michala: Medication Merry-go-round - Worst I've ever been

[michala]

@Altostrata no i discontinued the gabapentin after 4 days of use in january. i updated my signature. 

 

On 2/23/2022 at 3:17 AM, Altostrata said:

How do you feel before and after each dose?

before the dose of seroquel i am usually restless, in terror, akathisia of varying intensity, have SI, body vibrating, burning pain in different areas of my body. 

after the dose, i may get some mild anxiety, burning in extremities sometimes gets worse, less restless, less SI, and able to fall asleep after about 2 hours. 

[Altostrata]

22 hours ago, michala said:

after the dose, i may get some mild anxiety, burning in extremities sometimes gets worse, less restless, less SI, and able to fall asleep after about 2 hours. 

 

When does the mild anxiety and burning get worse, how long does it last? 

 

What is your sleep pattern? How do you feel when you get up in the morning?

 

22 hours ago, michala said:

akathisia of varying intensity, have SI, body vibrating, burning pain in different areas of my body. 

 

At what times of day are these symptoms at their worst?

[michala]

48 minutes ago, Altostrata said:

When does the mild anxiety and burning get worse, how long does it last? 

usually about 30 minutes after i take my dose of seroquel. the burning may last until i fall asleep, or sometimes it doesn’t happen at all. the anxiety usually goes away after about an hour and a half after i take my dose. it varies night to night, some nights are better than others and i can’t pinpoint a trigger that makes some nights easier than others. 

 

48 minutes ago, Altostrata said:

What is your sleep pattern? How do you feel when you get up in the morning?

my sleep pattern is mostly stable. a couple of nights i have woken up a few times with restlessness and my whole body vibrating and burning. other nights i may wake up one time with no symptoms and am able to get right back to sleep. 

 

48 minutes ago, Altostrata said:

At what times of day are these symptoms at their worst?

always first thing in the morning after i wake up, then in various intensity throughout the day with no obvious trigger that i can pinpoint, and usually at about 11pm things start to get progressively worse until i take my dose of seroquel. 

 

i had blood work done recently. my magnesium levels are too high (i do not take any supplements), vitamin d is extremely low, b12 is in range, i have low carbon dioxide levels, kidney and liver enzymes are high. i’m wondering if all of this could be contributing to my symptoms. i have been prescribed 5,000 IU of d3, but seeing as d3 is basically a steroid i hesitate to start that. 

[michala]

@Altostrata i’m sorry i forgot to tag you above. 

[Altostrata]

20 minutes ago, michala said:

usually at about 11pm things start to get progressively worse until i take my dose of seroquel. 

 

When did this start?

 

Do you take any other drugs daily? What is your daily drug schedule?

 

Please add the date you started 300mg Seroquel. Is it an immediate-release tablet?

[michala]

45 minutes ago, Altostrata said:

When did this start?

about a week ago. 

 

45 minutes ago, Altostrata said:

Do you take any other drugs daily? What is your daily drug schedule?

no i do not take any other drugs. i take 300mg seroquel at 12am. 

 

46 minutes ago, Altostrata said:

Please add the date you started 300mg Seroquel. Is it an immediate-release tablet?

i updated my signature. yes it’s an immediate release tablet. 

[michala]

@Altostrata i’m so sorry i forgot to tag you again. 

[Altostrata]

That looks like interdose withdrawal from immediate-release Seroquel, which has a half-life of only 7 hours. It should be taken in split doses.

 

Immediate-release Seroquel is usually given twice a day. Can your doctor give you a prescription for 75mg tablets, you can take 75mg in the morning and 225mg at night? You would start tapering from the night-time dose.

[michala]

34 minutes ago, Altostrata said:

That looks like interdose withdrawal from immediate-release Seroquel, which has a half-life of only 7 hours. It should be taken in split doses.

i have thought about that, it makes sense. i haven’t heard of anybody getting interdose wd from seroquel. 

 

36 minutes ago, Altostrata said:

Immediate-release Seroquel is usually given twice a day. Can your doctor give you a prescription for 75mg tablets, you can take 75mg in the morning and 225mg at night? You would start tapering from the night-time dose.

i can ask my psychiatrist about that. the problem is i am prescribed it off-label for sleep. i am still very unstable from the saphris CT and afraid to further destabilize by tapering. any thoughts? @Altostrata

[Altostrata]

300mg Seroquel is a huge dosage for sleep. The usual dosage is 25mg-50mg. The higher dosage puts you at higher risk for Seroquel's most serious adverse effects.

 

Your psychiatrist may suggest you take extended-release Seroquel, which will be more difficult to taper off, requiring conversion to either immediate-release tablets or a immediate-release liquid, which also would require split dosing to avoid interdose withdrawal.

 

Is your psychiatrist willing to help you minimize your dosage?

[LizaB]

1 minute ago, Altostrata said:

300mg Seroquel is a huge dosage for sleep. The usual dosage is 25mg-50mg. The higher dosage puts you at higher risk for Seroquel's most serious adverse effects.

 

Your psychiatrist may suggest you take extended-release Seroquel, which will be more difficult to taper off, requiring conversion to either immediate-release tablets or a immediate-release liquid, which also would require split dosing to avoid interdose withdrawal.

 

Is your psychiatrist willing to help you minimize your dosage?

I totally agree. I was given 75mg and that was the max and it caused me to hyperventilate. And then two weeks later I had a blood clot. My doctor didn’t want me taking more than 50 mg for insomnia, but I bedded her to let me try 75 and that was a mistake

[Altostrata]

I'm so sorry, @LizaB

[michala]

@Altostrata my psychiatrist is not fond of me… i tried reducing my seroquel while i was on saphris and successfully got down to 100mg. he was not pleased and insisted i stay on the seroquel “because i believe it’s helping your mood and intrusive thoughts”. mind you, both of those antipsychotics were prescribed off-label for insomnia. i don’t believe he would be supportive of that but i am looking for a new psychiatrist. 

[michala]

@LizaB that’s so scary, i’m sorry that happened to you.

[michala]

update: 

 

didn’t sleep much if at all last night. kept gasping for air while i was still awake trying to fall asleep. heart would race for 5 seconds then slow down and body would feel like it went numb. felt like half of my brain was wide awake and the other half was off. crazy hypnagogic hallucinations. would fall asleep and wake up several minutes later agitated and suicidal. don’t know more much more of this i can take. 

[michala]

none of this happened before the antibiotics. i feel like i kindled myself because i looked up interactions between seroquel and amoxicillin and found this: 

Amoxicillin may decrease the excretion rate of Quetiapine which could result in a higher serum level.

@Altostrata what do you think?

[michala]

@Altostrata is reinstatement of saphris still an option? i can’t continue to go on like this. i’m so scared and don’t feel safe. i don’t feel like i’ll make it another day

[Altostrata]

22 hours ago, michala said:

the anxiety usually goes away after about an hour and a half after i take my dose

 

This indicates the Seroquel is helping your withdrawal symptoms.

 

The way I interpret your symptom pattern: 1) 300mg at once Is too high a dose for you and causing adverse paradoxical effects shortly after you take it; 2) when 300mg Seroquel wears off a little, the paradoxical reaction relaxes and you feel better; 3) after the immediate-release Seroquel is metabolized overnight, you feel the withdrawal symptoms again.

 

Adverse reactions from the antibiotic are a wild card that may be adding to your symptom pattern. However, you are taking what appears to be an excessive dosage of Seroquel for sleep.

 

Splitting the Seroquel dose might relieve the paradoxical reaction at night because the dose would be lower, while taking a portion in the morning might help relieve the withdrawal symptoms until your nighttime dose. You can then start tapering the nighttime dose.

 

Switching back to Saphris brings in additional risk in that 1) you might experience withdrawal from Seroquel; 2) it may be difficult to figure out dose to replace the Seroquel; 3) while experimenting with the Saphris dose, you may experience your pre-existing withdrawal symptoms, new withdrawal symptoms, or adverse effects from Saphris.

 

It would be better to stick with Seroquel now. The immediate-release version comes in a range of dosages that will better enable dosage adjustment and tapering.

 

Your psychiatrist sounds like a fool. Any doctor can prescribe these drugs. If your GP is sympathetic to helping you minimize your drugs, there's no reason to keep the psychiatrist on your payroll. 

[michala]

12 minutes ago, Altostrata said:

Switching back to Saphris brings in additional risk in that 1) you might experience withdrawal from Seroquel; 2) it may be difficult to figure out dose to replace the Seroquel; 3) while experimenting with the Saphris dose, you may experience your pre-existing withdrawal symptoms, new withdrawal symptoms, or adverse effects from Saphris.

i was on saphris and seroquel at the same time. i was wondering if reinstating a micro dose of saphris along with the seroquel would be a bad idea? 

 

1 hour ago, michala said:

update: 

 

didn’t sleep much if at all last night. kept gasping for air while i was still awake trying to fall asleep. heart would race for 5 seconds then slow down and body would feel like it went numb. felt like half of my brain was wide awake and the other half was off. crazy hypnagogic hallucinations. would fall asleep and wake up several minutes later agitated and suicidal. don’t know more much more of this i can take. 

i don’t know if you saw this post but my sleep last night was horrible. i never experienced problems like this until the amoxicillin. my symptoms are morphing and changing so often it’s scary. 

[michala]

@Altostrata sorry i keep forgetting to tag you. 

[michala]

@Altostrata i don’t know if you saw my post above but my symptoms are severe. would reinstatement of saphris along with seroquel be a bad idea? i am struggling severely. i can’t put into words how bad off i am

[Altostrata]

You can expect your symptom pattern to be rocky as you slowly recover from the antibiotic. Plus, you seem to be having adverse effects from the amount of Seroquel you're taking. Please re-read 

 

[Elaine5]

How are you doing? 

[michala]

 i know i haven’t been on here in quite a while, i had to take time away to really focus on my recovery and i will say that a lot of things happened but i have been doing so much better… until today. 

 

i was diagnosed with covid today and was prescribed paxlovid as i am high risk. the problem is, i am still on 300 mg seroquel and there is a moderate interaction. doc wants me to drop to 50mg for 5 days while taking paxlovid, then go back up to 300 on the 6th day.

is this playing with fire? i cannot afford to get too sick, last time i had covid i ended up in the hospital…

any input is greatly appreciated

@Altostrata

[Altostrata]

From what I can tell, your doctor is correct. (For Europe, Pfizer says the administration of Paxlovid and quetiapine together is contraindicated.)

 

You will have to decide if you want to risk withdrawal from quetiapine if you reduce it so you can take Paxlovid. I would not take the 2 drugs together at the same time, that could cause even more problems.