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Tips for tapering off Seroquel (quetiapine)

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mutley

 

NOTE TO MEMBERS:

 

For details about tapering Seroquel see this post:

 

tips-for-tapering-off-seroquel-quetiapine

 


 

I'm taking an off label dose of Seoquel for PTSD related sleep problems. I've made progress w/trauma therapy and now want to come off of it. I went from 100mgs to 50 with relative ease over a 7 month period. Two weeks ago I went from 50mg to 37.25 and started experiencing broken sleep and nightmares. The sleep problems seem to be causing anxiety/adrenaline issues during the day, but my mood is still relatively good. Tonight I was planning to go back up to 43.75 to see if I can have a decent night's sleep. Anybody with similar experiences who can tell me what to expect with this kind of taper? I'm willing to be patient, but sometimes I lose faith that I will ever sleep properly without an antipsychotic:(.

 

Edited by ChessieCat
fixed up quote

seroquel

abilify

geodon

zyprexa

wellbutrin

prozac

paxil

effexor

sertraline

nortryptiline

lamictal

pregabalin

topamax

zonisimide

lorazepam

xanax

valium

 

Now I get high on life.

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Altostrata

You may wish to taper off slowly by 10% decrements to give your nervous system a chance to gradually adapt.

 

Cutting up pills and weighing with a digital scale may be one way to very gradually taper, or you may wish to have a compounding pharmacy make up a liquid solution.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Altostrata

For FDA information about regular Seroquel (immediate-release formulation), see http://www.drugs.com/pro/quetiapine-fumarate-tablets.html

Quote

Dosage Forms and Strengths
25 mg tablets
50 mg tablets
100 mg tablets
150 mg tablets
200 mg tablets
300 mg tablets
400 mg tablets

The immediate-release form is often taken twice a day.

For FDA information about Seroquel XR (extended-release formulation), see http://www.drugs.com/pro/seroquel-xr.html

 

Quote

Dosage Forms and Strengths
50 mg extended-release tablets
150 mg extended-release tablets
200 mg extended-release tablets
300 mg extended-release tablets
400 mg extended-release tablets
....
Switching Patients from SEROQUEL Tablets to Seroquel XR Tablets

Patients who are currently being treated with SEROQUEL (immediate release formulation) may be switched to Seroquel XR at the equivalent total daily dose taken once daily. Individual dosage adjustments may be necessary.
....
Withdrawal

Acute withdrawal symptoms, such as insomnia, nausea and vomiting have been described after abrupt cessation of atypical antipsychotic drugs, including quetiapine fumarate. 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 events (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.
....
Pharmacokinetics

....Elimination of quetiapine is mainly via hepatic metabolism. The mean-terminal half-life is approximately 7 hours for quetiapine and approximately 12 hours for norquetiapine within the clinical dose range. Steady-state concentrations are expected to be achieved within two days of dosing. Seroquel XR is unlikely to interfere with the metabolism of drugs metabolized by cytochrome P450 enzymes.

 

Reduce by 10% per month to start
To minimize the risk of withdrawal symptoms, we recommend a conservative taper of 10% from the previous dosage every few weeks. The amount of the decrease keeps getting smaller. Some people find they can go faster and some people find they have to go slower -- they can only tolerate decreases of a fraction of a milligram at a time. See Why taper by 10% of my dosage?
 
Very careful tapering is necessary when you have had psychotic symptoms. Such symptoms can appear as withdrawal symptoms; that will cause you to become diagnosed as relapsed and re-medicated. Read Psychiatrist: Some patients are better off without antipsychotics...

Tapering the extended-release form (Seroquel XR)
Since the lowest XR dosage available is 50mg, 50mg will be the smallest decrease you can make. If your starting dosage is 400mg or more, reducing by 50mg at a time may be tolerable for a few rounds.

Splitting an extended-release tablet appears possible (there are many reports on the Web of people doing this), but this compromises the extended-release quality, possibly resulting in immediate-release quetiapine. If you are used to the extended-release form, you may be sensitive to the "dosage dumping" resulting from immediate release of the drug.

The extended-release quality of Seroquel XR is due to a "matrix" formulation, not the coating on the tablet.

From: Pharmacopsychiatry: QuetiapineXR: A New Retard Formulation in the treatment of Schizophrenia, Reidel, Spellman, Seemuller, and Muller, 2008.

https://webcache.googleusercontent.com/search?q=cache:EavlraoOUogJ:https://pdfs.semanticscholar.org/ed0a/f2e5691f430229b8f46

 

Quote

Pharmaceutical Formulation and Chemical Structure

Quetiapine XR is available as quetiapine hemifumarate....All tablets are film-coated. The drug has the same chemical structure as quetiapine immediate-release (quetiapine IR). The galenic structure of quetiapine XR involves a polymeric gel matrix of hydroxypropylmethylcellulose (HPMC). Quetiapine is interlinked with the polymeric structure of HPMC in a net-like structure. HPMC widens its structure in the presence of water to form a smaller hard core and a softer outer cellulose gel membrane. Thus, the tablet can release the active drug continuously over a period of 20 hours.

 

You cannot make a liquid from quetiapine XR, the matrix formulation clumps into a gel (as it does with Pristiq).

 

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 (see below). (Generally, when you mix two types of tablets, for insurance coverage the prescription will need to be written for divided doses.)

 

You can cut up the 25mg immediate-release tablet in quarters or halves, enabling you to taper by 6.25mg or 12.5mg at a time. When you reach a daily dosage of 60mg, you may wish to use a liquid form to maintain a 10% rate of taper based on the last dosage.

Note that if you cut up quetiapine XR or switch your entire dose from the extended-release form to the immediate-release form, you may need to take a half-dose twice a day or make other dosage adjustments up or down according to your reactions.

Get a liquid compounded by a pharmacy
With a prescription, you can go to a compounding pharmacy to have a liquid made from immediate-release quetiapine, or custom capsules from quetiapine XR if necessary (the capsules probably will be more like the immediate-release form of the drug, as breaking the XR tablet may compromise the extended-release matrix).

See our topic on compounding pharmacies.

Make your own liquid
Immediate-release Seroquel is moderately soluble in water http://www.drugbank.ca/drugs/DB01224

 

According to http://www.elmmb.nhs.uk/formularies/specially-manufactured-medicines/?entryid36=34585&char=Q NHS UK advice for people who cannot take tablets:

 

Quote
  • Tablets not soluble, may try to crush and dissolve in warm water.
  • For oral use mix crushed tablet with yoghurt as it has a bitter taste.

 

According to http://www.new.ijpi.org/wp-content/uploads/2011/07/6.pdf
 

Quote

Formulation and In Vitro Evaluation of PH-Independent Sustained Release Drug Delivery System of Quetiapine Fumarate
HT Mulani, I Parmar, NJ Shah 2011

 

....

3.2. pH dependent stability of drug Drug solution was prepared with the concentration 300 ppm in 0.1 N HCl, 4.5 aceaate buffer, pH 6.8 phosphate buffer and 7.4 phosphate buffer; and observed for 24 hrs at predetermined time intervals. Drug is stable at pH range from 1.2 to 7.4 and showed the maximum 2 % degradation as compared to initial concentration (Table 2).

 

So it's most likely stable mixed with water for 24 hours.

 

FYI, here is a recipe for making quetiapine oral liquid from MIchigan Pediatric Compounding Standards http://www.mipedscompounds.org/sites/default/files/standard-formulations/Quetiapine.pdf (PDF)
 

Quote

Quetiapine 40 mg/mL

Oral Volume: 100 mL

Dosage Form: Suspension 30 days

 

Storage: Room temperature

Shake Well

 

Quetiapine fumarate 4 gram

Saccharin sodium 100 mg

Butylated hydroxytoluene 100 mg

Silica gel, micronized 3 gram

Peppermint oil 3 mL

Almond oil, sweet

 

Directions:

Weigh and measure each ingredient.

Add powders to approximately 50 mLs of sweet almond oil and mix well.

Add the peppermint oil and mix well.

Add sufficient sweet almond oil to the final volume and mix well.

Pour into clean, amber bottle and label.

Notes:

  Tablets may be substituted for the powder.

  No stability tests have been done on this preparation.

References:

 Intern J Pharm Compounding; 2011;15(4):342.

 

 

Use a combination of tablets or capsules and liquid

Rather than switch directly to an all-liquid dose, you may wish to take part of your dose in liquid and part in lower-dose tablets or capsules, gradually converting to all liquid as you get to lower dosages. This can be very convenient and reduce any problems switching from one form of the drug to another.

 

For example, you may wish to take a 50mg Seroquel XR tablet and the rest in liquid for your daily dose. As the liquid is made from immediate-release quetiapine, you may wish to take it later in the day -- see notes above for regular Seroquel.

 

If your doctor prescribes compounded liquid and tablets or capsules at the same time, most likely he or she will have to indicate "divided doses" in the prescriptions to get the drugs covered by insurance.

 

Edited by manymoretodays
updated, link restored above 3rd quote

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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lindamorellato

I have gotten a prescription for 50 mgs. I was previously cutting 100 mg in half, been doing that since June 2012. I can't figure out where to read on the site how to cut 10% off the 50 mg. tablets of my Quetiapine. The tables are very tiny. Thank you. Help.

 

Lina


Lexapro 20 mg.since Aug 2009

Lamotrigine -100 mg. sept. 2009

Seroquel-50 mg.

down from 100 for 6 months.

Been going off and on lexapro since October 2012

off and on Lamotrigine since October 2012.

Incidentally, massive headaches and monthly vomiting has ceased

since October 2012.

So right now no lexapro since Dec. 28th after only taking 15 tables from Nov.12-to Dec.28,2012.

No lamotrigine since mid October 2012.

50 MG. seroquel at bedtime since June 2012.

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Altostrata

See above.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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primrose

I think I am going to start a daily taper with 0.5% cuts, but I am stuck in my valium taper at the moment.

I was cutting less than 5% off my benzo, and holding for enough time, but could no longer tolerate that due to the extreme psych symptoms, so, I started a daily taper. I have had to slow that right down due to not dealing with symptoms for a few weeks.


pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta

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Skyler

I think I am going to start a daily taper with 0.5% cuts, but I am stuck in my valium taper at the moment.

I was cutting less than 5% off my benzo, and holding for enough time, but could no longer tolerate that due to the extreme psych symptoms, so, I started a daily taper. I have had to slow that right down due to not dealing with symptoms for a few weeks.

Hi Primrose, were you planning to taper both diazepam and seroquel at the same time? You should not taper two psychotropics simultaneously... Hold the diazepam and stabilize on that dose for a couple of months, then start to taper seroquel. Do I have that right, the extreme psych symptoms you describe are from diazepam WD, or are you meaning they are a seroquel side effect, which of course would involve a different approach.

 

You were doing so well, I'm sorry to hear you ran into difficulty!

 

Skyler


As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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primrose

 

I think I am going to start a daily taper with 0.5% cuts, but I am stuck in my valium taper at the moment.

I was cutting less than 5% off my benzo, and holding for enough time, but could no longer tolerate that due to the extreme psych symptoms, so, I started a daily taper. I have had to slow that right down due to not dealing with symptoms for a few weeks.

Hi Primrose, were you planning to taper both diazepam and seroquel at the same time? You should not taper two psychotropics simultaneously... Hold the diazepam and stabilize on that dose for a couple of months, then start to taper seroquel. Do I have that right, the extreme psych symptoms you describe are from diazepam WD, or are you meaning they are a seroquel side effect, which of course would involve a different approach.

 

You were doing so well, I'm sorry to hear you ran into difficulty!

 

Skyler

 

Hi Skyler

 

I am not planning to come off seroquel until I have got rid of the valium.

The symptoms I am feeling are from tapering the benzo at too high a daily rate.

I was holding the valium when i cut the seroquel.

I am surprised I ran into difficulty tapering the valium as I was only using cuts of 0.012mg per day.

Also, as it has taken me 3.5years to taper from 15mg valium, I started thinking that my symptoms were all in my head, given that many people slowly taper off higher amounts and still get to 0mg before me. i am not talking about those who taper too quick though.

Thanks


pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta

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Skyler

 

 

I think I am going to start a daily taper with 0.5% cuts, but I am stuck in my valium taper at the moment.

I was cutting less than 5% off my benzo, and holding for enough time, but could no longer tolerate that due to the extreme psych symptoms, so, I started a daily taper. I have had to slow that right down due to not dealing with symptoms for a few weeks.

Hi Primrose, were you planning to taper both diazepam and seroquel at the same time? You should not taper two psychotropics simultaneously... Hold the diazepam and stabilize on that dose for a couple of months, then start to taper seroquel. Do I have that right, the extreme psych symptoms you describe are from diazepam WD, or are you meaning they are a seroquel side effect, which of course would involve a different approach.

 

You were doing so well, I'm sorry to hear you ran into difficulty!

 

Skyler

 

Hi Skyler

 

I am not planning to come off seroquel until I have got rid of the valium.

The symptoms I am feeling are from tapering the benzo at too high a daily rate.

I was holding the valium when i cut the seroquel.

I am surprised I ran into difficulty tapering the valium as I was only using cuts of 0.012mg per day.

Also, as it has taken me 3.5years to taper from 15mg valium, I started thinking that my symptoms were all in my head, given that many people slowly taper off higher amounts and still get to 0mg before me. i am not talking about those who taper too quick though.

Thanks

 

Okay, this is the seroquel thread, so I thought you meant you were tapering off that as well.

 

I'm going to put this post and put it in one of the benzo threads and reply to you there.


As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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primrose

 

 

 

I think I am going to start a daily taper with 0.5% cuts, but I am stuck in my valium taper at the moment.

I was cutting less than 5% off my benzo, and holding for enough time, but could no longer tolerate that due to the extreme psych symptoms, so, I started a daily taper. I have had to slow that right down due to not dealing with symptoms for a few weeks.

Hi Primrose, were you planning to taper both diazepam and seroquel at the same time? You should not taper two psychotropics simultaneously... Hold the diazepam and stabilize on that dose for a couple of months, then start to taper seroquel. Do I have that right, the extreme psych symptoms you describe are from diazepam WD, or are you meaning they are a seroquel side effect, which of course would involve a different approach.

 

You were doing so well, I'm sorry to hear you ran into difficulty!

 

Skyler

 

Hi Skyler

 

I am not planning to come off seroquel until I have got rid of the valium.

The symptoms I am feeling are from tapering the benzo at too high a daily rate.

I was holding the valium when i cut the seroquel.

I am surprised I ran into difficulty tapering the valium as I was only using cuts of 0.012mg per day.

Also, as it has taken me 3.5years to taper from 15mg valium, I started thinking that my symptoms were all in my head, given that many people slowly taper off higher amounts and still get to 0mg before me. i am not talking about those who taper too quick though.

Thanks

 

Okay, this is the seroquel thread, so I thought you meant you were tapering off that as well.

 

I'm going to put this post and put it in one of the benzo threads and reply to you there.

 

Hi Skyler, I just replied over at the new thread.

I did cut seroquel two weeks ago, that went without event.


pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta

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Altostrata

If I were you, I'd hold on the Valium and get off Seroquel. It has more adverse health consequences.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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primrose

Hi Alto

 

The valium is the only wet medication I take, and if I were to start tapering the seroquel, i would have to liquefy that too, and at the moment, that would be too overwhelming for me, to have two wet medications to deal with.

I will taper the seroquel affer the valium though, I am comforted as I am on a low dose.


pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta

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Skyler

Hi Alto

 

The valium is the only wet medication I take, and if I were to start tapering the seroquel, i would have to liquefy that too, and at the moment, that would be too overwhelming for me, to have two wet medications to deal with.

I will taper the seroquel affer the valium though, I am comforted as I am on a low dose.

Primrose.. I wonder if this would continue to overwhelm, given you would be taking the same dose of diazepam every day, and only tapering seroquel (were you doing a mt?). I really do understand where you are coming from (I'm juggling 3 solutions), but after a bit of preliminary bumbling when there is an adjustment, it's easy for me to manage more than one drug. There is a learning curve, but it gets better... just a thought!

 

Skyler


As always, LISTEN TO YOUR BODY! A proud supporter of the 10% (or slower) rule.

 

Requip - 3/16 ZERO  Total time on 25 years.

 

Lyrica: 8/15 ZERO Total time on 7 or 8 yrs.

BENZO FREE 10/13 (started tapering 7/10)  Total time on 25 years.

 

Read my intro thread here, and check the about me section.  "No matter how cynical you get, it's almost impossible to keep up." Lily Tomlin

 

 

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Altostrata

It seems to me if you've hit a wall with the Valium, you might go off Seroquel in the meantime. Otherwise, you may be on Seroquel for an unnecessarily long time.

 

Also, if you hold on the Valium, you might adjust to it, making the next leg down easier.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Edted

Just some information from another post. My son had his first psychotic break when trying to come off Seroquel. Phillip Seeman has published a number of papers on Seroquel and why it is so difficult to come off it. Although it has been years since I read up on the drug, I believe that Seeman's work indicated that, like Clozapine, Seroquel binds poorly to the dopamine receptors and, when cutting back, it is easily displaced by Dopamine (American Journal of Psychiatry 1999; 156:876-884).

 

The so called, "therapeutic" level is right around (give or take 50 Mgs) 250 Mgs. It is right around this dosage that reductions should be very conservative, 10% or less. Doctors do not understand withdrawal and frequently recommend reductions of Seroquel of 50 Mgs or more. People on this site, who know far more than I do, will give you better advice.

 

I know receptor occupancy is far from the whole story, but I do think that knowledge of them can point to some of the "cliffs" to avoid. Any doctors advice about bouncing the drug up and down depending on how you are feeling is just plain wrong. My son was once on 1200 Mgs of Seroquel when he was in the hospital (years ago). The psychiatrist there responded to my alarm by telling me he had had people on 2,000 Mgs. My son is stable today, and will soon be starting to withdraw from his current med (Abilify). It would also probably help some people trying to understand how Seroquel works (or doesn't) to look at a post on "thelastpsychiatrist" from 2007. The guy can be a smart aleck and, at times, inappropriate, but seems to know his science. Be well, Ed

Edited by Altostrata
added paragraph breaks for readability

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Altostrata

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Edted

Alto:

Sorry for the confusion. I was referring to "the most important article on psychiatry...." Your first link. Even though receptor occupancy is only part of the story on how drugs work, I think it's important for people to understand that receptor occupancy and dosage are not an arithmetic progression. The champagne glass analogy may help.

Thanks,

Ed

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Altostrata

Ed, any more detail you can provide about your interpretation of this information would be welcome in this topic.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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Edted

Alto:

It will probably be a few days before I can write much, but I will, and it will just be my interpretation.

Regards,

Ed

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Edted

This is a cut and paste from a response to a particular poster, but hopefully some of the information will be useful to someone else. I'm not an expert, by any means, but when my son has been in withdrawal, I've tried to learn a little about the neuro-transmitter piece of the puzzle (that is just a piece). To answer your question, if you are experiencing withdrawal symptoms, sure sounds like it. Seroquel hits quite a few receptors, and withdrawing can trigger a "blowback" effect in any or all of them.

 

At this point in your withdrawal, it less likely to be with the histamine receptors (that would be expected around 50 Mgs). It would be expected to have already happened for dopamine (at around 250 Mgs). Right about now, you could have problems in three different areas: serotonic, muscarinic, and/or adrenergic. Mild serotonin toxicity is often characterized by nausea/vomiting, diarrhea, muscle spasms, and fever (the list is actually longer than that, but you will probably look up the symptoms to know more and I'm typing on an IPhone, so trying to keep it brief).

 

The surest indicator of serotonin toxicity is sustained muscle over activity). The next time you feel hot, take your temperature. With serotonin toxicity, your temperature will actually be elevated. If you find indications that you might have serotonin toxicity, you might try a day of altering your diet to see if you feel significantly better. Eliminate high serotonin foods (nuts, chicken, turkey, lean meat, fresh veggies, eggs, dairy, bananas, etc) instead have broth and potatoes, rice, overly boiled veggies, etc) and push water (no pulpy juices or pineapple).

 

If the problem is cholinergic blowback, you might try a day of foods high in atropine (bell peppers, potatoes, etc). If you are a smoker, you might wish to cut back just a little to see if that helps.

 

If the problem is adrenergic. Then you want to try to work off some of the excess epinephrine with very light exercise and see how you feel.

 

People on this site know a lot more than I do and may correct some of my advice. I know they will tell you to be cautious, make small changes, and pay careful attention to the effects of changes. You didn't mention how you split up your 87.5 Mgs for your 3X day doses. How you do that can effect things too. Hang in there and welcome to the best site on the web.

Edited by Altostrata
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Gizmo123

Very insightful! Bravo!


Seroquel 150mg 2/20. Klonopin 1mg. Zoloft 100mg

S- 100mg 3/10. K- .75 Zoloft 100mg

 

Norco 10/325 PRN max 3xday

 

Stopped Trazodone 1year ago

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Altostrata

chalie, I moved your post to start your Introductions topic here http://survivingantidepressants.org/index.php?/topic/6591-chalie-going-off-seroquel/

 

That will be the place to discuss your particular situation, where more people will see it.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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newbipo

Hi there!

 

I talked to my pharmacist and he told me I canot cut the Seroquel XL (XR)

 

how do I taper 10%  :(


After a long life (15 years) on and off antidepressants because of Anxiety and Panic attacks I decided to come off citalopram in November 2013...

01/14 - Citalopram 20mg - 0mg --> had severe symptoms and was diagnosed as Bipolar with rapide cycling and mixed state

02/14 - Seroquel 50 mg, Atenolol 25 mg 2xd, xanax 0.25 3xd

03/14 - Seroquel 300 mg, Atenolol 25 mg 2xd, xanax 0.25 2xd

04/14 - 05/14 Seroquel 400 mg, Atenolol 25mg 2xd, xanax 0.25 2xd

06/14 - 07/14 Seroquel 300 mg, Atenolol 25mg 2xd, Xanax 0.25 (reduced to 0.125)

07/14 - 08/14 Seroquel 250 mg (start to have anxiety and panic attacks again)

12/14 - Seroquel XR 300mg 200mg 50mg, Atenolol 50, Xanax 0.25 PRN

02/15 - 0 Of everything... 

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mammaP

For FDA information about regular Seroquel (immediate-release formulation), see http://www.drugs.com/pro/quetiapine-fumarate-tablets.html

Dosage Forms and Strengths

25 mg tablets

50 mg tablets

100 mg tablets

150 mg tablets

200 mg tablets

300 mg tablets

400 mg tablets

The immediate-release form is often taken twice a day.

 

For FDA information about Seroquel XR (extended-release formulation), see http://www.drugs.com/pro/seroquel-xr.html

Dosage Forms and Strengths

50 mg extended-release tablets

150 mg extended-release tablets

200 mg extended-release tablets

300 mg extended-release tablets

400 mg extended-release tablets

....

Switching Patients from SEROQUEL Tablets to Seroquel XR Tablets

 

Patients who are currently being treated with SEROQUEL (immediate release formulation) may be switched to Seroquel XR at the equivalent total daily dose taken once daily. Individual dosage adjustments may be necessary.

....

Withdrawal

 

​Acute withdrawal symptoms, such as insomnia, nausea and vomiting have been described after abrupt cessation of atypical antipsychotic drugs, including quetiapine fumarate. 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 events (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.

....

Pharmacokinetics

 

....Elimination of quetiapine is mainly via hepatic metabolism. The mean-terminal half-life is approximately 7 hours for quetiapine and approximately 12 hours for norquetiapine within the clinical dose range. Steady-state concentrations are expected to be achieved within two days of dosing. Seroquel XR is unlikely to interfere with the metabolism of drugs metabolized by cytochrome P450 enzymes.

Reduce by 10% per month to start

The 10% rule holds for Seroquel, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

 

See Why taper by 10% of my dosage?

 

Tapering the extended-release form (Seroquel XR)

Since the lowest XR dosage available is 50mg, 50mg will be the smallest decrease you can make. If your starting dosage is 400mg or more, this may be tolerable for a few rounds.

 

Splitting an extended-release tablet appears possible (there are many reports on the Web of people doing this), but this destroys the extended-release quality, resulting in immediate-release quetiapine. If you are used to the extended-release form, you may be sensitive to the "dosage dumping" resulting from immediate release of the drug.

 

From http://www.touchpsychiatry.com/system/files/private/articles/8219/pdf/riedel.pdf

Pharmaceutical Formulation and Chemical Structure

 

Quetiapine XR is available as quetiapine hemifumarate....All tablets are film-coated. The drug has the same chemical structure as quetiapine immediate-release (quetiapine IR). The galenic structure of quetiapine XR involves a polymeric gel matrix of hydroxypropylmethylcellulose (HPMC). Quetiapine is interlinked with the polymeric structure of HPMC in a net-like structure. HPMC widens its structure in the presence of water to form a smaller hard core and a softer outer cellulose gel membrane. Thus, the tablet can release the active drug continuously over a period of 20 hours.

You cannot make a liquid from quetiapine XR, the matrix formulation clumps into a gel (as it does with Pristiq). For more precise tapering, you may wish to switch to the immediate-release form, which comes in a 25mg dosage that you can cut up, and from which you can make a liquid (see below).

 

Note that if you cut up quetiapine XR or switch from the extended-release form to the immediate-release form, you may need to take a half-dose twice a day or make other dosage adjustments up or down according to your reactions.

 

Cut up 25mg immediate-release tablets

If I had to taper off Seroquel, I would cut up the 25mg tablets to taper down from the higher dosages.

 

Get a liquid compounded by a pharmacy

With a prescription, you can go to a compounding pharmacy to have a liquid made from immediate-release quetiapine, or custom capsules from quetiapine XR if necessary.

 

See our topic on compounding pharmacies.

 

Make a solution with water

As for a do-it-yourself solution, it looks like immediate-release Seroquel is moderately soluble in water http://www.drugbank.ca/drugs/DB01224

 

According to http://www.new.ijpi.org/wp-content/uploads/2011/07/6.pdf

Formulation and In Vitro Evaluation of PH-Independent Sustained Release Drug Delivery System of Quetiapine Fumarate

HT Mulani, I Parmar, NJ Shah 2011

3.2. pH dependent stability of drug Drug solution was prepared with the concentration 300 ppm in 0.1 N HCl, 4.5 aceaate buffer, pH 6.8 phosphate buffer and 7.4 phosphate buffer; and observed for 24 hrs at predetermined time intervals. Drug is stable at pH range from 1.2 to 7.4 and showed the maximum 2 % degradation as compared to initial concentration (Table 2).

So it's most likely stable mixed with water for 24 hours.

 

I haven't done this and I don't know anyone who has, so I can't say for sure it works.

 

You could ask your doctor to switch you over to immediate release tablets and make a liquid from them as above.  Many members make their own liquid from their tablets and get on fine with it. 


**I am not a medical professional, if in doubt please consult a doctor with withdrawal knowledge.

 

 

Different drugs occasionally (mostly benzos) 1976 - 1981 (no problem)

1993 - 2002 in and out of hospital. every type of drug + ECT. Staring with seroxat

2002  effexor. 

Tapered  March 2012 to March 2013, ending with 5 beads.

Withdrawal April 2013 . Reinstated 5 beads reduced to 4 beads May 2013

Restarted taper  Nov 2013  

OFF EFFEXOR Feb 2015    :D 

Tapered atenolol and omeprazole Dec 2013 - May 2014

 

Tapering tramadol, Feb 2015 100mg , March 2015 50mg  

 July 2017 30mg.  May 15 2018 25mg

Taking fish oil, magnesium, B12, folic acid, bilberry eyebright for eye pressure. 

 

My story http://survivingantidepressants.org/index.php?/topic/4199-hello-mammap-checking-in/page-33

 

Lesson learned, slow down taper at lower doses. Taper no more than 10% of CURRENT dose if possible

 

 

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primrose

Hi there!

 

I talked to my pharmacist and he told me I canot cut the Seroquel XL (XR)

 

how do I taper 10%  :(

Can you transfer to the normal immediate release seroquel?

I find, as it has a short half life, to divide the dose into 4 and take every 6  hours, or even dividing it into 3 and taking every 8.

You can also divide it by popping the pill into a measured amount of warm but not too hot, water in a small jar and extracting your cut with a syringe which can be bought easily.

Be sure to give the jar a good shake before taking out your cut if you do it this way, because seroquel is not fully soluble. (this only applies to the immediate release seroquel)


pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta

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newbipo

I notice something weird about Seroquel XL pills... specially the 50mg.

When I was on 250 I was feeling very sick... and then I read this:

 

http://thelastpsychiatrist.com/2007/07/the_most_important_article_on.html

 

http://psychopharmacologyinstitute.com/antipsychotics/quetiapine/mechanism-of-action/

 

I don't understand much about this... so I though... Does the action of 4 pills of 50mg, works as same as one pill of 200mg?

 

This extra 50mg was making me very drowsy, dizzier, nausea.... I taper to 200 and this feeling go better...

 

weird uhu


After a long life (15 years) on and off antidepressants because of Anxiety and Panic attacks I decided to come off citalopram in November 2013...

01/14 - Citalopram 20mg - 0mg --> had severe symptoms and was diagnosed as Bipolar with rapide cycling and mixed state

02/14 - Seroquel 50 mg, Atenolol 25 mg 2xd, xanax 0.25 3xd

03/14 - Seroquel 300 mg, Atenolol 25 mg 2xd, xanax 0.25 2xd

04/14 - 05/14 Seroquel 400 mg, Atenolol 25mg 2xd, xanax 0.25 2xd

06/14 - 07/14 Seroquel 300 mg, Atenolol 25mg 2xd, Xanax 0.25 (reduced to 0.125)

07/14 - 08/14 Seroquel 250 mg (start to have anxiety and panic attacks again)

12/14 - Seroquel XR 300mg 200mg 50mg, Atenolol 50, Xanax 0.25 PRN

02/15 - 0 Of everything... 

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andy

It only becomes a psychotic around 200mg below that it's a big dose of antihistamine hence why it zonks people out


2012 put on Citalopram and diazepam for 3 months for "depression" after filling in a 3 minute form at the doctors, had a massive reaction with panic attacks and extreme anxiety,never suffered panic attacks or anxiety before citalopram.Told to quit cold turkey which led to two hospital admissions during 2012/2013

December for 6 months Seroquel dosage adjusted up and down 50mg ,150mg ,100mg, caused severe tinnitus ,told to quit cold turkey

2013 January for 12 months Lorazapam given to me like sweets,told to quit cold turkey

2013 May Zoloft for 6 months ,told to quit cold turkey, reinstated 50mg tapered 2nd time over a month (to fast but I survived)messed up my sleep

Zyprexa April 2103 5mg until august 2014 ,dropped by doctor down to 2.5mg for one month went well but sleep was very poor for 3 weeks

End of 2015 I had to reinstate back up to 5mg due to constant insomnia that wouldnt go away Started a slow taper and found an understanding doctor who listened to me while I reduced
May 2016 drug free, sleeping and doing well in life again, it can be done http://survivingantidepressants.org/index.php?/topic/12078-finally-off-zyprexa/

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primrose

I notice something weird about Seroquel XL pills... specially the 50mg.

When I was on 250 I was feeling very sick... and then I read this:

 

http://thelastpsychiatrist.com/2007/07/the_most_important_article_on.html

 

http://psychopharmacologyinstitute.com/antipsychotics/quetiapine/mechanism-of-action/

 

I don't understand much about this... so I though... Does the action of 4 pills of 50mg, works as same as one pill of 200mg?

 

This extra 50mg was making me very drowsy, dizzier, nausea.... I taper to 200 and this feeling go better...

 

weird uhu

Hi

 

I had a look at the two links but sorry I still cannot answer your question.

I agree that seroquel is not an anti-psychotic at the very low doses.

It's a strange drug.

How is your taper going?


pregan taper 600mg down to 240mg, daily cuts since xmas

valium, just over 75mg, tapering 0.1 a day, will keep this more udated, cos amounts going down

i have borderline personality, chronic ptsd, and suspected adhd and substance misuse as a symptom, which i am addressing with help of medical staff, drugs agencies & mh sta

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Satch

I know Seroquel is moderately water soluable. 

 

Can it be made into a water suspension or can it be compounded by a pharmacy.

 

Just looking for an accurate way to do a slow taper.

 

THanks


Klonopin 2mg 2000-2005 Tapered off without bad symptoms

Ativan 1mg 2007-2010 Tapered with moderate problems

 

Klonopin 16 total mgs in Jan and Feb 2014 - got dependent and foolishly updosed by bad doctor to 1.25mg for 4 weeks.  Then horrific detox and placed on Neurontin 100mg, bid, Propanolol 40mg prn, Seroquel 100mg qhs and Remeron 15mg qhs.  Quickly dropped Neurontin and Propanolol.   Stuck on other two meds and still having strong symptoms from klonopin cold turkey.  Want someday to be med free and healed again

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Altostrata

Please read this topic from the beginning.


This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

All postings © copyrighted.

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CosmicMinds

Do you think this 10% rule applies to 25mg of seroquel too?

From my knowledge, at a dose so low it works as an antihistamine as opposed to anti psychotic properties


Seroquel-25mg

Ativan short term use.

1mg to 0.25mg one month (0.70mg avg)

Stopped, severe wd, ended up in ER

Second Mont use 0.25mg Avg (some days 0.50 some days none, didn't know I was going through withdrawal)

Ended up in ER again

 

0.375mg reinstate.

Nov-currently at 0.16mg not doing well

 

Supplements: Mag, vit d, fish oil, vit c

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Petunia

Reduce by 10% per month to start
The 10% rule holds for Seroquel, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

 

Please read the topic CM.  Regardless of how the drug 'works' at 25 mg, it still needs to be carefully tapered to avoid withdrawal symptoms from arising.


I'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal...if you are lucky enough to find one.

My Introduction Thread

Full Drug and Withdrawal History

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety) Xanax PRN ~ Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

Protracted withdrawal, with a very sensitized nervous system, slowly recovering as time passes

Supplements which have helped: Vitamin C, Magnesium, Taurine

Bad reactions: Many supplements but mostly fish oil and Vitamin D

June 2016 - Started daily juicing, mostly vegetables and lots of greens.

Aug 2016 - Oct 2016 Best window ever, felt almost completely recovered

Oct 2016 -Symptoms returned - bad days and less bad days.

April 2018 - No windows, but significant improvement, it feels like permanent full recovery is close.

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 

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CosmicMinds

Reduce by 10% per month to start

The 10% rule holds for Seroquel, just like other psychiatric drugs: Reduce by 10% per month, calculated on the last dosage. (The amount of the reduction gets progressively smaller.)

 

Please read the topic CM.  Regardless of how the drug 'works' at 25 mg, it still needs to be carefully tapered to avoid withdrawal symptoms from arising.

Ok, Yeah i had, sorry i was just curious if it applied to such a low dose when the drug isnt really considered an "anti psychotic". 

 

I dont know if this is factual or not but my doc had told me that the antihistaminic properties of seroquel isnt of much difference above 12.5mg and beyond. Essentially she was saying that at 12.5mg the drug influences up to 80% of those receptors, and above that its just smaller increments. So i would assume for those using seroquel for sleep, tapering  the last 12.5mg may prove the most difficult. 

 

Also, this may be a stupid question but are there interdose issues with seroquel? im taking it every 24 hours and i know the half life is something like 6 hours. I hope its not the case, unlike benzos. 


Seroquel-25mg

Ativan short term use.

1mg to 0.25mg one month (0.70mg avg)

Stopped, severe wd, ended up in ER

Second Mont use 0.25mg Avg (some days 0.50 some days none, didn't know I was going through withdrawal)

Ended up in ER again

 

0.375mg reinstate.

Nov-currently at 0.16mg not doing well

 

Supplements: Mag, vit d, fish oil, vit c

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Petunia

 

Also, this may be a stupid question but are there interdose issues with seroquel? im taking it every 24 hours and i know the half life is something like 6 hours. I hope its not the case, unlike benzos. 

 

 

Not a stupid question at all :)   Even though a low dose of seroquel is sometimes prescribed for sleep problems, as benzos sometimes are.  They work in a completely different way, on different receptors in the brain.  I've never heard of interdose withdrawal happening with seroquel, but it can cause significant withdrawal problems in some people if not tapered carefully, tapering off a low dose often causes sleep problems.


I'm not a doctor.  My comments are not medical advise. These are my opinions based on my own experience and what I've learned. Please discuss your situation with a medical practitioner who has knowledge of tapering and withdrawal...if you are lucky enough to find one.

My Introduction Thread

Full Drug and Withdrawal History

Brief Summary

Several SSRIs for 13 years starting 1997 (for mild to moderate partly situational anxiety) Xanax PRN ~ Various other drugs over the years for side effects

2 month 'taper' off Lexapro 2010

Short acute withdrawal, followed by 2 -3 months of improvement then delayed protracted withdrawal

DX ADHD followed by several years of stimulants and other drugs trying to manage increasing symptoms

Failed reinstatement of Lexapro and trial of Prozac (became suicidal)

May 2013 Found SA, learned about withdrawal, stopped taking drugs...healing begins.

Protracted withdrawal, with a very sensitized nervous system, slowly recovering as time passes

Supplements which have helped: Vitamin C, Magnesium, Taurine

Bad reactions: Many supplements but mostly fish oil and Vitamin D

June 2016 - Started daily juicing, mostly vegetables and lots of greens.

Aug 2016 - Oct 2016 Best window ever, felt almost completely recovered

Oct 2016 -Symptoms returned - bad days and less bad days.

April 2018 - No windows, but significant improvement, it feels like permanent full recovery is close.

VIDEO: Where did the chemical imbalance theory come from?



VIDEO: How are psychiatric diagnoses made?



VIDEO: Why do psychiatric drugs have withdrawal syndromes?



VIDEO: Can psychiatric drugs cause long-lasting negative effects?

VIDEO: Dr. Claire Weekes

 

 

 

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ang

1992 Dothiepin 375mg 8 weeks, exhaustion/depression.  Serotonin syndrome, oh yes!  seizures . Fell pregnant, 3rd baby, Nitrous Oxide, 3 weeks mental hospital pp psychosis. zoloft tegretol.

Feb 1996 ct tegretol, tapered Zoloft 8 weeks. as (unexpectedly)  pregnant. Steven died after 3 days.(Zolft HLHS baby).  98 had run in with Paxil, 2 tablets, 3 weeks taper, survived.
2005..menopause? exhausted again. Zyprexa, mad in three days, fallout....  Seroquel, Effexor, tegretol,   and 8 years of self destruction. Failed taper.
Damn 1/4 valium... nuts again! .fallout, zoloft 100mg  seroquol 400mg mirtazapine 45 mg  tegretol 400mg.  Mid 14 3 month taper. Nov 14 CRASH.
Mid 15 ....   75mg  seroquel,  3 x 1800mg SJW  2 week window end of December followed by 6 week wave
5/2 68mg seroquel, 2.5 x 1800mg SJW::::20/2 61mg seroquel, 2.5 x  SJW::: 26/2 54mg seroquel, 2 x SJW::::21/3 43mg seroquel, 1 x 2700SJW :::: 23/4 36mg seroquel 1 x 1800 SJW
15/5 33mg seroquel, 1 x SJW::::   28/5 30mg seroquel, 1 x SJW::::;  18/6 25mg seroquel 1/2 SJW::::, 11/7 21mg seroquel 1/2 SJW::, 26/7 18mg seroquel 1/2 SJW:::, 9/8 12mg seroquel :::, 16/8 6mg seroquel ;;;;, 12/9 0 jump.

23/9  3mg.....,  27/9 0mg.  Reinstated, 6mg, then 12mg.............  LIGHTBULB MOMENT,  I have  MTHFR 2x mutations.  CFS and issues with MOULD in my home. So I left home, and working 150km away during week, loving it.

Oh was hard, panic attacks first week, gone now, along with the mould issues.

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ang

During clinical trials, seizures occurred in 0.5% (20/3490) of patients treated with quetiapine fumarate compared to 0.2% (2/954) on placebo   (That was only one of a lot of other things).  Has woken me up from my drug induced brain coma.  Isn't that one in 200 had seizures??  


1992 Dothiepin 375mg 8 weeks, exhaustion/depression.  Serotonin syndrome, oh yes!  seizures . Fell pregnant, 3rd baby, Nitrous Oxide, 3 weeks mental hospital pp psychosis. zoloft tegretol.

Feb 1996 ct tegretol, tapered Zoloft 8 weeks. as (unexpectedly)  pregnant. Steven died after 3 days.(Zolft HLHS baby).  98 had run in with Paxil, 2 tablets, 3 weeks taper, survived.
2005..menopause? exhausted again. Zyprexa, mad in three days, fallout....  Seroquel, Effexor, tegretol,   and 8 years of self destruction. Failed taper.
Damn 1/4 valium... nuts again! .fallout, zoloft 100mg  seroquol 400mg mirtazapine 45 mg  tegretol 400mg.  Mid 14 3 month taper. Nov 14 CRASH.
Mid 15 ....   75mg  seroquel,  3 x 1800mg SJW  2 week window end of December followed by 6 week wave
5/2 68mg seroquel, 2.5 x 1800mg SJW::::20/2 61mg seroquel, 2.5 x  SJW::: 26/2 54mg seroquel, 2 x SJW::::21/3 43mg seroquel, 1 x 2700SJW :::: 23/4 36mg seroquel 1 x 1800 SJW
15/5 33mg seroquel, 1 x SJW::::   28/5 30mg seroquel, 1 x SJW::::;  18/6 25mg seroquel 1/2 SJW::::, 11/7 21mg seroquel 1/2 SJW::, 26/7 18mg seroquel 1/2 SJW:::, 9/8 12mg seroquel :::, 16/8 6mg seroquel ;;;;, 12/9 0 jump.

23/9  3mg.....,  27/9 0mg.  Reinstated, 6mg, then 12mg.............  LIGHTBULB MOMENT,  I have  MTHFR 2x mutations.  CFS and issues with MOULD in my home. So I left home, and working 150km away during week, loving it.

Oh was hard, panic attacks first week, gone now, along with the mould issues.

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