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Tips for tapering off Seroquel (quetiapine)

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VitaminB

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

 

 

 

Sadly, I am in the same boat as your son in terms of landing back in the hospital trying to go down from 250mg. 

I have read that article from the last psychiatrist too... I haven't really stayed at 600mg for long and haven't been dosed higher than that... maybe at 800mg for a while. 

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simack

Hello all I just have a quick question regarding tapering Seroquel. I recently made the switch from a 50mg instant release tablet to 50ml of liquid Seroquel. I did this simply by letting one 50mg tablet dissolve into 50ml of water then drinking it.

However doing this caused me to become destabilised... Is it safe to taper this way? I know this can happen switching to liquid medication, but does anyone know what's happening here? Am I experiencing an increase our decrease in dose?

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VitaminB

I read through this thread completely today. Is there anyone out there who as gone off Seroquel from high doses of 600? 

 

I am at 425 (100 morning) (325 at night)...... can I dissolve a 100mg pill and take a solid 200mg pill when I get to below 300 at night? The taper might be way easier at a slow 3% pace by liquid titration. 25's and 50's are mentioned in the liquid titration process, has anyone done 100mg pills?  I could taper my morning dose this way too. 

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MNgal1960

I have read in other places about switching to liquid being destabilizing to some people and then you have to wait to stabilize to actually taper.

 

I don't know anything about getting off high doses except I have read people doing it. The problem with the larger pills is it either makes a very strong suspension or you have to use a ton of water. I tried liquid for awhile and used 100ml of water for 25mg Seroquel tablet. The stronger the liquid, the more you are affected my tiny errors in measuring.  The weaker, the less. Maybe someone who has used larger tablets could chime in.

 

I think Seroquel doesn't actually dissolve, only disintegrates. You have to be sure to shake and shake before doing a pull out of the medication because the tiny particles are just floating around in the water and not actually dissolved, so they could sink back to the bottom.

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scallywag

When changing from a tablet to liquid formulation, it can be helpful to make the switch in steps. Liquids are absorbed more quickly in our digestive systems.

 

Start with a small portion of your dose as liquid and take the rest in tablet/capsule. For example, If you're taking 200 mg, take 50 mg as liquid and the remainder as the tablet. Do that for a few weeks *or* longer, then go to half liquid half tablet.

 

If you have questions about your specific dosage please post your questions in your intro thread.

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VitaminB

I have read in other places about switching to liquid being destabilizing to some people and then you have to wait to stabilize to actually taper.

 

I don't know anything about getting off high doses except I have read people doing it. The problem with the larger pills is it either makes a very strong suspension or you have to use a ton of water. I tried liquid for awhile and used 100ml of water for 25mg Seroquel tablet. The stronger the liquid, the more you are affected my tiny errors in measuring.  The weaker, the less. Maybe someone who has used larger tablets could chime in.

 

I think Seroquel doesn't actually dissolve, only disintegrates. You have to be sure to shake and shake before doing a pull out of the medication because the tiny particles are just floating around in the water and not actually dissolved, so they could sink back to the bottom.

 

Thanks for the tip on it being destabilizing. I am on 100morning and 325night right now, so maybe I could dissolve the 25mg at night to see how it effects me. 

 

I saw that seroquel does come in a liquid from one of Alto's posts. I will have to look into that if the tablets are going to be stubborn dissolving. 

 

 

 

 

scalawagWhen changing from a tablet to liquid formulation, it can be helpful to make the switch in steps. Liquids are absorbed more quickly in our digestive systems.

 

Start with a small portion of your dose as liquid and take the rest in tablet/capsule. For example, If you're taking 200 mg, take 50 mg as liquid and the remainder as the tablet. Do that for a few weeks *or* longer, then go to half liquid half tablet.

 

If you have questions about your specific dosage please post your questions in your intro thread.

 

 

Ok. I will go back to intro thread. Thanks for the heads up on taking it slow. 

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MNgal1960

Does anyone have any reliable data on whether or not Seroquel will remain stable in water or Ora-Plus or any liquid so one could make up a few days supply at a time? Thanks.

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scallywag

MNgal: Alto's post on the first page answers a lot of questions, including the one you're asking.

 

Her answer is that the liquid is "probably stable for 24 hours." Please also read the part where she talks about switching over to liquid in stages -- initially taking most of your dose in tablet form then gradually increasing the amount you take as liquid.

 

Alto's post about Seroquel

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freespirit123

I wasn't on for that long so maybe that had something to do with it, a few months. But I have a digital scale and just chipped away each night. I was on Lunesta at the time so I'm sure that helped

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MNgal1960

Thanks Scallwag. I wasn't sure. I thought that the 24 hours was referring to the extended release form. My brain isn't working so well. I will try to read it again.

 

FreeSpirit, I have been trying to use a digital scale and dry cutting, but I find it so frustrating and my scale is hard to calibrate. I was hoping I could make up a batch of liquid more easily. But if I have to make a fresh batch every day, that will also be too difficult for me. I'm not in good shape and am usually alone.

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MNgal1960

I have been holding and dry cutting for weeks and have been continued to experience a big spike in my neuropathy. Could the inaccuracy of dry cutting Seroquel cause neuropathy? I have heard suspensions are more accurate, but I don't know if I'm mentally up to figuring out how to make a suspension. The directions are so confusing and I can't afford OraPlus.

 

Has anyone ever heard of tapering Seroquel causing neuropathy? It could be something else. I've had it in the past from other triggers. I am trying to figure out what the trigger could be. I'm barely functioning.

 

Sorry if I asked this elsewhere and forgot. My memory is shot.

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Justin

I have been holding and dry cutting for weeks and have been continued to experience a big spike in my neuropathy. Could the inaccuracy of dry cutting Seroquel cause neuropathy? I have heard suspensions are more accurate, but I don't know if I'm mentally up to figuring out how to make a suspension. The directions are so confusing and I can't afford OraPlus.

 

Has anyone ever heard of tapering Seroquel causing neuropathy? It could be something else. I've had it in the past from other triggers. I am trying to figure out what the trigger could be. I'm barely functioning.

 

Sorry if I asked this elsewhere and forgot. My memory is shot.

 

Hi MNgal1960,

Sorry to hear about your difficulties.  I have been following some of the previous instruction in order to cut down on Seroquel.  Specifically, every 2 weeks or so I reduce the dose by 5%.  This is a slightly more conservative way of reducing 10% per month as others on this board recommend.  This approach works well for me.  I'm using the following scale in order to weigh the pills:  https://amzn.com/B0012TDNAM.  I use a razor blade to cut them.  If you have trouble with the cutting being inaccurate and the target weight is difficult to achieve you could have your doctor prescribe you with multiple pills of smaller doses and cut down the smaller mg pills (for instance, rather than cutting down 50mg pill I find it easier to cut down a single 25mg pill and take that along with a whole 25mg pill in order to get back to the 47.5mg range..)

-Justin

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MNgal1960

 

I have been holding and dry cutting for weeks and have been continued to experience a big spike in my neuropathy. Could the inaccuracy of dry cutting Seroquel cause neuropathy? I have heard suspensions are more accurate, but I don't know if I'm mentally up to figuring out how to make a suspension. The directions are so confusing and I can't afford OraPlus.

 

Has anyone ever heard of tapering Seroquel causing neuropathy? It could be something else. I've had it in the past from other triggers. I am trying to figure out what the trigger could be. I'm barely functioning.

 

Sorry if I asked this elsewhere and forgot. My memory is shot.

 

Hi MNgal1960,

Sorry to hear about your difficulties.  I have been following some of the previous instruction in order to cut down on Seroquel.  Specifically, every 2 weeks or so I reduce the dose by 5%.  This is a slightly more conservative way of reducing 10% per month as others on this board recommend.  This approach works well for me.  I'm using the following scale in order to weigh the pills:  https://amzn.com/B0012TDNAM.  I use a razor blade to cut them.  If you have trouble with the cutting being inaccurate and the target weight is difficult to achieve you could have your doctor prescribe you with multiple pills of smaller doses and cut down the smaller mg pills (for instance, rather than cutting down 50mg pill I find it easier to cut down a single 25mg pill and take that along with a whole 25mg pill in order to get back to the 47.5mg range..)

-Justin

 

Thanks, Justin. I am trying to cut down the smallest tablet available using a filet-type knife that is almost as thin as a razor blade and a mg scale. I'm just really bad at it. On multiple meds. Tired and clumsy, so my manual dexterity isn't the greatest.

 

I'm below 25mg and have been going v-e-r-y slowly. I also have an autoimmune disorder so sometimes it's impossible to tell if the illness is causing the symptoms or the taper is too fast. Or if I'm just the world's worst dry cutter! :P

 

I'm glad to hear things are going well for you so far. It sounds like you are a good dry cutter.

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genlady

From personal experience, coming off Seroquel was a nightmare.  I was on 600mg. and tapered by 25mg. per month and still had sweating/chills, vomiting, mood swings, hallucinations, pychotic epidoses, head burning sensations, dizziness, sensitive to light and sound, vision problems.  Be very careful if you are sensitive to chemicals like I am .  While on anti depressants I was very sensitive to the side effects as well.  

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genlady

I have been holding and dry cutting for weeks and have been continued to experience a big spike in my neuropathy. Could the inaccuracy of dry cutting Seroquel cause neuropathy? I have heard suspensions are more accurate, but I don't know if I'm mentally up to figuring out how to make a suspension. The directions are so confusing and I can't afford OraPlus.

 

Has anyone ever heard of tapering Seroquel causing neuropathy? It could be something else. I've had it in the past from other triggers. I am trying to figure out what the trigger could be. I'm barely functioning.

 

Sorry if I asked this elsewhere and forgot. My memory is shot.

I experienced neuropathy while coming off Seroquel.  I have been off of it for five months and still have it, but not as severe.  

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MNgal1960

Hi gen. I'm sorry to hear you still have neuropathy. I decided to try liquifying my Seroquel so that my dosing was more stable and so I could make much smaller cuts in hopes of making my symptoms less severe. I just can't seem to make small enough cuts with my mg scale.

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lanah

I read that Shep only slept for 3 hours when she hit 12 mgs, i'm in the same place now also only sleeping 3 hours. I've been holding for three months now and i still get those 
nights. So i was wondering if this is typical around this dosage? 
 

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MNgal1960

I have read of people who have only taken half of a 25mg tablet for sleep, so 12.5mg. These people were not withdrawing though. It was their regular dose.

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dukke

In your experience, how much time should you wait after you have stabilized on a particular dosage, before you start tapering again? This might be a better indicator then the 1 month 10% taper rule..

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Altostrata

Most people will stabilize after a reduction within a week. We recommend reductions at monthly intervals to give the nervous system a good 3 weeks to settle down between cuts.

 

See

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dukke

Thank you very much Altostrata, I think I'm stabilized now, been so for 1 week. So I'll wait another 2 weeks to tapper like you suggest. 

 

 

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scallywag
On 2017-07-17 at 1:07 PM, dukke said:

In your experience, how much time should you wait after you have stabilized on a particular dosage, before you start tapering again? This might be a better indicator then the 1 month 10% taper rule..

 

On 2017-07-17 at 2:21 PM, Altostrata said:

Most people will stabilize after a reduction within a week. We recommend reductions at monthly intervals to give the nervous system a good 3 weeks to settle down between cuts.

 

There are some members who have reported that their symptoms didn't show up until close to 3 weeks after a dose decrease on an "anti-psychotic."  It wouldn't hurt to take longer holds than 3-4 weeks, especially at the start of your taper so that you learn your symptom pattern.

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rapunzel2

has anybody experienced weight gain when withdrawing seroquel? I know that mostly it causes weight gain while taking it. however, I have been very slim all my life and even taking seroquel didn't change that. but now I'm gaining weight, although I'm eating very healthily. I'm trying to understand, is this weight gain because of seroquel (which messes with metabolism pretty badly) or because of fluoxetine withdrawal. 

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JanCarol

I just found this article about the many doctors who prescribe Seroquel (off label!)  for sleep - 

 

National Post - Drug Safety Expert urges Doctors to stop Prescribing Antipsychotic (Seroquel) for Insomnia)

 

Yes, rapunzel - Seroquel causes metabolism and blood sugar imbalances which can remove appetite control (always hungry! never satiated!) and cause weight gain.

 

I would suggest that you not worry about your weight until you've been off the drugs for awhile - as it takes awhile to re-adjust your metabolism.  Focus on healthy eating and keep moving - work on improving your cardiovascular fitness and muscle strength and flexibility.  Some people have the weight melt away, some of us have to work harder at it after the drugs are gone (that's me).  You will never know which drug is the source of the problem, as all of them fiddle the endocrine system in some way.  

 

Looking at what is done is counterproductive.  Look instead at what you want to do.

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rapunzel2

thanks, JanCarol! 

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dukke

I'm using the Gem20 scale: http://www.betterbasics.com/guide/SW-GEM20-SIL

 

I'm currently at 46mg Seroquel, has anyone got experience of until when can one tapper successfully using this scale? Until what amount (mg)?

 

Where I live it's very difficult to get a liquid version of the medication prepared by a compound farmacy.

 

Thanks, best regards,

 

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ChessieCat

From the first page of this topic:

 

On 09/08/2014 at 5:55 AM, mammaP said:

 

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. 

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dukke

@ChessieCat I know. Don't get me wrong but "Get on fine with it" is probably an overstatement. From what I've read most members are experiencing horrible withdrawal. I think we've got to look not only at how much people have been able to cut down on their medication but also at how much side effects they are experiencing. I prefer tapering less and being able of having less side effects than the opposite.

 

Don't get me wrong I'm not saying I know best, or that there is a better way. I'm just saying that I don't think there is enough evidence to support saying that making your own liquid water suspension is better than weighing the pill in a digital scale. Some members have said that Seroquel doesn't dissolve well in water. Making your own water suspension is probably more work, you have to be more careful, you'll be dealing with things you don't exactly master (pharmaceutical sciences). Then there is the shelve life time of such a custom made solution.

I personally feel weighing the pills is better.

 

Ideally I would be able to get a compound pharmacy to prepare me a liquid version of Seroquel, I think that's the best option, but where I am, I don't know of such pharmacies and more important I don't know which Medical Doctor would prescribe me that.

 

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dukke

Hi,

 

Two questions (and please don't move this to my personal thread, these are general Seroquel questions):

 

1 - Years ago; I remember my doctor saying that he recommended me taking the original brand of Seroquel and not a generic one. Where I live we can get generic Seroquel (or generic any other medication), that is not actually called Seroquel but also contains quetiapine and is manufactured by another company. The advantage is that they are cheaper.

     So the reason for him to say that I should take the orginal brand (Seroquel) is that the other brands don't guarantee a consistent dosage in each pill, some might have more, some less...

     Is this true? Should I buy the orignal brand. If I'm tapering and this is true then buying the orignal brand would be even more important, I think.

 

2 - My main withdrawal problem is insomina, followed by occasional diarrhea, followed by irritability, although not totally sure diarrhea is caused only by withdrawal. My question is should I try to change Seroquel for another medication that has less side effects but still tackles insomnia as good as Seroquel or even better? Do you know of such medication or any suggestion? I think hipnotics only target insomnia though I don't know if they are better for you than Seroquel and I think but am not sure that they should only be taken over a short amount of time.

 

 

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Altostrata

Hi, dukke. We need to take up the insomnia and other symptoms on your Intro thread 😊

 

In the US, generics are permitted to have some degree of dosage variance -- and so do the brand-names. I would call the manufacturer of the generic quetiapine available in Spain to see what their quality assurance guidelines are. I believe the EU is somewhat more strict than the US.

 

If you feel confident in the response, you might try a switch by taking a partial dose of the brand-name with a partial dose of the generic for a while. Many of our members have moved to generics in this way. Otherwise, some people are sensitive to the differences between drug brands.

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Deee

I have read this thread and the main admin note which are very helpful, but haven’t found anyone with experience tapering off 50 mg XR seroquel. What has the experience been moving completely from XR to immediate release (and then tappering)? Or has anyone gone from 50 XR to nothing at all since this is the lowest dosage in XR? 

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Altostrata

Hello, Deee. Please start a topic for yourself in the Introductions section of this site. While you're there, use search for "seroquel" and you will see many people tapering Seroquel.

 

Do not go from 50mg Seroquel XR to nothing. That is known as cold turkey.

 

You can always make an intermediate dosage of Seroquel by adding an amount in liquid form:

 

On 9/27/2012 at 6:19 PM, Altostrata said:

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. ....

 

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dukke

@Altostrata : I totally understand why you move posts around from one thread to another. But my advise would be to not be too strict about this as it is very frustrating for users whenever this happens and may even lead to some abandoning or start to be discouraged from using it.

 

I keep thinking that maybe a forum is not the best medium for this. I think maybe a wiki with all the information about each topic would be best with an accompanied forum with very little moving around of posts, a wiki would be like wikipedia but only for things related to the topic of this forum. The content would be submitted by members with other members reviewing those submissions, accepting, rejecting or purposing changes to them. Just my 2 cents.

 

I think just a small number of people will actually look at my intro thread and the questions I pose here will serve anyone who is on Seroquel. The more people looking at this questions the more answers will appear.

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dukke

.. I think it's also confusing to some users, when posts are moved around.

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Altostrata

Good points. A wiki would be a better way to present the tapering topics. I suppose I could close all the tapering topics to comments and avoid the comment-moving. But we also want people to add their own suggestions for tapering techniques. We want to present high-utility tapering information that's widely applicable.

 

Most of the views of the Tapering forum are from unregistered guests peeking in from searches on the Web.

 

Usually, a person asking a question in a Tapering topic about their own personal taper is not widely applicable, as it requires so much context particular to that person. That is why comments are moved -- responses would take a Tapering topic off-topic.

 

We also want to keep case histories all together in the Introductions forum, to educate doctors. Believe it or not, there are doctors who read this site and learn from the case histories. If it was the usual disorganized Internet forum, the progress of any individual would be all over the site and pretty much lost as valuable information.

 

The Introductions forum is highly trafficked by members who can respond to posts. The mods look at the Introductions forum first for any questions regarding tapering. Questions about individual tapers can be lost elsewhere. If you have questions about your personal taper, please post them in your Introductions topic.

 

 

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dukke

Yes, I understand why you move the posts. Don't get me wrong, you're doing an awesome job, this is the best site for anyone trying to get rid of anti-depressants. I just wanted to give my opinion, my 2 cents, to help make it a bit better. My opinion is that would be best to loosen up a bit on moving posts around.

 

A wiki allows for outside contributions, these contributions from other members are then subject to  review by members of the wiki who can be elected as moderators.

 

A forum also has value, I think having the two would be better. Right now information is a bit scattered around a forum thread, you have to read a lot to get all the information, and some like you said may be posted by people who don't have that much experience with the topic. A wiki allows to gather all the information in one place, categorized and subject to moderators acceptance.

 

 

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