| Mechanism of action | Nonselective blockade of postsynaptic dopaminergic D2 receptors in the brain [9] | Antagonism of serotonin 5-HT2 and dopamine D2 receptors [9] | Selective α2- adrenergic receptor agonist [9] | Potent antagonist of serotonin 5-HT2A and 5-HT2C, histamine H1, dopamine D1-4, and alpha1-adrenergic receptors. Moderate antagonist of muscarinic M1-5, and 5-HT3 receptors [9] |
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| Half life | Decanoate: 21 days Lactate: 20 hours (Intramuscular (IM)) 14-26 hours (IV) 14-37 hours (oral) [9] | 6 hours [10] | Up to 3 hours, significantly prolonged with severe hepatic impairment [9] | Oral and IM: 30 hours; approximately 1.5 times greater in elderly [9] |
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| Metabolism | Mainly hepatic metabolism to inactive metabolites [9] | Metabolised by liver to active metabolites with low activity levels [10] | Hepatic metabolism [9] | Mainly hepatic metabolism with 40% removed via first pass metabolism [9] |
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| Effect with hepatic impairment | No dosage adjustment needed but concentration may increase in patients with hepatic impairment [9] | Higher plasma levels are expected in the hepatically impaired population, and dosage adjustment may be needed [11] | No dosage adjustment recommended but consider dose reduction in patients with hepatic impairment [9] | No dosage adjustment needed. Use with caution in patients with hepatic impairment [9] |
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| Effect with renal impairment | No dosage adjustment needed [9] | Renal insufficiency does not need dosage adjustments. However, in severe renal impairment, alterations in protein binding of quetiapine may affect its pharmacokinetics [10,11] | No dosage adjustment needed [9] | No dosage adjustment needed [9] |
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| Peak concentration | Decanoate: 6 days Lactate: 20 minutes (IM) 2-6 hours (oral) [9] | 1-2h [10] | IV loading dose: 15-30 minutes [9] | Short acting injection: 15-45 minutes Extended release injection: ~7 days Oral: ~6 hours [9] |
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| Advantages | Low treatment cost [9] | Low risk of EPS (extrapyramidal symptoms) and QTc prolongation compared to typical antipsychotics [1,7] | Analgesia and sedation with minimal respiratory depression [12] | No QTc prolongation [13] |
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| Side effects | QTc prolongation, drowsiness, hypotension and EPS [9] | Somnolence, orthostatic hypotension, and tachycardia [9] | Bradycardia, hypotension [9] | Orthostatic hypotension, EPS, weight gain, drowsiness, transaminitis [9] |
