Mosby's 2014 Nursing Drug Reference (340 page)

Black Box Warning:

Children, suicidal ideation, increased mortality in elderly patients with dementia-related psychosis

• Adult:
PO
(monotherapy or adjunct to lithium, divalproex), not at increased risk for hypotension 50 mg bid on day 1, 100 mg on day 2 in 2 divided doses as tolerated to 400 mg/day on day 4, range 400-800 mg/day

• Geriatric, debilitated, or at risk for hypotension:
PO
25 mg bid, titrate upward slowly

• Child ≥10 yr/adolescents:
PO
25 mg bid day 1, 50 mg, bid day 2, 100 mg bid day 3, 150 mg bid day 4, 300 mg bid beginning day 5 dose adjusted

• Adult:
PO
(not at risk for hypotension) 25 mg bid, titrate upward; (XR) 300 mg/day in
PM
, range 400-800 mg/day

• Adult:
PO EXT REL
50 mg/day in
PM
on days 1, 2; on day 3, give 150 mg in
PM

• Geriatric, debilitated or at risk for hypotension:
PO EXT REL
50 mg, may increase by 50 mg/day based on response

• 
Reduced dose to geriatric patients

• 
Anticholinergic agent on order from prescriber for EPS

• 
Avoid use of CNS depressants

• 
Immediate release:
without regard to meals

• 
Ext rel:
without food or with light meal ≤300 calories; swallow whole; do not split, crush, chew, can switch from immediate release to extended release by giving total daily dose q day

Increase:
CNS depression—alcohol, opioid analgesics, sedative/hypnotics, antihistamines

Increase:
hypotension—alcohol, antihypertensives

Increase:
QUEtiapine clearance, decrease QUEtiapine effect—phenytoin,
thioridazine, barbiturates, glucocorticoids, carBAMazepine, rifampin

Increase:
QUEtiapine action—fluconazole, itraconazole, ketoconazole (CYP3A4 inhibitors)

Increase:
effects of erythromycin

Decrease:
QUEtiapine clearance—cimetidine

Decrease:
effects of DOPamine agonists, levodopa, LORazepam

Increase:
cholesterol, triglycerides, LFTs, glucose

Decrease:
thyroid tests, WBC

 
CV status: QT prolongation, tachycardia, orthostatic B/P

Black Box Warning:

Mental status before initial administration, AIMS assessment; affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances; suicidal thoughts/behaviors (child/young adult); dementia (geriatric patients)

 
Suicide:
restrict amount of product given; usually suicidal thoughts/behaviors occur early during treatment and among children/adolescents/young adults

• 
Baseline blood glucose, LFTs, neurologic function, ophthalmologic exam, cholesterol profile, weight, monitor glucose often in diabetes mellitus

• 
B/P standing, lying; pulse, respirations; determine q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; watch for ECG changes

• 
Dizziness, faintness, palpitations, tachycardia on rising

• 
EPS:
including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)

 
Neuroleptic malignant syndrome:
hyperthermia, increased CPK, altered mental status, muscle rigidity, seizures, tachycardia, diaphoresis, hypo/hypertension, fatigue; notify prescriber immediately if symptoms occur

• 
Constipation, urinary retention daily; if these occur, increase bulk, water in diet

• 
Supervised ambulation until patient stabilized on medication; do not involve patient in strenuous exercise program because fainting possible; patient should not stand still for long period of time

• 
Storage in tight, light-resistant container

• 
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia; reorganization of patterns of thought, speech

• 
Not to become overheated

• 
Not to use if pregnancy is planned or suspected, not to breastfeed

• 
To rise slowly to prevent orthostatic hypotension

• 
To take medication only as prescribed, not to crush, chew ext rel product, not to use with alcohol, to take regular tabs without regard to food, ext rel without food

• 
That follow-up is necessary, including LFTs, blood glucose, neurologic, cholesterol profile, weight

• 
If drowsiness occurs, to avoid hazardous activities such as driving, not to stand quickly, may be worse during first few days of dose change

• 
To avoid use of OTC meds unless directed by prescriber

• 
To notify prescriber if pregnancy planned, suspected; not to breastfeed

• 
To notify prescriber immediately of fever, difficulty breathing, fatigue, sore throat, rash, bleeding

• 
Suicide:
thoughts/behaviors, primarily among children/adolescents/young adults

• 
To have eye exam before treatment and q6mo, cataracts may occur