects when compared to younger patients.
Efficacy and safety has not been evaluated in patients over 65 years with depressive episodes in the framework of bipolar disorder.

Children and adolescents
The safety and efficacy of Seroquel have not been evaluated in children and adolescents.

Renal Impairment:
Dosage adjustment is not necessary in patients with renal impairment.

Hepatic Impairment:
Quetiapine is extensively metabolised by the liver. Therefore, Seroquel should be used with caution in patients with known hepatic impairment, especially during the initial dosing period. Patients with known hepatic impairment should be started with 25 mg/day. The dosage should be increased daily with increments of 25 - 50 mg/day until an effective dosage, depending on the clinical response and tolerability of the individual patient.