<?xml version="1.0" encoding="UTF-8"?><section ID="williamsonbk1173117025563">
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<code code="43685-7" codeSystem="2.16.840.1.113883.6.1" displayName="WARNINGS AND PRECAUTIONS SECTION"/>
<title>5 WARNINGS AND PRECAUTIONS</title>
<effectiveTime value="20250122"/>
<excerpt>
<highlight>
<text>
<list listType="unordered">
<item>
<caption>•</caption>
<content styleCode="italics">Cerebrovascular Adverse Reactions:</content> Increased incidence of cerebrovascular adverse reactions (e.g., stroke, transient ischemic attack) has been seen in elderly patients with dementia-related psychoses treated with atypical antipsychotic drugs <linkHtml href="#ID_85fe04ae-a0a4-4bce-b830-974939080aa3">(5.3) </linkHtml>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Neuroleptic Malignant Syndrome (NMS): </content>Manage with immediate discontinuation and close monitoring <linkHtml href="#ID_2d59c277-e288-4a9c-8d74-6155d22fd746">(5.4)</linkHtml>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Metabolic Changes:</content> Atypical antipsychotics have been associated with metabolic changes. These metabolic changes include hyperglycemia, dyslipidemia, and weight gain <linkHtml href="#ID_03147eb2-acd8-4ba3-bc5f-a7fc729feecd">(5.5)</linkHtml>
<list listType="unordered">
<item>
<caption>∘</caption>Hyperglycemia and Diabetes Mellitus: Monitor patients for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Monitor glucose regularly in patients with diabetes or at risk for diabetes</item>
<item>
<caption>∘</caption>Dyslipidemia: Undesirable alterations have been observed in patients treated with atypical antipsychotics. Appropriate clinical monitoring is recommended, including fasting blood lipid testing at the beginning of, and periodically, during treatment</item>
<item>
<caption>∘</caption>Weight Gain: Gain in body weight has been observed; clinical monitoring of weight is recommended</item>
</list>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Tardive Dyskinesia:</content> Discontinue if clinically appropriate <linkHtml href="#ID_3813d249-6b50-4530-ad1f-263dd7e86820">(5.6)</linkHtml>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Hypotension:</content> Use with caution in patients with known cardiovascular or cerebrovascular disease <linkHtml href="#williamsonbk1173119764403">(5.7)</linkHtml>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Increased Blood Pressure in Children and Adolescents:</content> Monitor blood pressure at the beginning of, and periodically during treatment in children and adolescents <linkHtml href="#ID_22914871-71ed-4e33-a442-14ac1646756e">(5.9)</linkHtml>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Leukopenia, Neutropenia and Agranulocytosis:</content> Monitor complete blood count frequently during the first few months of treatment in patients with a pre-existing low white cell count or a history of leukopenia/neutropenia and discontinue SEROQUEL at the first sign of a decline in WBC in absence of other causative factors <linkHtml href="#williamsonbk1210943379090">(5.10)</linkHtml>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Cataracts:</content> Lens changes have been observed in patients during long-term quetiapine treatment. Lens examination is recommended when starting treatment and at 6-month intervals during chronic treatment <linkHtml href="#ID_8711f8ca-9041-4bae-b5e3-cfc3749fe82c">(5.11)</linkHtml>
</item>
<item>
<caption>•</caption>
<content styleCode="italics">Anticholinergic(antimuscarinic) Effects</content>: Use with caution with other anticholinergic drugs and in patients with urinary retention, prostatic hypertrophy, or constipation <linkHtml href="#ID_661e43da-d3b2-4463-b144-db45a3aa8fc5">(5.20)</linkHtml>
</item>
</list>
</text>
</highlight>
</excerpt>
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<title>5.1 Increased Mortality in Elderly Patients with Dementia-Related Psychosis</title>
<text>
<paragraph>Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death. Analysis of 17 placebo-controlled trials (modal duration of 10 weeks), largely in patients taking atypical antipsychotic drugs, revealed a risk of death in drug-treated patients of between 1.6 to 1.7 times the risk of death in placebo-treated patients. Over the course of a typical 10-week controlled trial, the rate of death in drug-treated patients was about 4.5%, compared to a rate of about 2.6% in the placebo group. Although the causes of death were varied, most of the deaths appeared to be either cardiovascular (e.g., heart failure, sudden death) or infectious (e.g., pneumonia) in nature. Observational studies suggest that, similar to atypical antipsychotic drugs, treatment with conventional antipsychotic drugs may increase mortality. The extent to which the findings of increased mortality in observational studies may be attributed to the antipsychotic drug as opposed to some characteristic(s) of the patients is not clear. SEROQUEL is not approved for the treatment of patients with dementia-related psychosis <content styleCode="italics">[see </content>
<content styleCode="italics">
<linkHtml href="#ID_b8a6883b-048a-4395-84c4-b27537f77ba6">Boxed Warning</linkHtml>]</content>.</paragraph>
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<title>5.2 Suicidal Thoughts and Behaviors in Adolescents and Young Adults</title>
<text>
<paragraph>Patients with major depressive disorder (MDD), both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders, and these disorders themselves are the strongest predictors of suicide. There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment. Pooled analyses of short-term placebo-controlled trials of antidepressant drugs (SSRIs and others) showed that these drugs increase the risk of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults (ages 18-24) with major depressive disorder (MDD) and other psychiatric disorders. Short-term studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24; there was a reduction with antidepressants compared to placebo in adults aged 65 and older.</paragraph>
<paragraph>The pooled analyses of placebo-controlled trials in children and adolescents with MDD, obsessive-compulsive disorder (OCD), or other psychiatric disorders included a total of 24 short-term trials of 9 antidepressant drugs in over 4400 patients. The pooled analyses of placebo-controlled trials in adults with MDD or other psychiatric disorders included a total of 295 short-term trials (median duration of 2 months) of 11 antidepressant drugs in over 77,000 patients. There was considerable variation in risk of suicidality among drugs, but a tendency toward an increase in the younger patients for almost all drugs studied. There were differences in absolute risk of suicidality across the different indications, with the highest incidence in MDD. The risk differences (drug vs. placebo), however, were relatively stable within age strata and across indications. These risk differences (drug-placebo difference in the number of cases of suicidality per 1000 patients treated) are provided in Table 2.</paragraph>
<table width="100%">
<caption>Table 2: Drug-Placebo Difference in Number of Cases of Suicidality per 1000 Patients Treated</caption>
<col width="13%"/>
<col width="86%"/>
<tbody>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Age Range</content>
</paragraph>
</td>
<td styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Drug-Placebo Difference in Number of Cases of Suicidality per 1000 Patients Treated</content>
</paragraph>
</td>
</tr>
<tr>
<td styleCode="Rrule Lrule Botrule " valign="top"/>
<td styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>
<content styleCode="bold">Increases Compared to Placebo</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph><18</paragraph>
</td>
<td styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>14 additional cases</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>18-24</paragraph>
</td>
<td styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>5 additional cases</paragraph>
</td>
</tr>
<tr>
<td styleCode="Rrule Lrule Botrule " valign="top"/>
<td styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>
<content styleCode="bold">Decreases Compared to Placebo</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>25-64</paragraph>
</td>
<td styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>1 fewer case</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>≥65</paragraph>
</td>
<td styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>6 fewer cases</paragraph>
</td>
</tr>
</tbody>
</table>
<paragraph>No suicides occurred in any of the pediatric trials. There were suicides in the adult trials, but the number was not sufficient to reach any conclusion about drug effect on suicide.</paragraph>
<paragraph>It is unknown whether the suicidality risk extends to longer-term use, i.e., beyond several months. However, there is substantial evidence from placebo-controlled maintenance trials in adults with depression that the use of antidepressants can delay the recurrence of depression.</paragraph>
<paragraph>
<content styleCode="bold">All patients being treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the initial few months of a course of drug therapy, or at times of dose changes, either increases or decreases.</content>
</paragraph>
<paragraph>The following symptoms, anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania, have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and non-psychiatric. Although a causal link between the emergence of such symptoms and either the worsening of depression and/or the emergence of suicidal impulses has not been established, there is concern that such symptoms may represent precursors to emerging suicidality.</paragraph>
<paragraph>Consideration should be given to changing the therapeutic regimen, including possibly discontinuing the medication, in patients whose depression is persistently worse, or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient's presenting symptoms.</paragraph>
<paragraph>
<content styleCode="bold">Families and caregivers of patients being treated with antidepressants for major depressive disorder or other indications, both psychiatric and non-psychiatric, should be alerted about the need to monitor patients for the emergence of agitation, irritability, unusual changes in behavior, and the other symptoms described above, as well as the emergence of suicidality, and to report such symptoms immediately to healthcare providers. Such monitoring should include daily observation by families and caregivers. </content>Prescriptions for SEROQUEL should be written for the smallest quantity of tablets consistent with good patient management, in order to reduce the risk of overdose.</paragraph>
<paragraph>
<content styleCode="bold">Screening Patients for Bipolar Disorder:</content> A major depressive episode may be the initial presentation of bipolar disorder. It is generally believed (though not established in controlled trials) that treating such an episode with an antidepressant alone may increase the likelihood of precipitation of a mixed/manic episode in patients at risk for bipolar disorder. Whether any of the symptoms described above represent such a conversion is unknown. However, prior to initiating treatment with an antidepressant, including SEROQUEL, patients with depressive symptoms should be adequately screened to determine if they are at risk for bipolar disorder; such screening should include a detailed psychiatric history, including a family history of suicide, bipolar disorder, and depression.</paragraph>
</text>
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<title>5.3 Cerebrovascular Adverse Reactions, Including Stroke, in Elderly Patients with Dementia-Related Psychosis</title>
<text>
<paragraph>In placebo-controlled trials with risperidone, aripiprazole, and olanzapine in elderly subjects with dementia, there was a higher incidence of cerebrovascular adverse reactions (cerebrovascular accidents and transient ischemic attacks) including fatalities compared to placebo-treated subjects. SEROQUEL is not approved for the treatment of patients with dementia-related psychosis <content styleCode="italics">[see also </content>
<content styleCode="italics">
<linkHtml href="#ID_b8a6883b-048a-4395-84c4-b27537f77ba6">Boxed Warning</linkHtml>
</content>
<content styleCode="italics"> and <linkHtml href="#ID_65b423e3-2ab9-456e-a3f1-81c89fe869fa">Warnings and Precautions (5.1)</linkHtml>].</content>
</paragraph>
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<effectiveTime value="20200107"/>
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<section ID="ID_2d59c277-e288-4a9c-8d74-6155d22fd746">
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<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.4 Neuroleptic Malignant Syndrome (NMS)</title>
<text>
<paragraph>A potentially fatal symptom complex sometimes referred to as Neuroleptic Malignant Syndrome (NMS) has been reported in association with administration of antipsychotic drugs, including SEROQUEL. Rare cases of NMS have been reported with SEROQUEL. Clinical manifestations of NMS are hyperpyrexia, muscle rigidity, altered mental status, and evidence of autonomic instability (irregular pulse or blood pressure, tachycardia, diaphoresis, and cardiac dysrhythmia). Additional signs may include elevated creatinine phosphokinase, myoglobinuria (rhabdomyolysis) and acute renal failure.</paragraph>
<paragraph>The diagnostic evaluation of patients with this syndrome is complicated. In arriving at a diagnosis, it is important to exclude cases where the clinical presentation includes both serious medical illness (e.g., pneumonia, systemic infection, etc.) and untreated or inadequately treated extrapyramidal signs and symptoms (EPS). Other important considerations in the differential diagnosis include central anticholinergic toxicity, heat stroke, drug fever, and primary central nervous system (CNS) pathology.</paragraph>
<paragraph>The management of NMS should include: 1) immediate discontinuation of antipsychotic drugs and other drugs not essential to concurrent therapy; 2) intensive symptomatic treatment and medical monitoring; and 3) treatment of any concomitant serious medical problems for which specific treatments are available. There is no general agreement about specific pharmacological treatment regimens for NMS.</paragraph>
<paragraph>If a patient requires antipsychotic drug treatment after recovery from NMS, the potential reintroduction of drug therapy should be carefully considered. The patient should be carefully monitored since recurrences of NMS have been reported.</paragraph>
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<title>5.5 Metabolic Changes </title>
<text>
<paragraph>Atypical antipsychotic drugs have been associated with metabolic changes that include hyperglycemia/diabetes mellitus, dyslipidemia, and body weight gain. While all of the drugs in the class have been shown to produce some metabolic changes, each drug has its own specific risk profile. In some patients, a worsening of more than one of the metabolic parameters of weight, blood glucose, and lipids was observed in clinical studies. Changes in these metabolic profiles should be managed as clinically appropriate.</paragraph>
<paragraph>Hyperglycemia and Diabetes Mellitus</paragraph>
<paragraph>Hyperglycemia, in some cases extreme and associated with ketoacidosis or hyperosmolar coma or death, has been reported in patients treated with atypical antipsychotics, including quetiapine. Assessment of the relationship between atypical antipsychotic use and glucose abnormalities is complicated by the possibility of an increased background risk of diabetes mellitus in patients with schizophrenia and the increasing incidence of diabetes mellitus in the general population. Given these confounders, the relationship between atypical antipsychotic use and hyperglycemia-related adverse reactions is not completely understood. However, epidemiological studies suggest an increased risk of hyperglycemia-related adverse reactions in patients treated with the atypical antipsychotics. Precise risk estimates for hyperglycemia-related adverse reactions in patients treated with atypical antipsychotics are not available.</paragraph>
<paragraph>Patients with an established diagnosis of diabetes mellitus who are started on atypical antipsychotics should be monitored regularly for worsening of glucose control. Patients with risk factors for diabetes mellitus (e.g., obesity, family history of diabetes) who are starting treatment with atypical antipsychotics should undergo fasting blood glucose testing at the beginning of treatment and periodically during treatment. Any patient treated with atypical antipsychotics should be monitored for symptoms of hyperglycemia including polydipsia, polyuria, polyphagia, and weakness. Patients who develop symptoms of hyperglycemia during treatment with atypical antipsychotics should undergo fasting blood glucose testing. In some cases, hyperglycemia has resolved when the atypical antipsychotic was discontinued; however, some patients required continuation of anti-diabetic treatment despite discontinuation of the suspect drug.</paragraph>
<paragraph>
<content styleCode="italics">Adults:</content>
</paragraph>
<table width="100%">
<caption>Table 3: Fasting Glucose - Proportion of Patients Shifting to ≥126 mg/dL in Short-Term (≤12 weeks) Placebo-Controlled Studies<footnote ID="_Ref365548037">Includes SEROQUEL and SEROQUEL XR data.</footnote>
</caption>
<col width="20%"/>
<col width="46%"/>
<col width="16%"/>
<col width="6%"/>
<col width="12%"/>
<tbody>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Laboratory Analyte</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Category Change (At Least Once) from Baseline</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Treatment Arm</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">N</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Patients</content>
</paragraph>
<paragraph>
<content styleCode="bold">n (%)</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Fasting</paragraph>
<paragraph>Glucose</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Normal to High</paragraph>
<paragraph>(<100 mg/dL to</paragraph>
<paragraph>≥126 mg/dL)</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Quetiapine</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>2907</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>71 (2.4%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>1346</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>19 (1.4%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Borderline to High</paragraph>
<paragraph>(≥100 mg/dL and <126 mg/dL to</paragraph>
<paragraph>≥126 mg/dL)</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Quetiapine</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>572</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>67 (11.7%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>279</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>33 (11.8%)</paragraph>
</td>
</tr>
</tbody>
</table>
<paragraph>In a 24-week trial (active-controlled, 115 patients treated with SEROQUEL) designed to evaluate glycemic status with oral glucose tolerance testing of all patients, at Week 24 the incidence of a post-glucose challenge glucose level ≥200 mg/dL was 1.7% and the incidence of a fasting blood glucose level ≥126 mg/dL was 2.6%. The mean change in fasting glucose from baseline was 3.2 mg/dL and mean change in 2-hour glucose from baseline was -1.8 mg/dL for quetiapine.</paragraph>
<paragraph>In 2 long-term placebo-controlled randomized withdrawal clinical trials for bipolar I disorder maintenance, mean exposure of 213 days for SEROQUEL (646 patients) and 152 days for placebo (680 patients), the mean change in glucose from baseline was +5.0 mg/dL for SEROQUEL and –0.05 mg/dL for placebo. The exposure-adjusted rate of any increased blood glucose level (≥126 mg/dL) for patients more than 8 hours since a meal (however, some patients may not have been precluded from calorie intake from fluids during fasting period) was 18.0 per 100 patient years for SEROQUEL (10.7% of patients; n=556) and 9.5 for placebo per 100 patient years (4.6% of patients; n=581).</paragraph>
<paragraph>
<content styleCode="italics">Children and Adolescents: </content>
</paragraph>
<paragraph>In a placebo-controlled SEROQUEL monotherapy study of adolescent patients (13–17 years of age) with schizophrenia (6 weeks duration), the mean change in fasting glucose levels for SEROQUEL (n=138) compared to placebo (n=67) was –0.75 mg/dL versus –1.70 mg/dL. In a placebo-controlled SEROQUEL monotherapy study of children and adolescent patients (10–17 years of age) with bipolar mania (3 weeks duration), the mean change in fasting glucose level for SEROQUEL (n=170) compared to placebo (n=81) was 3.62 mg/dL versus –1.17 mg/dL. No patient in either study with a baseline normal fasting glucose level (<100 mg/dL) or a baseline borderline fasting glucose level (≥100 mg/dL and <126 mg/dL) had a blood glucose level of ≥126 mg/dL. </paragraph>
<paragraph>In a placebo-controlled SEROQUEL XR monotherapy study (8 weeks duration) of children and adolescent patients (10-17 years of age) with bipolar depression, in which efficacy was not established, the mean change in fasting glucose levels for SEROQUEL XR (n=60) compared to placebo (n=62) was 1.8 mg/dL versus 1.6 mg/dL. In this study, there were no patients in the SEROQUEL XR or placebo-treated groups with a baseline normal fasting glucose level (<100 mg/dL) that had an increase in blood glucose level >126 mg/dL. There was one patient in the SEROQUEL XR group with a baseline borderline fasting glucose level (>100 mg/dL and <126 mg/dL) who had an increase in blood glucose level of >126 mg/dL compared to zero patients in the placebo group.</paragraph>
<paragraph>Dyslipidemia</paragraph>
<paragraph>
<content styleCode="italics">Adults:</content>
</paragraph>
<paragraph>Table 4 shows the percentage of adult patients with changes in total cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol from baseline by indication in clinical trials with SEROQUEL.</paragraph>
<table width="100%">
<caption>Table 4: Percentage of Adult Patients with Shifts in Total Cholesterol, Triglycerides, LDL-Cholesterol, and HDL-Cholesterol from Baseline to Clinically Significant Levels by Indication</caption>
<col width="30%"/>
<col width="16%"/>
<col width="18%"/>
<col width="6%"/>
<col width="11%"/>
<tbody>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Laboratory Analyte</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Indication</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Treatment Arm</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">N</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Patients</content>
</paragraph>
<paragraph>
<content styleCode="bold">n (%)</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Total Cholesterol ≥240 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnote ID="_Ref365548314">6 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>137</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>24 (18%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>92</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>6 (7%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar</paragraph>
<paragraph>Depression<footnote ID="_Ref365548404">8 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>463</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>41 (9%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>250</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>15 (6%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Triglycerides ≥200 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnoteRef IDREF="_Ref365548314"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>120</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>26 (22%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>70</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>11 (16%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar</paragraph>
<paragraph>Depression<footnoteRef IDREF="_Ref365548404"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>436</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>59 (14%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>232</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>20 (9%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>LDL-</paragraph>
<paragraph>Cholesterol</paragraph>
<paragraph>≥160 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnoteRef IDREF="_Ref365548314"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnote ID="_Ref365548466">Parameters not measured in the SEROQUEL registration studies for schizophrenia.</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnoteRef IDREF="_Ref365548466"/>
</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnoteRef IDREF="_Ref365548466"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnoteRef IDREF="_Ref365548466"/>
</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar</paragraph>
<paragraph>Depression<footnoteRef IDREF="_Ref365548404"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>465</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>29 (6%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>256</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>12 (5%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>HDL- Cholesterol</paragraph>
<paragraph>≤40 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnoteRef IDREF="_Ref365548314"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnoteRef IDREF="_Ref365548466"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnoteRef IDREF="_Ref365548466"/>
</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnoteRef IDREF="_Ref365548466"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>na<footnoteRef IDREF="_Ref365548466"/>
</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar</paragraph>
<paragraph>Depression<footnoteRef IDREF="_Ref365548404"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>393</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>56 (14%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>214</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>29 (14%)</paragraph>
</td>
</tr>
</tbody>
</table>
<paragraph>
<content styleCode="italics">Children and Adolescents: </content>
</paragraph>
<paragraph>Table 5 shows the percentage of children and adolescents with changes in total cholesterol, triglycerides, LDL-cholesterol, and HDL-cholesterol from baseline in clinical trials with SEROQUEL.</paragraph>
<table width="100%">
<caption>Table 5: Percentage of Children and Adolescents with Shifts in Total Cholesterol, Triglycerides, LDL-Cholesterol, and HDL-Cholesterol from Baseline to Clinically Significant Levels</caption>
<col width="30%"/>
<col width="16%"/>
<col width="18%"/>
<col width="6%"/>
<col width="11%"/>
<tbody>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Laboratory </content>
</paragraph>
<paragraph>
<content styleCode="bold">Analyte</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Indication</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Treatment Arm</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">N</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Patients</content>
</paragraph>
<paragraph>
<content styleCode="bold">n (%)</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Total Cholesterol ≥200 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnote ID="_Ref365548696">13-17 years, 6 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>107</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>13 (12%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>56</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>1 (2%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Mania<footnote ID="_Ref365548723">10-17 years, 3 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>159</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>16 (10%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>66</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>2 (3%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Triglycerides</paragraph>
<paragraph>≥150 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnoteRef IDREF="_Ref365548696"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>103</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>17 (17%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>51</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>4 (8%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Mania<footnoteRef IDREF="_Ref365548723"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>149</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>32 (22%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>60</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>8 (13%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>LDL-Cholesterol ≥130 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnoteRef IDREF="_Ref365548696"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>112</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>4 (4%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>60</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>1 (2%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Mania<footnoteRef IDREF="_Ref365548723"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>169</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>13 (8%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>74</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>4 (5%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>HDL-Cholesterol ≤40 mg/dL</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnoteRef IDREF="_Ref365548696"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>104</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>16 (15%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>54</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>10 (19%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Mania<footnoteRef IDREF="_Ref365548723"/>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>154</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>16 (10%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>61</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>4 (7%)</paragraph>
</td>
</tr>
</tbody>
</table>
<paragraph>In a placebo-controlled SEROQUEL XR monotherapy study (8 weeks duration) of children and adolescent patients (10 to 17 years of age) with bipolar depression, in which efficacy was not established, the percentage of children and adolescents with shifts in total cholesterol (≥200 mg/dL), triglycerides (≥150 mg/dL), LDL-cholesterol (≥ 130 mg/dL), and HDL-cholesterol (≤40 mg/dL) from baseline to clinically significant levels were: total cholesterol 8% (7/83) for SEROQUEL XR vs. 6% (5/84) for placebo; triglycerides 28% (22/80) for SEROQUEL XR vs. 9% (7/82) for placebo; LDL-cholesterol 2% (2/86) for SEROQUEL XR vs. 4% (3/85) for placebo and HDL-cholesterol 20% (13/65) for SEROQUEL XR vs. 15% (11/74) for placebo.</paragraph>
<paragraph>Weight Gain </paragraph>
<paragraph>Increases in weight have been observed in clinical trials. Patients receiving quetiapine should receive regular monitoring of weight.</paragraph>
<paragraph>
<content styleCode="italics">Adults</content>: </paragraph>
<paragraph>In clinical trials with SEROQUEL the following increases in weight have been reported.</paragraph>
<table width="100%">
<caption>Table 6: Proportion of Patients with Weight Gain ≥7% of Body Weight (Adults)</caption>
<col width="35%"/>
<col width="32%"/>
<col width="17%"/>
<col width="6%"/>
<col width="11%"/>
<tbody>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Vital Sign</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Indication</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Treatment Arm</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">N</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Patients</content>
</paragraph>
<paragraph>
<content styleCode="bold">n (%)</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="8" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>
<content styleCode="bold">Weight Gain ≥7% of Body Weight</content>
</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnote ID="_Ref365549048">up to 6 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>391</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>89 (23%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>206</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>11 (6%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Mania (monotherapy)<footnote ID="_Ref365549118">up to 12 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>209</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>44 (21%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>198</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>13 (7%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Mania (adjunct therapy)<footnote ID="_Ref365549128">up to 3 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>196</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>25 (13%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>203</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>8 (4%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Depression<footnote ID="_Ref365549134">up to 8 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>554</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>47 (8%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>295</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>7 (2%)</paragraph>
</td>
</tr>
</tbody>
</table>
<paragraph>
<content styleCode="italics">Children and Adolescents: </content>
</paragraph>
<paragraph>In two clinical trials with SEROQUEL, one in bipolar mania and one in schizophrenia, reported increases in weight are included in Table 7.</paragraph>
<table width="100%">
<caption>Table 7: Proportion of Patients with Weight Gain ≥7% of Body Weight (Children and Adolescents)</caption>
<col width="36%"/>
<col width="16%"/>
<col width="18%"/>
<col width="6%"/>
<col width="11%"/>
<tbody>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Vital Sign</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Indication</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Treatment Arm</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">N</content>
</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Patients</content>
</paragraph>
<paragraph>
<content styleCode="bold">n (%)</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="4" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>
<content styleCode="bold">Weight Gain ≥7% of Body Weight</content>
</paragraph>
</td>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Schizophrenia<footnote ID="_Ref365549217">6 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>111</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>23 (21%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>44</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>3 (7%)</paragraph>
</td>
</tr>
<tr>
<td align="center" rowspan="2" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Bipolar Mania<footnote ID="_Ref365549232">3 weeks duration</footnote>
</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>SEROQUEL</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>157</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>18 (12%)</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>68</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0 (0%)</paragraph>
</td>
</tr>
</tbody>
</table>
<paragraph>The mean change in body weight in the schizophrenia trial was 2.0 kg in the SEROQUEL group and -0.4 kg in the placebo group and in the bipolar mania trial, it was 1.7 kg in the SEROQUEL group and 0.4 kg in the placebo group.</paragraph>
<paragraph>In an open-label study that enrolled patients from the above two pediatric trials, 63% of patients (241/380) completed 26 weeks of therapy with SEROQUEL. After 26 weeks of treatment, the mean increase in body weight was 4.4 kg. Forty-five percent of the patients gained ≥7% of their body weight, not adjusted for normal growth. In order to adjust for normal growth over 26 weeks, an increase of at least 0.5 standard deviation from baseline in BMI was used as a measure of a clinically significant change; 18.3% of patients on SEROQUEL met this criterion after 26 weeks of treatment. </paragraph>
<paragraph>In a clinical trial for SEROQUEL XR in children and adolescents (10-17 years of age) with bipolar depression, in which efficacy was not established, the percentage of patients with weight gain ≥7% of body weight at any time was 15% (14/92) for SEROQUEL XR vs. 10% (10/100) for placebo. The mean change in body weight was 1.4 kg in the SEROQUEL XR group vs. 0.6 kg in the placebo group.</paragraph>
<paragraph>When treating pediatric patients with SEROQUEL for any indication, weight gain should be assessed against that expected for normal growth.</paragraph>
</text>
<effectiveTime value="20200918"/>
</section>
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<component>
<section ID="ID_3813d249-6b50-4530-ad1f-263dd7e86820">
<id root="ba38a55e-4375-4a15-b8fd-d0aee830adec"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.6 Tardive Dyskinesia</title>
<text>
<paragraph>A syndrome of potentially irreversible, involuntary, dyskinetic movements may develop in patients treated with antipsychotic drugs, including quetiapine. Although the prevalence of the syndrome appears to be highest among the elderly, especially elderly women, it is impossible to rely upon prevalence estimates to predict, at the inception of antipsychotic treatment, which patients are likely to develop the syndrome. Whether antipsychotic drug products differ in their potential to cause tardive dyskinesia is unknown.</paragraph>
<paragraph>The risk of developing tardive dyskinesia and the likelihood that it will become irreversible are believed to increase as the duration of treatment and the total cumulative dose of antipsychotic drugs administered to the patient increase. However, the syndrome can develop, although much less commonly, after relatively brief treatment periods at low doses or may even arise after discontinuation of treatment. </paragraph>
<paragraph>Tardive dyskinesia may remit, partially or completely, if antipsychotic treatment is withdrawn. Antipsychotic treatment, itself, however, may suppress (or partially suppress) the signs and symptoms of the syndrome and thereby may possibly mask the underlying process. The effect that symptomatic suppression has upon the long-term course of the syndrome is unknown.</paragraph>
<paragraph>Given these considerations, SEROQUEL should be prescribed in a manner that is most likely to minimize the occurrence of tardive dyskinesia. Chronic antipsychotic treatment should generally be reserved for patients who appear to suffer from a chronic illness that (1) is known to respond to antipsychotic drugs, and (2) for whom alternative, equally effective, but potentially less harmful treatments are not available or appropriate. In patients who do require chronic treatment, the smallest dose and the shortest duration of treatment producing a satisfactory clinical response should be sought. The need for continued treatment should be reassessed periodically.</paragraph>
<paragraph>If signs and symptoms of tardive dyskinesia appear in a patient on SEROQUEL, drug discontinuation should be considered. However, some patients may require treatment with SEROQUEL despite the presence of the syndrome.</paragraph>
</text>
<effectiveTime value="20220127"/>
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<id root="5c2edb66-d97e-4f77-84cf-c3b49d5e837a"/>
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<title>5.7 Hypotension</title>
<text>
<paragraph>Quetiapine may induce orthostatic hypotension associated with dizziness, tachycardia and, in some patients, syncope, especially during the initial dose-titration period, probably reflecting its α<sub>1</sub>-adrenergic antagonist properties. Syncope was reported in 1% (28/3265) of the patients treated with SEROQUEL, compared with 0.2% (2/954) on placebo and about 0.4% (2/527) on active control drugs. Orthostatic hypotension, dizziness, and syncope may lead to falls.</paragraph>
<paragraph>SEROQUEL should be used with particular caution in patients with known cardiovascular disease (history of myocardial infarction or ischemic heart disease, heart failure, or conduction abnormalities), cerebrovascular disease or conditions which would predispose patients to hypotension (dehydration, hypovolemia, and treatment with antihypertensive medications). The risk of orthostatic hypotension and syncope may be minimized by limiting the initial dose to 25 mg twice daily <content styleCode="italics">[see <linkHtml href="#ID_1ead488d-26c6-4023-8222-129ac9cccf40">Dosage and Administration (2.2)</linkHtml>].</content> If hypotension occurs during titration to the target dose, a return to the previous dose in the titration schedule is appropriate.</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
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<component>
<section ID="ID_08046d61-fc7e-4c55-836a-fec82ada4f83">
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<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.8 Falls </title>
<text>
<paragraph>Atypical antipsychotic drugs, including SEROQUEL, may cause somnolence, postural hypotension, motor, and sensory instability, which may lead to falls and, consequently, fractures or other injuries. For patients with diseases, conditions, or medications that could exacerbate these effects, complete fall risk assessments when initiating antipsychotic treatment and recurrently for patients on long-term antipsychotic therapy.</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
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<component>
<section ID="ID_22914871-71ed-4e33-a442-14ac1646756e">
<id root="48b032fd-6460-4c79-8241-921ae6eef73d"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.9 Increases in Blood Pressure (Children and Adolescents)</title>
<text>
<paragraph>In placebo-controlled trials in children and adolescents with schizophrenia (6-week duration) or bipolar mania (3-week duration), the incidence of increases at any time in systolic blood pressure (≥20 mmHg) was 15.2% (51/335) for SEROQUEL and 5.5% (9/163) for placebo; the incidence of increases at any time in diastolic blood pressure (≥10 mmHg) was 40.6% (136/335) for SEROQUEL and 24.5% (40/163) for placebo. In the 26-week open-label clinical trial, one child with a reported history of hypertension experienced a hypertensive crisis. Blood pressure in children and adolescents should be measured at the beginning of, and periodically during treatment. </paragraph>
<paragraph>In a placebo-controlled SEROQUEL XR clinical trial (8 weeks duration) in children and adolescents (10-17 years of age) with bipolar depression, in which efficacy was not established, the incidence of increases at any time in systolic blood pressure (≥20 mmHg) was 6.5% (6/92) for SEROQUEL XR and 6.0% (6/100) for placebo; the incidence of increases at any time in diastolic blood pressure (≥10 mmHg) was 46.7% (43/92) for SEROQUEL XR and 36.0% (36/100) for placebo. </paragraph>
</text>
<effectiveTime value="20190826"/>
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<component>
<section ID="williamsonbk1210943379090">
<id root="f4f89f89-591f-46d5-b3ec-b9f23fdd7638"/>
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<title>5.10 Leukopenia, Neutropenia, and Agranulocytosis</title>
<text>
<paragraph>In clinical trial and postmarketing experience, events of leukopenia/neutropenia have been reported temporally related to atypical antipsychotic agents, including SEROQUEL. Agranulocytosis has been reported. </paragraph>
<paragraph>Agranulocytosis (defined as absolute neutrophil count <500/mm3) has been reported with quetiapine, including fatal cases and cases in patients without pre-existing risk factors. Neutropenia should be considered in patients presenting with infection, particularly in the absence of obvious predisposing factor(s), or in patients with unexplained fever, and should be managed as clinically appropriate.</paragraph>
<paragraph>Possible risk factors for leukopenia/neutropenia include pre-existing low white cell count (WBC) and history of drug induced leukopenia/neutropenia. Patients with a pre-existing low WBC or a history of drug induced leukopenia/neutropenia should have their complete blood count (CBC) monitored frequently during the first few months of therapy and should discontinue SEROQUEL at the first sign of a decline in WBC in absence of other causative factors.</paragraph>
<paragraph>Patients with neutropenia should be carefully monitored for fever or other symptoms or signs of infection and treated promptly if such symptoms or signs occur. Patients with severe neutropenia (absolute neutrophil count <1000/mm3) should discontinue SEROQUEL and have their WBC followed until recovery.</paragraph>
</text>
<effectiveTime value="20191129"/>
</section>
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<component>
<section ID="ID_8711f8ca-9041-4bae-b5e3-cfc3749fe82c">
<id root="a26a39d7-31ca-4fec-8b82-191a7206302b"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.11 Cataracts</title>
<text>
<paragraph>The development of cataracts was observed in association with quetiapine treatment in chronic dog studies <content styleCode="italics">[see </content>
<content styleCode="italics">
<linkHtml href="#ID_b660eb39-bd5a-4d4c-816f-0af4a58ea32c">Nonclinical Toxicology (13.2)</linkHtml>
</content>
<content styleCode="italics">]</content>. Lens changes have also been observed in adults, children, and adolescents during long-term SEROQUEL treatment, but a causal relationship to SEROQUEL use has not been established. Nevertheless, the possibility of lenticular changes cannot be excluded at this time. Therefore, examination of the lens by methods adequate to detect cataract formation, such as slit lamp exam or other appropriately sensitive methods, is recommended at initiation of treatment or shortly thereafter, and at 6-month intervals during chronic treatment.</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
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<component>
<section ID="williamsonbk1310564988191">
<id root="3650a41a-2523-4f1d-a356-d21037aa239c"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.12 QT Prolongation</title>
<text>
<paragraph>In clinical trials, quetiapine was not associated with a persistent increase in QT intervals. However, the QT effect was not systematically evaluated in a thorough QT study. In post marketing experience, there were cases reported of QT prolongation in patients who overdosed on quetiapine <content styleCode="italics">[see <linkHtml href="#williamsonbk1263236951731">Overdosage (10.1)</linkHtml>], </content>in patients with concomitant illness, and in patients taking medicines known to cause electrolyte imbalance or increase QT interval <content styleCode="italics">[see <linkHtml href="#williamsonbk1173118423951">Drug Interactions (7.1)</linkHtml>]</content>.</paragraph>
<paragraph>The use of quetiapine should be avoided in combination with other drugs that are known to prolong QTc including Class 1A antiarrythmics (e.g., quinidine, procainamide) or Class III antiarrythmics (e.g., amiodarone, sotalol), antipsychotic medications (e.g., ziprasidone, chlorpromazine, thioridazine), antibiotics (e.g., gatifloxacin, moxifloxacin), or any other class of medications known to prolong the QTc interval (e.g., pentamidine, levomethadyl acetate, methadone).</paragraph>
<paragraph>Quetiapine should also be avoided in circumstances that may increase the risk of occurrence of torsade de pointes and/or sudden death including (1) a history of cardiac arrhythmias such as bradycardia; (2) hypokalemia or hypomagnesemia; (3) concomitant use of other drugs that prolong the QTc interval; and (4) presence of congenital prolongation of the QT interval. </paragraph>
<paragraph>Caution should also be exercised when quetiapine is prescribed in patients with increased risk of QT prolongation (e.g., cardiovascular disease, family history of QT prolongation, the elderly, congestive heart failure, and heart hypertrophy).</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
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<component>
<section ID="ID_9184f7c9-e27f-443e-aa6a-b4045eaee191">
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<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.13 Seizures</title>
<text>
<paragraph>During clinical trials, seizures occurred in 0.5% (20/3490) of patients treated with SEROQUEL compared to 0.2% (2/954) on placebo and 0.7% (4/527) on active control drugs. As with other antipsychotics, SEROQUEL should be used cautiously in patients with a history of seizures or with conditions that potentially lower the seizure threshold, e.g., Alzheimer’s dementia. Conditions that lower the seizure threshold may be more prevalent in a population of 65 years or older.</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
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<component>
<section ID="ID_8c4da513-5214-4c56-b5ae-fd6831a32d31">
<id root="e2cfd0ca-081d-4ba3-b88c-25ab70bd3ea1"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.14 Hypothyroidism</title>
<text>
<paragraph>Adults: Clinical trials with quetiapine demonstrated dose-related decreases in thyroid hormone levels. The reduction in total and free thyroxine (T<sub>4</sub>) of approximately 20% at the higher end of the therapeutic dose range was maximal in the first six weeks of treatment and maintained without adaptation or progression during more chronic therapy. In nearly all cases, cessation of quetiapine treatment was associated with a reversal of the effects on total and free T<sub>4</sub>, irrespective of the duration of treatment. The mechanism by which quetiapine effects the thyroid axis is unclear. If there is an effect on the hypothalamic-pituitary axis, measurement of TSH alone may not accurately reflect a patient’s thyroid status. Therefore, both TSH and free T<sub>4</sub>, in addition to clinical assessment, should be measured at baseline and at follow-up. </paragraph>
<paragraph>In the mania adjunct studies, where SEROQUEL was added to lithium or divalproex, 12% (24/196) of SEROQUEL treated patients compared to 7% (15/203) of placebo-treated patients had elevated TSH levels. Of the SEROQUEL treated patients with elevated TSH levels, 3 had simultaneous low free T<sub>4</sub> levels (free T<sub>4</sub> <0.8 LLN).</paragraph>
<paragraph>About 0.7% (26/3489) of SEROQUEL patients did experience TSH increases in monotherapy studies. Some patients with TSH increases needed replacement thyroid treatment. </paragraph>
<paragraph>In all quetiapine trials, the incidence of shifts in thyroid hormones and TSH were<linkHtml href="#ContentofLabeling_footnote1">1</linkHtml>: decrease in free T<sub>4</sub> (<0.8 LLN), 2.0% (357/17513); decrease in total T<sub>4</sub> (<0.8LLN), 4.0% (75/1861); decrease in free T<sub>3 </sub>(<0.8 LLN), 0.4% (53/13766); decrease in total T<sub>3 </sub>(<0.8LLN), 2.0% (26/1312), and increase in TSH (>5mIU/L), 4.9% (956/19412). In eight patients, where TBG was measured, levels of TBG were unchanged. </paragraph>
<paragraph>Table 8 shows the incidence of these shifts in short-term placebo-controlled clinical trials.</paragraph>
<table width="100%">
<caption>Table 8: Incidence of Shifts in Thyroid Hormone Levels and TSH in Short-Term Placebo-Controlled Clinical Trials<footnote ID="_Ref365549448">Based on shifts from normal baseline to potentially clinically important value at any time post-baseline. Shifts in total T<sub>4</sub>, free T<sub>4</sub>, total T<sub>3</sub>, and free T<sub>3</sub> are defined as <0.8 x LLN (pmol/L) and shift in TSH is >5 mlU/L at any time.</footnote>
<footnote ID="_Ref365549547">Includes SEROQUEL and SEROQUEL XR data.</footnote>
</caption>
<col width="11%"/>
<col width="8%"/>
<col width="11%"/>
<col width="9%"/>
<col width="11%"/>
<col width="8%"/>
<col width="11%"/>
<col width="9%"/>
<col width="11%"/>
<col width="11%"/>
<tbody>
<tr>
<td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Total T<sub>4</sub>
</content>
</paragraph>
</td>
<td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Free T<sub>4</sub>
</content>
</paragraph>
</td>
<td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Total T<sub>3</sub>
</content>
</paragraph>
</td>
<td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">Free T<sub>3</sub>
</content>
</paragraph>
</td>
<td align="center" colspan="2" styleCode="Rrule Botrule Lrule Toprule " valign="top">
<paragraph>
<content styleCode="bold">TSH</content>
</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Quetiapine</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Quetiapine</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Quetiapine</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Quetiapine</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Quetiapine</paragraph>
</td>
<td align="center" styleCode="Rrule Lrule Botrule " valign="top">
<paragraph>Placebo</paragraph>
</td>
</tr>
<tr>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>3.4 %</paragraph>
<paragraph>(37/1097)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0.6%</paragraph>
<paragraph>(4/651)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0.7%</paragraph>
<paragraph>(52/7218)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0.1%</paragraph>
<paragraph>(4/3668)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0.5%</paragraph>
<paragraph>(2/369)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0.0%</paragraph>
<paragraph>(0/113)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0.2%</paragraph>
<paragraph>(11/5673)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>0.0%</paragraph>
<paragraph>(1/2679)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>3.2%</paragraph>
<paragraph>(240/7587)</paragraph>
</td>
<td align="center" styleCode="Rrule Botrule Lrule " valign="top">
<paragraph>2.7%</paragraph>
<paragraph>(105/3912)</paragraph>
</td>
</tr>
</tbody>
</table>
<paragraph>In short-term placebo-controlled monotherapy trials, the incidence of reciprocal, shifts in T<sub>3</sub> and TSH was 0.0 % for both quetiapine (1/4800) and placebo (0/2190) and for T<sub>4</sub> and TSH the shifts were 0.1% (7/6154) for quetiapine versus 0.0% (1/3007) for placebo. </paragraph>
<paragraph>
<content styleCode="italics">Children and Adolescents: </content>
</paragraph>
<paragraph>In acute placebo-controlled trials in children and adolescent patients with schizophrenia (6-week duration) or bipolar mania (3-week duration), the incidence of shifts for thyroid function values at any time for SEROQUEL treated patients and placebo-treated patients for elevated TSH was 2.9% (8/280) vs. 0.7% (1/138), respectively, and for decreased total thyroxine was 2.8% (8/289) vs. 0% (0/145), respectively. Of the SEROQUEL treated patients with elevated TSH levels, 1 had simultaneous low free T<sub>4</sub> level at end of treatment.</paragraph>
</text>
<effectiveTime value="20250122"/>
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<component>
<section ID="ID_85457b59-d785-4c07-9488-44432524084b">
<id root="012f612c-f507-44dd-94c9-38da8b956cdf"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.15 Hyperprolactinemia</title>
<text>
<paragraph>
<content styleCode="italics">Adults</content>: During clinical trials with quetiapine, the incidence of shifts in prolactin levels to a clinically significant value occurred in 3.6% (158/4416) of patients treated with quetiapine compared to 2.6% (51/1968) on placebo.</paragraph>
<paragraph>
<content styleCode="italics">Children and Adolescents:</content>
</paragraph>
<paragraph>In acute placebo-controlled trials in children and adolescent patients with bipolar mania (3-week duration) or schizophrenia (6-week duration), the incidence of shifts in prolactin levels to a value (>20 µg/L males; >26 µg/L females at any time) was 13.4% (18/134) for SEROQUEL compared to 4% (3/75) for placebo in males and 8.7% (9/104) for SEROQUEL compared to 0% (0/39) for placebo in females. </paragraph>
<paragraph>Like other drugs that antagonize dopamine D<sub>2 </sub>receptors, SEROQUEL elevates prolactin levels in some patients and the elevation may persist during chronic administration. Hyperprolactinemia, regardless of etiology, may suppress hypothalamic GnRH, resulting in reduced pituitary gonadotrophin secretion. This, in turn, may inhibit reproductive function by impairing gonadal steroidogenesis in both female and male patients. Galactorrhea, amenorrhea, gynecomastia, and impotence have been reported in patients receiving prolactin-elevating compounds. Long-standing hyperprolactinemia when associated with hypogonadism may lead to decreased bone density in both female and male subjects. </paragraph>
<paragraph>
<content styleCode="xmChange">Tissue culture experiments indicate that approximately one-third of human breast cancers are prolactin dependent in vitro, a factor of potential importance if the prescription of these drugs is considered in a patient with previously detected breast cancer. As is common with compounds which increase prolactin release, mammary gland, and pancreatic islet cell neoplasia (mammary adenocarcinomas, pituitary, and pancreatic adenomas) was observed in carcinogenicity studies conducted in mice and rats [see <linkHtml href="#williamsonbk1183982202881">Nonclinical Toxicology (13.1)</linkHtml>]. Published epidemiologic studies have shown inconsistent results when exploring the potential association between hyperprolactinemia and breast cancer.</content>
</paragraph>
</text>
<effectiveTime value="20250122"/>
</section>
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<component>
<section ID="ID_aa61052e-0e3f-4782-8b85-2e9780150264">
<id root="73711328-c0d3-469d-8f47-9915511b55a9"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.16 Potential for Cognitive and Motor Impairment</title>
<text>
<paragraph>Somnolence was a commonly reported adverse event reported in patients treated with SEROQUEL especially during the 3-5 day period of initial dose-titration. In schizophrenia trials, somnolence was reported in 18% (89/510) of patients on SEROQUEL compared to 11% (22/206) of placebo patients. In acute bipolar mania trials using SEROQUEL as monotherapy, somnolence was reported in 16% (34/209) of patients on SEROQUEL compared to 4% of placebo patients. In acute bipolar mania trials using SEROQUEL as adjunct therapy, somnolence was reported in 34% (66/196) of patients on SEROQUEL compared to 9% (19/203) of placebo patients. In bipolar depression trials, somnolence was reported in 57% (398/698) of patients on SEROQUEL compared to 15% (51/347) of placebo patients. Since SEROQUEL has the potential to impair judgment, thinking, or motor skills, patients should be cautioned about performing activities requiring mental alertness, such as operating a motor vehicle (including automobiles) or operating hazardous machinery until they are reasonably certain that SEROQUEL therapy does not affect them adversely. Somnolence may lead to falls.</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
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<component>
<section ID="ID_b725d825-9f41-4199-a669-c936757f7e79">
<id root="157feee8-8b95-4eca-994f-7212866518ac"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.17 Body Temperature Regulation</title>
<text>
<paragraph>Although not reported with SEROQUEL, disruption of the body's ability to reduce core body temperature has been attributed to antipsychotic agents. Appropriate care is advised when prescribing SEROQUEL for patients who will be experiencing conditions which may contribute to an elevation in core body temperature, e.g., exercising strenuously, exposure to extreme heat, receiving concomitant medication with anticholinergic activity, or being subject to dehydration.</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
</component>
<component>
<section ID="ID_5b166463-82e6-44cb-a1c0-7a0f6bee2408">
<id root="101748b5-fc7c-4c3e-b22b-7235cda2efcf"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.18 Dysphagia</title>
<text>
<paragraph>Esophageal dysmotility and aspiration have been associated with antipsychotic drug use. Aspiration pneumonia is a common cause of morbidity and mortality in elderly patients, in particular those with advanced Alzheimer's dementia. SEROQUEL and other antipsychotic drugs should be used cautiously in patients at risk for aspiration pneumonia.</paragraph>
</text>
<effectiveTime value="20190826"/>
</section>
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<component>
<section ID="ID_4fcd10ff-3ff4-415a-b552-9c05eab8547b">
<id root="cb84b790-349a-4be8-bc9f-94856d065aa5"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.19 Discontinuation Syndrome</title>
<text>
<paragraph>Acute withdrawal symptoms, such as insomnia, nausea, and vomiting have been described after abrupt cessation of atypical antipsychotic drugs, including SEROQUEL. In short-term placebo-controlled, monotherapy clinical trials with SEROQUEL XR that included a discontinuation phase which evaluated discontinuation symptoms, the aggregated incidence of patients experiencing one or more discontinuation symptoms after abrupt cessation was 12.1% (241/1993) for SEROQUEL XR and 6.7% (71/1065) for placebo. The incidence of the individual adverse reactions (i.e., insomnia, nausea, headache, diarrhea, vomiting, dizziness, and irritability) did not exceed 5.3% in any treatment group and usually resolved after 1 week post-discontinuation. Gradual withdrawal is advised <content styleCode="italics">[see </content>
<content styleCode="italics">
<linkHtml href="#ID_d576a2c5-73d3-4104-8788-a403a9ed5679">Use in Specific Populations (8.1)</linkHtml>
</content>
<content styleCode="italics">]</content>.</paragraph>
</text>
<effectiveTime value="20220127"/>
</section>
</component>
<component>
<section ID="ID_661e43da-d3b2-4463-b144-db45a3aa8fc5">
<id root="9b31bb4a-cdd8-463f-bc66-99d344372d46"/>
<code code="42229-5" codeSystem="2.16.840.1.113883.6.1" displayName="SPL UNCLASSIFIED SECTION"/>
<title>5.20 Anticholinergic (antimuscarinic) Effects </title>
<text>
<paragraph>Norquetiapine, an active metabolite of quetiapine, has moderate to strong affinity for several muscarinic receptor subtypes. This contributes to anticholinergic adverse reactions when SEROQUEL is used at therapeutic doses, taken concomitantly with other anticholinergic medications, or taken in overdose. SEROQUEL should be used with caution in patients receiving medications having anticholinergic (antimuscarinic) effects <content styleCode="italics">[see <linkHtml href="#williamsonbk1173118423951">Drug Interactions (7.1)</linkHtml>, <linkHtml href="#williamsonbk1263236951731">Overdosage (10.1)</linkHtml>, and <linkHtml href="#ID_8b8d233d-f1f0-48a6-86ff-a75677975844">Clinical Pharmacology (12.1)</linkHtml>]</content>.</paragraph>
<paragraph>Constipation was a commonly reported adverse event in patients treated with quetiapine and represents a risk factor for intestinal obstruction. Intestinal obstruction has been reported with quetiapine, including fatal reports in patients who were receiving multiple concomitant medications that decrease intestinal motility.</paragraph>
<paragraph>SEROQUEL should be used with caution in patients with a current diagnosis or prior history of urinary retention, clinically significant prostatic hypertrophy, or constipation.</paragraph>
</text>
<effectiveTime value="20220127"/>
</section>
</component>
</section>
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