The Basics
What is Quetiapine?
Used alone or together with other medicines to treat bipolar disorder (depressive and manic episodes) and schizophrenia.
Brand names for Quetiapine
Seroquel, Seroquel Xr
How Quetiapine is classified
Antipsychotic Agents
Quetiapine During Pregnancy
Quetiapine pregnancy category
Category N/ANote that the FDA has deprecated the use of pregnancy categories, so for some medications, this information isn’t available. We still think it’s useful to list historical info, however, given what a common proxy this has been in the past.
What we know about taking Quetiapine while pregnant
Advise pregnant women to notify their healthcare provider if they become pregnant or intend to become pregnant during treatment with SEROQUEL. Advise patients that SEROQUEL may cause extrapyramidal and/or withdrawal symptoms (agitation, hypertonia, hypotonia, tremor, somnolence, respiratory distress, and feeding disorder) in a neonate. Advise patients that there is a pregnancy registry that monitors pregnancy outcomes in women exposed to SEROQUEL during pregnancy [see Use In Specific Populations].
Taking Quetiapine While Breastfeeding
What are recommendations for lactation if you're taking Quetiapine?
Maternal quetiapine doses of up to 400 mg daily produce low levels in milk. Limited long-term follow-up of infants exposed to quetiapine indicates that infants generally developed normally. Systematic reviews of second-generation antipsychotics concluded that quetiapine seemed to be the first- or second-choice agent during breastfeeding.[1][2] Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
Maternal / infant drug levels
Maternal quetiapine doses of up to 400 mg daily produce low levels in milk. Limited long-term follow-up of infants exposed to quetiapine indicates that infants generally developed normally. Systematic reviews of second-generation antipsychotics concluded that quetiapine seemed to be the first- or second-choice agent during breastfeeding.[1][2] Monitor the infant for drowsiness and developmental milestones, especially if other antipsychotics are used concurrently.
Possible effects of Quetiapine on milk supply
Unlike the phenothiazines, quetiapine has a minimal effect on serum prolactin levels.[21][22][23]
Galactorrhea occurred in a woman who was not breastfeeding while she was taking venlafaxine 112.5 mg daily and quetiapine. Galactorrhea occurred 10 days after her quetiapine dose was increased to 50 mg daily a few days after starting the drug at 12.5 mg daily. Her serum prolactin level was 27.3 mcg/L (normal 2 to 30 mcg/L) and decreased to 8.5 mcg/L 2 weeks after discontinuing the drug. Galactorrhea ceased 1 week later.[24]
The maternal prolactin level in a mother with established lactation may not affect her ability to breastfeed.
Possible alternatives to Quetiapine
Haloperidol, Olanzapine, Risperidone.
List of References
Lactation sources: Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK501922/1. Uguz F. Second-generation antipsychotics during the lactation period: A comparative systematic review on infant safety. J Clin Psychopharmacol. 2016;36:244-52. PMID: 27028982
2. Pacchiarotti I, Leon-Caballero J, Murru A et al. Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder. Eur Neuropsychopharmacol. 2016;26:1562-78. PMID: 27568278
3. Lee A, Giesbrecht E, Dunn E et al. Excretion of quetiapine in breast milk. Am J Psychiatry. 2004;161:1715-6. PMID: 15337669
4. Misri S, Corral M, Wardrop AA, Kendrick K. Quetiapine augmentation in lactation: a series of case reports. J Clin Psychopharmacol. 2006;26:508-11. PMID: 16974194
5. Rampono J, Kristensen JH, Ilett KF et al. Quetiapine and breast feeding. Ann Pharmacother. 2007;41:711-4. PMID: 17374621
6. Kruninger U, Meltzer V, Hiemke C et al. [Pregnancy and lactation under treatment with quetiapin]. Psychiatr Prax. 2007;34 (Suppl 1):S75-6.
7. Yazdani-Brojeni P, Taguchi N, Garcia-Bournissen F et al. Quetiapine in human milk and simulation-based assessment of infant exposure. Clin Pharmacol Ther. 2010;87 (Suppl 1):S3-4. Abstract. DOI: doi:10.1038/clpt.2009.268
8. Tanoshima R, Yazdani-Brojeni P, Taguchi N et al. Quetiapine in human breast milk – population PK analysis of milk levels and simulated infant exposure. J Popul Ther Clin Pharmacol. 2012;19:e267-e268. Abstract.
9. Var L, Ince I, Topuzoglu A, Yildiz A. Management of postpartum manic episode without cessation of breastfeeding: A longitudinal follow up of drug excretion into breast milk. Eur Neuropsychopharmacol. 2013;23 (Suppl 2):S382. Abstract.
10. Aydin B, Nayir T, Sahin S, Yildiz A. Olanzapine and quetiapine use during breastfeeding: Excretion into breast milk and safe breastfeeding strategy. J Clin Psychopharmacol. 2015. PMID: 25679127
11. Yazdani-Brojeni P, Tanoshima R, Taguchi N et al. Quetiapine excretion into human breast milk? J Clin Psychopharmacol. 2018;38:362-4. PMID: 29912789
12. Van Boekholt AA, Hartong EG, Huntjens-Fleuren H et al. Quetiapine concentrations during exclusive breastfeeding and maternal quetiapine use. Ann Pharmacother. 2015;49:743-4. PMID: 25975996
13. Balke LD. Quetiapine effective in the treatment of bipolar affective disorder during pregnancy. World J Biol Psychiatry. 2001;2:303S. Abstract P021-15.
14. Seppala J. Quetiapine (‘Seroquel’) is effective and well tolerated in the treatment of psychotic depression during breast-feeding. Int J Neuropsychopharmacol. 2004;7 (Suppl 1):S245. Abstract P01.431. DOI: doi:10.1017/S1461145704004547
15. Ritz S. Quetiapine monotherapy in post-partum onset bipolar disorder with a mixed affective state. Eur Neuropsychopharmacol. 2005;15 (Suppl 3):S407. Abstract. DOI: doi:10.1016/S0924-977X(05)80825-9
16. Gentile S. Quetiapine-fluvoxamine combination during pregnancy and while breastfeeding. Arch Womens Ment Health. 2006. PMID: 16633783
17. Newport DJ, Ritchie JC, Knight BT et al. Venlafaxine in human breast milk and nursing infant plasma: determination of exposure. J Clin Psychiatry. 2009;70:1304-10. PMID: 19607765
18. Levesque S, Riley C. Fetal exposure to lamotrigine and quetiapine in two consecutive pregnancies. Arch Womens Ment Health. 2017;20:237-9. PMID: 27785634
19. Sharma V, Sommerdyk C. Lamotrigine in the prevention of bipolar II postpartum depression. Prim Care Companion CNS Disord. 2016;18 (6):Letter. PMID: 27907274
20. Uguz F. Prophylactic use of olanzapine and quetiapine from pregnancy to the postpartum period in women with bipolar disorder: A case series. J Matern Fetal Neonatal Med. 2017;30:2569-71. PMID: 27809629
21. Atmaca M, Kuloglu M, Tezcan E et al. Quetiapine is not associated with increase in prolactin secretion in contrast to haloperidol. Arch Med Res. 2002;33(6):562-5. PMID: 12505103
22. Maguire GA. Prolactin elevation with antipsychotic medications: mechanisms of action and clinical consequences. J Clin Psychiatry. 2002;63 (Suppl 4):56-62. PMID: 11913677
23. Arvanitis LA, Miller BG. Multiple fixed doses of Seroquel (quetiapine) in patients with acute exacerbation of schizophrenia: a comparison with haloperidol and placebo. The seroquel trial 13 study group. Biol Psychiatry. 1997;42:233-46. PMID: 9270900
24. Pae CU, Kim JJ, Lee CU et al. Very low dose quetiapine-induced galactorrhea in combination with venlafaxine. Hum Psychopharmacol. 2004;19:433-4. PMID: 15303249
Disclaimer: This material is provided for educational purposes only and is not intended for medical advice, diagnosis, or treatment. Consult your healthcare provider with any questions.
