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Tips for tapering off Seroquel (quetiapine)

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Justin

Hi everyone, this is my first post.  Firstly, I greatly appreciate all of the insight and ideas.  Secondly, a question about my options:

 

Background - I'm on 100mg of Seroquel for sleep.  I've been on it for 6 years.  I want to get off (or reduce as much as possible.  I've tried to reduce dosage on 2 occasions (prior to finding this site).  First time I tried taking 75mg.  I had a horrible night and went right back to 100mg.  A year later I tried 87.5mg.  Same result, so I went right back to 100mg.

 

Question - Based on those experiences, is there anything wrong with trying a 5% reduction (using a mg scale as other posts suggest) for the first couple weeks to see how I react - rather than the 10% reduction that's recommended here?  I think I'd be less fearful (trying to avoid nocebo effect) if I tried a smaller reduction first.

 

Also, would there be any benefit to taking some melatonin the first couple nights of the reduction to help with the transition?

 

Thanks

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Petunia

Welcome Justin,

I think trying a 5% reduction would be a great idea. Adding melatonin at the same time probably wouldn't be a good idea because whatever happens, or doesn't happen, you wont know whether to attribute it to the drug cut or the melatonin. If you can establish the right rate of tapering for you personally, you shouldn't need to add anything else to help with sleep.

 

Please would you start an introduction topic for yourself here:  Introductions and updates  so we can get to know you and continue providing ongoing support and suggestions relevant to your specific situation.

 

It would be great if you would put your drug and withdrawal history in your signature. Doing this helps people understand your context, it appears below each of your posts. Here are instructions for how to do it:

 

http://survivinganti...your-signature/

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Songbird

is there anything wrong with trying a 5% reduction (using a mg scale as other posts suggest) for the first couple weeks to see how I react - rather than the 10% reduction that's recommended here?

 

Nothing wrong with it, it's a good idea.  The 10% is the maximum recommended dose cut, so less than 10% is also okay.  Some people find 10% too much, but are successful with smaller percentage drops.

 

Also, would there be any benefit to taking some melatonin the first couple nights of the reduction to help with the transition?

 

I agree with Petunia that it would be better to try the drop first to see how it goes, and not confuse things with melatonin.  However, as someone who has been on Seroquel for sleep and used melatonin to transition, I can say it worked for me.  I would try the very small drop in dose first - you might find that you don't need to add the melatonin.  If you experience mild to moderate sleep difficulties but have no major w/d symptoms, then you could try melatonin to help with sleep.  If you experience major sleep problems or other major w/d symptoms then you might have dropped too much. 

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lanah

If I would do a microtaper how fast would I go? 

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freespirit123

Just wanted to give a heads up about my tapering. I have successfully tapered off Sero., 3 wks and going strong!

 

If I can do it, so can you. I took it for bedtime along with Lunesta which I'm still taking. I feel so much better off of it. No more shaky hands or anxiety. It was actually causing more anxious thoughts for me. So glad I'm off!

 

I had a couple of bad nights and has to take Ativan for about 2-3 nights (.25mg) but that's it. I still have early wake up but I've been using Magnesium, Melatonin (1mg) and salt and honey and it gets me back to sleep.

 

I'm here if anyone has questions. You can do it!!!!

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freespirit123

However I do have a question and tried to find online and couldn't. How long does it take for your brain to get back to normal after Sero use?

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Altostrata

This varies from person to person. Recovery will be very gradual and probably in waves and windows.

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maria323

Hi freespirit123! what kind of magnesium do u use? Do u take it at night along with the melatonin? I don't have a problem getting to sleep but I wake at 2 or 3 ish and need something to get me back to sleep. I've been taking 12.5 of seroquel as needed but I want to stop taking it.

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Altostrata

Please take discussions of magnesium to the magnesium topic in Symptoms, or discuss on freespirit's Intro topic. It is off-topic here.

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lanah

Can someone help me set up a liquid microtaper for seroquel?
Which liquid do I use, what kind of tools do I need? I'm at about 15 mg , i was considering tapering 0,1 mg at first. But I'm too brain fogged to really read through a lot of threads so if someone could help me with a specific plan that would be very helpful, thank you
I'm afraid that the powder wouldn't be totally absorbed and I would be taking weird dosages

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Alia02

I have found this drug much harder to drop that the anti depressant. Its going to take a while. I have been on it for about 20 years.

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aries19835

does anyone have a dosage guideline for seroquel? Like at what point it is only on histamine, serotonin, and dopamine. At what dosage should the taper be really careful about? Also at what dosage seroquel is for schizophrenia, bipolar, mania, and finally insomnia?

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Altostrata

Hi, aries. The receptor occupancy of Seroquel at various dosages is not really relevant to tapering. As long as reducing the drug cause withdrawal symptoms, you need to taper.

 

While psychiatry pretends there are definite "therapeutic" dosages, the fact is that dosage is individual (usually, the prescribed dosage is too high), whether the dosage is "therapeutic" is completely subjective (often the doctor's opinion), and drug treatment of any psychiatric condition is trial and error.

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Alia02

Thanks for that info Altostrata. I certainly do feel like the research re Seroquel withdrawl and its impact has not been done yet. My experiences of it are certainly much different than what I was told I would experience. (Also one a pain Psych told me he didnt need to undertake  research because my reaction to drugs was his research and that I was the experiment. I remember laughing with him...but not now)

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Rainmaker7

Hi everyone, 

 

I would like to confirm that I am understanding this thing correctly: is it OK to taper standard Seroquel by cutting the pill (without making a liquid form)? 

 

I take 50 mg (2 pills of 25 mg each), I bought a digital scale and it's  accurate in measuring. So I started by reducing 5% and then 10%.

 

 

[before I tried to dissolve a pill in water and it seems that some powder remains attached to the glass. I find more comfortable by cutting the pill.]

 

The coating seems to be just a very thin layer, I don't think it 's meant to have a use as a gastrointestinal protection.

 

Thanks for your help  :)

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mammaP

Hi Rainmaker, welcome to SA. Yes that is fine, here is the post that explains in detail the ways to taper seroquel / quetiapine. 

 

You will need to leave at least 3 weeks between cuts. Tapering fast can result in psychosis, even if it wan't prescribed for psychosis! 

 

Would you like to start a topic in the intro forum, so we can get to know you? That would be your journal where you can log your progress and ask any questions about your taper.  The intro forum is also a good place for doctors to see case histories and the devastating effects that some drugs have on people, and how some people taper successfully by using the 10% method.  :)

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MNgal1960

I'm tapering Seroquel, too, Rainmaker, and have been cutting using a scale. It's slow going, but it does seem to work to dry cut it.

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Rainmaker7

Hi Rainmaker, welcome to SA. Yes that is fine, here is the post that explains in detail the ways to taper seroquel / quetiapine. 

 

You will need to leave at least 3 weeks between cuts. Tapering fast can result in psychosis, even if it wan't prescribed for psychosis! 

 

Would you like to start a topic in the intro forum, so we can get to know you? That would be your journal where you can log your progress and ask any questions about your taper.  The intro forum is also a good place for doctors to see case histories and the devastating effects that some drugs have on people, and how some people taper successfully by using the 10% method.  :)

 

thanks a lot mammaP

 

I'm tapering Seroquel, too, Rainmaker, and have been cutting using a scale. It's slow going, but it does seem to work to dry cut it.

 

Hi MNgal1960, good luck to you too. It's tough road but we have to make it

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MNgal1960

Well, I am getting very frustrated with the dry cutting. I just dread doing it, but it looks like Seroquel is not really very soluble in water, if my understanding of this thread is correct. I find som eo fhte links very confusing. :(  Is it best to stick with dry cutting?

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scallywag

MNGal -- Seroquel is "moderately soluble" in water.  The implication of moderate solubility is that you will have undissolved particles in the liquid. To deal with that, you shake the liquid and remove a dose from the centre of the suspension.

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MNgal1960

Thanks, Scallywag. I will try that and see what happens.

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MNgal1960

I was wondering if tapering off of Seroquel causes the same kind of symptoms as tapering off of AD or benzos. And are there symptoms that seem to the the most common no matter what drug you're tapering?

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Shep

Hi, MNgal. Yes, there are a lot of overlapping symptoms with AD's, benzos, and antipsychotics. Insomnia, mood swings, cog fog, and GI problems are just a few that can come from any of these drugs. 

 

And many people coming off antipsychotics have been polydrugged, so that makes it even more complicated, especially due to the possibility of kindling. 

 

Sending healing vibes your way. 

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MNgal1960

Thank you, Shep. I tapered my Q from 25mg down to 17mg and found I had anxiety and neuropathy. I am also on Valium with one previous failed taper attempt. I wondered if the Q taper was causing my symptoms or if it was somehow tangled up with the Valium. The gabapentin is supposed to help with Restless Leg Syndrome and neuropathy but doesn't seem to do much. I particularly wonder about the neuropathy because I have it from an illness, also, but it was particularly bad during the taper. It makes it so hard to know if I'm tapering too fast or if it's just my "typical" neuropathy flaring up. Grrrr.

 

At any rate, I am pausing my Q taper here and going to try an ultra-slow taper of the V to get it lower. I wonder if it will be similar to the Q (which was also ultra-slow). Wish I could get all the way off the Q because it messes up my mornings, I can't drive or function until at least 10AM even though I'm awake at 6AM.

 

I'm so tired and so frustrated by how slow this process is.

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rapunzel2

question about seroquel. when the withdrawal insomnia passes, will the sleep actually improve with lower seroquel dose? if it has been taken only for sleep with doses 25-50mg?

 

is it like antidepressants, which may induce depression when taken long term, then depression is withdrawal symptom, and then when all that resolves, depression gets better. 

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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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