Beached: Trying to Taper off Seroquel XR

[Beached]

Hi,

 

I want to get off Seroquel XR (extended release) for a variety of reasons.  I am very sensitive to meds and am on the smallest XR dose of 50 mg that I was prescribed for mania and anxiety.  It has worked for that but it has also become very sedating and with it I have been sleeping longer.  I am 68 years old and I want to live with as much energy and mental abilities as I can while I can.  Last October, I started much more intensive mindfulness to be able to cope, and it has helped a lot.  With research coming out about anticholinergic meds (which includes Seroquel) and the elderly (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4377853/), the hassle I have with getting Seroquel XR, and dealing with changes in my medical  providers, I would like to stop.  Unfortunately, my PMHNP tried generic Seroquel immediate release, and it had side effects that I could not tolerate.  She left and her temporary replacements just want to keep the same meds going.

 

So how to taper off the smallest dose of Seroquel XR is my issue.  Changing to generic is not possible.  My medical providers don't want me to change and are not helpful.  I am thankful to have read some of SurvivingAntidepressants 2 weeks ago, but I did not join and I have not followed the guideline here of tapering off by 10% for a month.  I have looked on http://survivingantidepressants.org/index.php?/topic/1707-tips-for-tapering-off-seroquel-quetiapine/ (including Altostrata's  helpful comments that you can't make a liquid from Seroquel XR and "you may need to take a half-dose twice a day or make other dosage adjustments up or down according to your reactions") and elsewhere on the internet and have read that several people have split the Seroquel XR capsules, and that it is thought that by doing so it acts more like immediate release.  But the recommended tapering by 10% does not look possible with splitting, and it is guess work of how a split XR is acting compared to an unsplit XR.  On April 19, instead of taking one XR 50 mg per day in the evening, I split a capsule and took 1/2 capsule at night and 1/4 capsule in the late morning, so I have been taking 1/4 less capsule per day.  But that 1/4 less is not necessarily the same as 1/4 less XR.  The first 5 days had mild to moderate symptoms, including mania and depression but were recognizable and manageable with mindful acceptance and patience.  On the positive side, I am sleeping less than I was with the entire 50 mg XR, and my brain wasn't so fuzzy and sedated!  Yay!  

 

I thought things were going very well, and on May 2, I continued 1/2 capsule in the evening but reduced to 1/8 capsule in the late morning.  This afternoon, my most significant symptoms came of mild dizziness, mild nausea, and hot flashes.  I became anxious, but mindfulness and putting Seabands (acupressure wrist bands) on for the nausea and dizziness has helped.  This evening, still wearing the Seabands, I am doing OK, except I am humbled by the power of Seroquel XR and trying to get off it.  But I am not sure what to do.  I can see now I should have stayed longer on my initial reduction for at least 4 weeks as recommended here because I have read that withdrawal symptoms may not appear for 3 weeks, so my symptoms today could be the first signs of stronger symptoms from the initial withdrawal or could be from my May 2 decline.  My impatience has not helped.

 

This afternoon I also decided to join and post to Surviving Antidepressants because I do not have people around me to support me, and I haven't told anyone.  I have been in AA for over 20 years, but some in AA take a dim view of psychiatric meds so I don't think I will get much support there and I haven't brought it up.  I can post here in a community of people dealing with withdrawing from meds, and I am not alone.  In writing this, I feel relief.

 

Thanks for having this Forum!  

 

 

 

 

 

 

[ChessieCat]

Hi Beached,

 

Welcome to SA.  It sounds like you have been finding your way around the site.

 

Seroquel is available in immediate release 25 mg.  From Post No 5:

 

"For more precise tapering, you may wish to take part of your dose in the immediate-release form, which comes in a 25mg dosage that you can cut up, and from which you can make a liquid"

 

Further down the page in Post No 5 it explains how to do this.

 

If your withdrawal symptoms are unbearable you could updose a small amount and then stabilise there for a while before continuing at a 10% taper of the previous amount.

 

What should I expect from my doctor about withdrawal symptoms?

How do you talk to a doctor about tapering and withdrawal?

 

Please use your Intro/Update topic to ask questions and as a journal of your progress.  It is a good idea to update your signature each time you change dose (please write this as mgs not as 1/2 or 1/4 capsule - thanks) and include the date each time you make a change.  This way your drug history can be seen at a glance.

 

Someone with more knowledge of Seroquel should be along soon.

[Beached]

 

Seroquel is available in immediate release 25 mg.  From Post No 5:

 

"For more precise tapering, you may wish to take part of your dose in the immediate-release form, which comes in a 25mg dosage that you can cut up, and from which you can make a liquid"

 

Further down the page in Post No 5 it explains how to do this.

 

...

 

Please use your Intro/Update topic to ask questions and as a journal of your progress.  It is a good idea to update your signature each time you change dose (please write this as mgs not as 1/2 or 1/4 capsule - thanks) and include the date each time you make a change.  This way your drug history can be seen at a glance.

 

 

Hi ChessieCat,

 

Thanks for your response!  Unfortunately, 25 mg quetiapine (generic Seroquel) immediate release (IR) is not an option for me.  I tried it last fall as a replacement for extended release, but the immediate release had new side effects that the Seroquel XR did not have and that were intolerable, so I had to quit the immediate release.  My PMHNP thought the new side effects could be from the filler used in the generic immediate release that I was sensitive to.  My sensitivities are what they are, though I wish I didn't have them.

 

Since from what I have read, including Altostrata's post that splitting an extended release Seroquel can make it act more like immediate release, I am not sure what dosage that 1/2 capsule of XR 50 mg is--I am guessing that it would not be the same as 25 mg XR but as all the coating except one end is intact, it might not be the same as 25 mg of immediate release either.  A 1/4 capsule of XR with one open end from the cut may be different than 1/4 capsule that has both ends cut because the two exposed ends may release different.  I suspect that the more exposed sides that a split XR capsule has, the less it is like an XR.  So I see your point that using mg would be handier and easier to understand.  Though I don't see how to do the recommended 10% tapering when splitting an XR because with splitting an XR, the time release effects of the XR are changed.  Reducing by 1/8 of an immediate release tablet would be 12.5% reduction in immediate release, but reducing by 1/8 of a extended release is likely not a 12.5% reduction in extended release because of at least two exposed sides and if it is more like immediate release, then it becomes a different medication than the extended release that I had originally been trying to taper off.  Confusing and a complication in trying to taper off...   

 

And trying to make it a liquid does not appear to be an option because as Altostrata notes it gels.   

 

Thanks again!  

[ChessieCat]

Hi again,

 

It may be that taking the immediate release resulted in dose dumping if you took the full dose at one time.  Possibly splitting your dose throughout the day may work without causing the issues.  Other members here are tapering Seroquel and should be able to help with suggestions.