Seroquel dose for sleep

Announcement

I also take quetiapine. I’ve been taking various doses on and off for many years. I first started taking it as a sleep aid since the medication I was taking at the time caused insomnia and I started getting delusional from lack of sleep. I’ve also taken it as a kind of “booster” for other meds (at higher doses).
I also used to take clonazepam for anxiety. I took it during the day, it made me a little drowsy and made concentrating even harder. I’ve since switched to alprazolam, which doesn’t cause me any drowsiness. But I still take quetiapine. It’s the last medication that I take at night, an hour or two before bedtime. I find the effects a little…. haphazard. Some days it’ll knock me asleep in no time (whether I’m ready or not). Other days it takes longer. Sometimes I don’t really feel tired until I get into bed.
But, for some strange reason, it’s the only prescription that, over the years, I’ve reduced the dose and stopped without consulting my doctor. I need it to sleep. If I don’t take it I don’t sleep through the night. When I start taking it (low dose)I start to dream (vivid nightmares), as I get used it, it gets easier and better. But then one day I’ll decide that it’s getting too difficult to wake up with a clear head, or I’ll get depressed about the sheer amount of pills in my palm, and stop taking my quetiapine. But I always come back to it.
It’s always tricky, this balancing act we play with our medication. But the best advice about dosage, side effects and whatnot is to talk with your pharmacist. My pharmacist has helped me through tricky dosage changes and medication switches. So, try a few things that you’re comfortable trying (as you said, taking one med later/after the other). And just know that your pharmacist is always a great source of information about these things. I hope you figure it out without too much difficulty.
The side effects you described (fatigue, blurred vision) are the same ones I feel. If I fight them and try to stay up they get worse. So I would recommend taking the quetiapine much later than dinnertime. Try it an hour or two before bedtime.


Quetiapine (Seroquel® and generics) has been available in Canada since 1998. It is approved for schizophrenia, bipolar disorder and, as of 2010, for major depressive disorder (MDD) refractory to treatment with antidepressants.1 It is widely prescribed in low doses for management of sleep disorders, despite lacking approval for this use.2

In 2010 almost $20 million was spent on quetiapine in British Columbia, placing it 21st in cost, ahead of pantoprazole and amlodipine. At almost 1 million prescriptions, quetiapine was the 9th most frequently prescribed drug in B.C., leading rabeprazole and citalopram and close behind zopiclone and metformin. Given the wide range of drugs available for psychosis and mood disorders, these indications likely account for a minority of quetiapine’s use in 2010. This is supported by the fact that 58% of B.C. quetiapine prescriptions were for the 25 mg tablet, whereas the recommended dose range for the approved disorders is 150 to 800 mg/day. Similarly in the United States, up to 70% of newer antipsychotic prescribing is for conditions other than psychosis.3

This letter examines efficacy and safety evidence about use of low dose quetiapine for sleep disorders.

What is quetiapine?

Quetiapine is a dibenzothiazapine derivative which antagonizes multiple receptors, including serotonin (5HT1A and 5HT2), dopamine (D1 and D2), histamine H1 and adrenergic alpha 1 and alpha 2 receptors, but the mechanism of action for any use is unknown. At least one metabolite, norquetiapine, may also be pharmacologically active, including antagonism of muscarinic M1 receptors (anti-cholinergic).1

Pharmacokinetics and cost

Quetiapine is eliminated by metabolism in the liver with average half-life of 6-7 hours. This is prolonged in people > 65 years. Norquetiapine is present at lower concentrations, but has a longer half-life.1 Quetiapine 25 to 50 mg daily costs $0.32-$0.64 per day in B.C.

Evidence for use in primary insomnia

Two published randomized controlled trials evaluated quetiapine’s effect on sleep in patients not suffering from other medical conditions or psychiatric illness.4,5 Only one studied patients suffering from primary insomnia5; the other was in healthy subjects without insomnia4.

The healthy subject study evaluated 14 males using a randomized, double-blind, crossover, placebo-controlled, single-center design. Placebo or quetiapine at 25 and 100 mg doses were given on 3 consecutive nights with a 4-day washout period before crossover. Polysomnographic recordings were made nightly and subjective sleep-rating questionnaires completed each morning. Both doses of quetiapine produced statistically significant improvements in objective and subjective ratings of sleep, including total sleep time, sleep efficiency, sleep latency and duration of stage 2 sleep. The 100 mg dose increased periodic leg movements and decreased REM sleep. Two out of 14 subjects taking quetiapine withdrew from the study because of symptomatic orthostatic hypotension.4

In the primary insomnia study, 25 patients were randomized to quetiapine 25 mg or placebo. Patients were asked to record a sleep diary for one week before and two weeks after initiation of treatment. No statistically significant improvements were found in the primary outcomes of total sleep time, sleep latency, daytime alertness and sleep satisfaction.5

Potential adverse effects

Very few data are available concerning adverse effects of low dose quetiapine. Two out of 14 healthy males using 25 or 100 mg withdrew due to orthostatic hypotension during short-term use. Extrapyramidal symptoms, including dystonia, akathisia, and tardive dyskinesia have been associated with quetiapine with both high and low dose regimens.1 A recent case report describes two patients on low dose quetiapine for insomnia who discontinued the drug due to akathisia.6 Two out of 13 patients discontinued quetiapine due to exacerbation of restless leg symptoms in an open-label trial of low dose quetiapine for insomnia in Parkinson’s disease.7

Most adverse effects observed with quetiapine have been reported during high dose treatment (150 to 800 mg daily) of bipolar mania or schizophrenia. Common side effects at high doses include weight gain, somnolence, increased cholesterol and triglyceride levels, insulin resistance, dry mouth, dizziness, and orthostatic hypotension. Life-threatening adverse events are rare with high dose quetiapine, but include neuroleptic malignant syndrome and neutropenia.1 One small double-blind RCT found that quetiapine worsened cognitive decline in dementia.8 Quetiapine increases mortality in elderly demented patients (ARI=2.3%) and as a result has a “black box” warning in the US similar to other antipsychotic drugs.1 Quetiapine is also known to have abuse potential.9,10,11,12,13

Does the evidence warrant use of quetiapine for insomnia?

The two small trials described above do not provide sufficient evidence to justify prescribing quetiapine for insomnia. A recent review reached similar conclusions.14 Two general reviews of primary insomnia also conclude that antipsychotics are not a recommended treatment.15,16 Widespread use of quetiapine as a sleep aid is occurring in the absence of evidence for effectiveness or safety.2

Why is this happening? Benzodiazepine and non-benzodiazepine hypnotics such as the “z-drugs” (e.g. zopiclone) are the short-term drug treatment of choice for insomnia. However, their use has been constrained by their adverse effects, the rapid development of tolerance, withdrawal effects, and the potential for dependence and abuse.17,18,19 The adverse effects of low dose quetiapine are largely unknown. Case reports suggest that akathisia and other extrapyramidal symptoms, periodic leg movements, restless leg syndrome and orthostatic hypotension may be of concern. It is unknown whether weight gain and metabolic changes may complicate chronic low dose use.

A large double-blind RCT comparing quetiapine with benzodiazepines or “z-drugs” is needed to evaluate the short-term efficacy of quetiapine for primary insomnia with a primary outcome of improved sleep measures documented in a sleep laboratory. In addition long-term effectiveness needs to be studied in RCTs in patients taking such drugs over at least one year, either daily or intermittently. This is necessary to establish whether the benefits outweigh the harms for long-term use and properly elucidate the incidence of adverse effects, withdrawal symptoms and potential for abuse.

Conclusions

  • Quetiapine is not approved nor recommended for primary insomnia.
  • Quetiapine is commonly prescribed off-label as a sleep aid, but only one RCT examined its use in patients with insomnia. It found no benefit.
  • No published RCT evidence exists comparing quetiapine with other drugs for insomnia.
  • Management of primary insomnia should focus on education and encouragement of appropriate sleep habits. Drugs should be limited to short duration, intermittent use, or daily use only in exceptional cases.

The draft of this Therapeutics Letter was submitted for review to 65 experts and primary care physicians in order to correct any inaccuracies and to ensure that the information is concise and relevant to clinicians.

Seroquel (Quetiapine) Overdose: Risks & Withdrawal Timeline

Symptoms and Signs of a Seroquel/Quetiapine Overdose

  • As compared to other antipsychotic medications, Seroquel is relatively safe in terms of overdose, according to a report published in the Indian Journal of Psychiatry. This means that even if overdose does occur, the risks may not be as high to the patient as they would be in the case of other antipsychotic medications.
  • The researchers cite a case study in which one woman attempted suicide with a 1400 milligram dose of Seroquel. She experienced extreme drowsiness and irregular heartbeat, but after gastric lavage, an anxiety medication given via IV, and 14 hours of medical supervision, she was released.1
  • Cases of Seroquel overdose do not always end so positively, however. A toxic dose of quetiapine may result in symptoms that, when not managed by immediately by medical professionals (as described in the situation above), may put the individual at severe risk.

Signs of a Seroquel overdose

Immediate emergency medical care is necessary in the case of a Seroquel overdose. Medical providers will manage your airway and ensure adequate ventilation. IV fluids may be needed to counter hypotension and circulatory collapse. Cardiac monitoring may be used to detect any aberrant heart rhythms, and appropriate antiarrhythmic medications may need to be administered. Gastric lavage (commonly called “stomach pumping”) and activated charcoal may be started in an attempt at removing any additional medication remaining in your upper GI tractI.2

May include:2

  • Seizures.
  • Profound drowsiness/sedation.
  • Drop in blood pressure/orthostatic hypertension.
  • Dizziness/fainting/loss of consciousness.
  • Rapid heart rate.
  • QT prolongation/arrhythmias (irregular heart rhythms).
  • Coma.
  • Death.

Seroquel Withdrawal Timelines

The timeline along which the symptoms of Seroquel withdrawal will develop will also vary significantly from person to person based on the same issues that impact the type of withdrawal symptoms experienced.

For example, some may experience minimal withdrawal symptoms for a week or two after they stop taking a low dose of Seroquel. With higher doses, the withdrawal syndrome may be more severe. Tapering the dose slowly under the care of a physician can alleviate withdrawal distress.4

Seroquel withdrawal symptoms may include:3

  • Headaches.
  • Insomnia.
  • Dizziness.
  • Irritability.
  • Nausea and vomiting.
  • Diarrhea.

Regular Seroquel use for an extended period of time is associated with a discontinuation syndrome. Should it be determined that use of the medication is no longer the best choice for treatment, cessation of use should be monitored by a physician. Abruptly stopping ingestion of Seroquel when there is physical dependence can trigger withdrawal symptoms.

These symptoms may vary depending on the regular dose being used, how long the person has been taking the drug, the other medications in current use and/or being stopped at the same time, and could be additionally influenced by the symptoms of the underlying mental health disorder being treated.

Frequently asked questions on Seroquel

  • How long does it take for Seroquel to get out of your system?
    It may vary depending on the regular dose being used, how long the person has been taking the drug.
  • How do you stop withdrawals from Seroquel?
    Some may experience minimal withdrawal symptoms for a week or two after they stop taking a low dose of Seroquel. With higher doses, the withdrawal syndrome may be more severe.
  • What happens if you suddenly stop taking Seroquel?
    Abruptly stopping ingestion of Seroquel when there is physical dependence can trigger withdrawal symptoms.
  • Do Seroquel side effects go away?
    Some may experience withdrawal symptoms for a week or two

Sources:

As Seroquel can, in rare cases, cause serious heart rhythm disturbances that can lead to a cardiac arrest, he sends patients for an electrocardiogram before prescribing it.

He has an explanation of how anti-psychotics leaked into general practice.

“In psychiatry, we see people having a very difficult time with disordered sleeping patterns and in desperation sometimes we use anti-psychotic medication – not because they are psychotic – but

“We try to normalise their sleep to help get some order back in their lives. Then we send them back to their GPs who are impressed at how well the anti-psychotic medication works and think they’ll try

Typically, a patient will arrive at the GP complaining they can’t sleep. Pressed for time, the GP often recommends a drug.

That there is no time to take a comprehensive history is compounded by the fact that the medical education doctors receive about sleeping pills is patchy.

Blackwell says most are not particularly aware of how these pills work, why they work in some and not others and whether a particular sleeping problem is masking something else.

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Many GPs have become weary of prescribing benzodiazepines, such as Normison, because they worry about dependence, increasing use and possible addiction.

Many patients are weary of taking the so called Z drugs, such as Stilnox (Zolpidem) because there has been much negative press linking them to erratic behaviour.

So low dose, anti-psychotics seem a good alternative although there is a possibility of psychological dependence.

Hang-over effect

A person who has taken a significant dose of Seroquel and who has not taken other drugs that interact with it, may have to wait almost to lunchtime before the drug is out of their system, says

“They will still manage over-learnt, routine tasks but their executive function will be compromised. They won’t be able to bring their full cognitive capacity on-line to make the best decisions.”

“In short, these drugs are not a substitute for effective sleep health and lifestyle management.”

Nicholas Glozier, consultant psychiatrist and Professor of Psychological Medicine at Neurosleep, and the Brain and Mind Research Institute, Sydney Medical School, says Seroquel is now the ‘go to’

The drug is known to have negative effects on metabolism, which is a concern for people, without mental illness, taking it. He says many are at the time of life where they are prone to diabetes and cardio-metabolic problems and are taking a medication that raises the risk of that happening.

Seroquel: 7 things you should know

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

  • Confusion, headache, drowsiness, agitation, constipation, weight gain, dry mouth and blurred vision.
  • Sedation – which may affect your ability to drive or operate machinery. Avoid alcohol.
  • May cause a lowering of blood pressure – this may be particularly noticeable when going from a sitting to standing position and may increase the risk of falls. Seroquel may also increase blood pressure in some people.
  • Should not be used in seniors with dementia-related psychosis because it increases their risk of death.
  • Interaction or overdosage may cause serotonin syndrome (symptoms include mental status changes , fast heart rate, dizziness, flushing, muscle tremor or rigidity and stomach symptoms ). Another serious syndrome called Neuroleptic Malignant Syndrome (NMS) has also been reported; symptoms include high body temperature, muscle rigidity, and mental disturbances; discontinue Seroquel immediately and seek urgent medical advice if symptoms of NMS develop.
  • May increase the risk of bleeding, especially if used with other drugs that also increase bleeding risk.
  • May also cause anxiety, nervousness or insomnia. There is a risk of tardive dyskinesia (uncontrollable, repetitive, facial movements) associated with all antipsychotics, including Seroquel.
  • Significant weight loss has been reported, although may cause weight gain in some people.
  • May precipitate a manic episode in people with undiagnosed bipolar disorder.
  • May cause lowering of total body sodium (hyponatremia); elderly people or people taking diuretics or already dehydrated may be more at risk.
  • May cause a discontinuation syndrome if abruptly stopped; symptoms include irritability, low mood, dizziness, electric shock sensations, headache and confusion.
  • High blood sugar levels that may lead to the development of diabetes and elevations in cholesterol or triglyceride levels have been reported. Hypothyroidism (low thyroid levels) associated with Seroquel use may also occur.
  • As with similar medications, Seroquel may increase the risk of suicidal thoughts or behavior in young adults; risk is higher in those aged less than 25.
  • The extended-release form of Seroquel should not be given to anyone younger than 18 years.

Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, .

Quetiapine, Oral Tablet

All possible dosages and drug forms may not be included here. Your dosage, drug form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • the severity of your condition
  • other medical conditions you have
  • how you react to the first dose

Drug forms and strengths

Generic: Quetiapine

Brand: Seroquel

  • Form: immediate-release oral tablet
  • Strengths: 25 mg, 50 mg, 100 mg, 200 mg, 300 mg, and 400 mg

Brand: Seroquel XR

  • Form: extended-release oral tablet
  • Strengths: 50 mg, 150 mg, 200 mg, 300 mg, and 400 mg

Dosage for schizophrenia

Adult dosage (ages 18–64 years)

Immediate-release tablets

  • Typical starting dosage:
    • Day 1: 25 mg twice daily.
    • Days 2 and 3: Your doctor will increase your dose by 25–50 mg. The total dosage should be taken two or three times daily.
    • Day 4: 300–400 mg daily, taken in 2 or 3 divided doses.
  • Dosage increases:
    • Your doctor may further increase your dosage not more often than every two days. The increase would be 25–50 mg added to your previous dosage. The total dosage would be taken twice daily.
    • The recommended dosage range is 150–750 mg per day.
  • Maintenance dosage: Your doctor may keep you on this medication to help control symptoms on an ongoing basis. The dosage range for maintenance use is 400–800 mg per day, taken in 2 or 3 divided doses.
  • Maximum dosage: 800 mg per day, taken in 2 or 3 divided doses.

Extended-release tablets

  • Typical starting dosage: 300 mg once per day.
  • Dosage increases: Your doctor may increase your dosage every day by no more than 300 mg once per day. The recommended dosage range is 400–800 mg once per day.
  • Maximum dosage: 800 mg per day.

Senior dosage (ages 65 years and older)

Your doctor may start you on a lowered dosage or a different dosing schedule. This can help keep levels of this drug from building up too much in your body. Your doctor may start you at a dosage of 50 mg daily. They may later increase it, adding 50 mg to your daily dose. The dosage may be increased at a slower rate, and a lower total daily dose may be used to lessen the risk of side effects.

Child dosage (ages 0–17 years)

SCHIZOPHRENIA EPISODES

Child dosage (ages 13–17 years)

Immediate-release tablets

  • Typical starting dosage:
    • Day 1: 25 mg twice daily.
    • Day 2: 100 mg per day, taken in divided doses twice daily.
    • Day 3: 200 mg per day, taken in divided doses twice daily.
    • Day 4: 300 mg per day, taken in divided doses twice daily.
    • Day 5: 400 mg per day, taken in divided doses twice daily.
  • Dosage increases: Your doctor may further increase your child’s dosage by no more than 100 mg per day. The recommended dosage range is 400–800 mg per day, taken in 2 or 3 divided doses.
  • Maximum dosage: 800 mg per day, taken in 2 or 3 divided doses.

Extended-release tablets

Typical starting dosage:

    • Day 1: 50 mg once daily.
    • Day 2: 100 mg once daily.
    • Day 3: 200 mg once daily.
    • Day 4: 300 mg once daily.
    • Day 5: 400 mg once daily.
  • Dosage increases: Your doctor may further increase your child’s dosage within the recommended dosage range of 400–800 mg once per day.
  • Maximum dosage: 800 mg once per day.

Child dosage (ages 0–12 years)

It has not been confirmed that quetiapine is safe and effective to use for this purpose in children younger than 13 years.

SCHIZOPHRENIA MAINTENANCE

Child dosage (ages 0–17 years)

This medication has not been studied in children to use for this purpose. It should not be used in children younger than 18 years.

Dosage for bipolar I disorder (manic or mixed episodes)

Adult dosage (ages 18–64 years)

Immediate-release tablets

  • Typical starting dosage:
    • Day 1: 100 mg per day, taken in divided doses twice daily.
    • Day 2: 200 mg per day, taken in divided doses twice daily.
    • Day 3: 300 mg per day, taken in divided doses twice daily.
    • Day 4: 400 mg per day, taken in divided doses twice daily.
  • Dosage increases: Your doctor may further increase your dosage by no more than 200 mg per day.
  • Maintenance dosage: Your doctor may keep you on this medication to help control symptoms on an ongoing basis. The dosage range for maintenance use is 400–800 mg per day, taken in 2 or 3 divided doses.
  • Maximum dosage: 800 mg per day, taken in 2 or 3 divided doses.

Extended-release tablets

  • Typical starting dosage:
    • Day 1: 300 mg once per day.
    • Day 2: 600 mg once per day.
    • Day 3: 400–800 mg once per day.
  • Dosage increases: Your doctor may change your dosage within the recommended range of 400–800 mg once per day.
  • Maximum dosage: 800 mg once per day.

Senior dosage (ages 65 years and older)

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body. Your doctor may start you at a dosage of 50 mg daily. They may later increase it, adding 50 mg to your daily dose. The dosage may be increased at a slower rate, and a lower total daily dose may be used to lessen the risk of side effects.

Child dosage (ages 10–17 years)

Immediate-release tablets

  • Typical starting dosage:
    • Day 1: 25 mg twice daily.
    • Day 2: 100 mg per day, taken in divided doses twice daily.
    • Day 3: 200 mg per day, taken in divided doses twice daily.
    • Day 4: 300 mg per day, taken in divided doses twice daily.
    • Day 5: 400 mg per day, taken in divided doses twice daily.
  • Dosage increases: Your doctor may further increase your dose by no more than 100 mg per day. The recommended dosage range is 400–600 mg per day taken in divided doses up to three times daily.
  • Maximum dosage: 600 mg per day in 2 or 3 divided doses.

Extended-release tablets

  • Typical starting dosage:
    • Day 1: 50 mg once per day.
    • Day 2: 100 mg once per day.
    • Day 3: 200 mg once per day.
    • Day 4: 300 mg once per day.
    • Day 5: 400 mg once per day.
  • Dosage increases: Your doctor may change your dose, within the recommended dosage range of 400–600 mg once per day.
  • Maximum dosage: 600 mg once per day.

Child dosage (ages 0–9 years)

It hasn’t been confirmed that quetiapine is safe and effective to use for this purpose in children younger than 10 years.

Dosage for bipolar I disorder (maintenance)

Child dosage (ages 0–17 years)

It hasn’t been confirmed that quetiapine is safe and effective to use for this purpose in children younger than 18 years.

Dosage for bipolar disorder (depressive episodes)

Adult dosage (ages 18–64 years)

Immediate-release tablets

  • Typical starting dosage:
    • Day 1: 50 mg daily, taken at bedtime.
    • Day 2: 100 mg daily, taken at bedtime.
    • Day 3: 200 mg daily, taken at bedtime.
    • Day 4: 300 mg daily, taken at bedtime.
  • Maximum dosage: 300 mg daily, taken at bedtime.

Extended-release tablets

  • Typical starting dosage:
    • Day 1: 50 mg once daily at bedtime.
    • Day 2: 100 mg once daily at bedtime.
    • Day 3: 200 mg once daily at bedtime.
    • Day 4: 300 mg once daily at bedtime.
  • Maximum dosage: 300 mg once daily at bedtime.

Senior dosage (ages 65 years and older)

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body. Your doctor may start you at a dosage of 50 mg daily. They may later increase it, adding 50 mg to your daily dose. The dosage may be increased at a slower rate, and a lower total daily dose may be used to lessen the risk of side effects.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that quetiapine is safe and effective to use for this purpose in children younger than 18 years.

Dosage for major depression in people already taking antidepressants

Extended-release tablets

Adult dosage (ages 18–64 years)

  • Typical starting dosage:
    • Days 1 and 2: 50 mg once daily.
    • Day 3: 150 mg once daily.
  • Dosage increases: Your doctor may change your dosage, within the recommended range of 150–300 mg once per day.
  • Maximum dosage: 300 mg once daily.

Senior dosage (ages 65 years and older)

Your doctor may start you on a lowered dose or a different dosing schedule. This can help keep levels of this drug from building up too much in your body. Your doctor may start you at a dosage of 50 mg daily. They may later increase it, adding 50 mg to your daily dose. The dosage may be increased at a slower rate, and a lower total daily dose may be used to lessen the risk of side effects.

Child dosage (ages 0–17 years)

It hasn’t been confirmed that quetiapine is safe and effective to use for this purpose in children younger than 18 years.

Special dosage considerations

  • For people with liver disease: Your doctor should start your dosage at 25 mg daily. This dosage may be increased by 25–50 mg daily.
  • Use with drugs called CYP3A4 inhibitors: Quetiapine dosage should be decreased to one-sixth of the original dosage when given with certain drugs called CYP3A4 inhibitors. Ask your doctor or pharmacist if you’re taking a CYP3A4 inhibitor. Examples of these drugs include ketoconazole, itraconazole, indinavir, ritonavir, or nefazodone. When the CYP3A4 inhibitor is stopped, the dose of quetiapine should be increased by 6 times the previous dose.
  • Use with drugs called CYP3A4 inducers: Quetiapine dose should be increased by five times the original dose when given with certain drugs called CYP3A4 inducers. Ask your doctor or pharmacist if you’re taking a CYP3A4 inducer. Examples of these drugs include phenytoin, carbamazepine, rifampin, or St. John’s wort. When the CYP3A4 inducer is stopped, the dose of quetiapine should be reduced to the original dose within 7–14 days.

Dosage warnings

If you have stopped quetiapine for more than one week, you’ll need to be restarted at a lower dosage. The dosage will then need to be increased according to the dosage schedule from when you first started the medication.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

▪️ The quetiapine dose prescribed will depend on the condition being treated and will be personalized for each individual. Quetiapine is usually started on a low dose and increased gradually over the first few days. These instructions should be printed on the medication label.

▪️ If you’ve been prescribed immediate-release (standard) quetiapine tablets for schizophrenia or a manic episode, these are usually taken twice a day. If you’ve been prescribed them for depression in bipolar disorder, they are taken once a day at bedtime.

▪️ If you’ve been prescribed modified-release quetiapine tablets (these have XL after the brand name, for example Seroquel XL) these are taken once a day. They are designed to release the quetiapine slowly and continuously as the tablet passes through your gut, to help provide a steady blood level of the medicine throughout the day. Quetiapine XL tablets should be swallowed whole and not broken, crushed or chewed, as this would damage their modified-release action. Take your daily dose of quetiapine XL at the same time each day. If you’re taking it to treat depression your dose should be taken at bedtime.

Should I take quetiapine with or without food?

▪️ Immediate-release quetiapine tablets can be taken either with or without food, on a full or empty stomach.

▪️ Modified-release quetiapine tablets should be taken without food, at least one hour before a meal or two hours after a meal.

What should I do if I miss a quetiapine dose?

▪️ Try to always take your quetiapine at the same time(s) each day, as part of your regular daily routine – this will help you remember to take it.

▪️ If you forget to take a dose of quetiapine at your usual time, take it as soon as you remember – unless it’s nearly time for your next dose. In this case just leave out the missed dose and take your next dose as usual. Do not take a double dose to make up for a missed dose.

How long do I need to take quetiapine for?

▪️ You need to keep taking quetiapine every day, even if you feel better and think you don’t need it any more, unless you’re advised to stop taking it by your doctor.

▪️ Treatment with quetiapine is usually needed on a long-term basis, unless it doesn’t work for you or you get unacceptable side effects. It controls the symptoms of the illness but doesn’t actually cure it. This means that if you suddenly stop taking quetiapine you could relapse.

▪️ If you’re taking quetiapine to control a manic or depressive episode, the length of time you need to keep taking it after the episode is controlled depends on your individual circumstances, and whether your doctor wants you to keep taking it long-term as a mood stabiliser.

▪️ If and when treatment is stopped this shouldn’t be done suddenly, because this has the potential to cause a relapse or withdrawal symptoms, such as nausea, vomiting, difficulty sleeping, headache, diarrhoea, dizziness and irritability. If treatment with quetiapine is going to be stopped, this should be done gradually. Always follow the instructions given by your doctor.

How long does quetiapine take to work?

▪️ It can take a few weeks of taking quetiapine for it to build up to its full effect, but some people find it starts to help within the first week. Your doctor will want to check on your progress during this time and may want to increase your dose if they think it’s necessary. It’s important to keep taking it as prescribed, even if you think it’s not helping to begin with. If you feel your symptoms (particularly depression) have got worse, or if you have any distressing thoughts or feelings about suicide or harming yourself in these first few weeks, or indeed at any point during treatment or after stopping treatment, then it is very important to talk to your doctor.

▪️ Treatment with quetiapine is usually long-term and it’s important to keep taking it every day, as directed by your doctor, even once you start to feel better. Stopping treatment can lead to a relapse, so you should only stop taking the medicine if your doctor recommends this.

Read more about quetiapine

  • What is quetiapine used for and how does it work?
  • What should I know before taking quetiapine?
  • What are the possible side effects of quetiapine?
  • Can I take other medicines with quetiapine?

Last updated: 20.05.2019

Rita Ghelani (BPharm, MRPharmS) Pharmacist A UK registered practising pharmacist with over 20 years’ experience, Rita is a member of the medical journalists’ association (MJA) and has a wealth of experience in community pharmacy.

What is Seroquel and should you take it for insomnia?

The evidence so far suggests off-label prescribing for insomnia places users at unnecessary risk of harm. Credit: Flavio Ronco/Flickr, CC BY-NC-ND

Quetiapine, sold under the brand name Seroquel, is a short-acting antipsychotic drug. It’s used to treat schizophrenia, bipolar I disorder and as an add-on treatment for major depression and generalised anxiety disorder in people who haven’t responded to other therapies. The recommended dose range for these conditions is 200-800mg a day.

Off-label prescribing is when a drug is prescribed for uses outside those for which it has been licensed. It’s relatively common in psychiatry and may help patients who haven’t responded to standard treatments. But due to the lack of evidence for the safety and efficacy of off-label uses, there is a potential for harm.

Doctors prescribe quetiapine off-label for various conditions, including anxiety, autism, post-traumatic stress disorder, substance abuse and obsessive compulsive disorder. It is also increasingly prescribed off-label for insomnia, usually at lower doses of 100mg or less a day.

But the evidence so far suggests the risks of prescribing quetiapine off-label outweigh any benefits.

Rise in use

Since quetiapine came onto the market in 1997, prescription rates have skyrocketed, especially in the United States, where it became the fifth-biggest-selling pharmaceutical in 2010.

Prescriptions for quetiapine also increased significantly in Australia between 2000 and 2011.

Patients switching from another antipsychotic to quetiapine cannot account for these changes; the rise is most likely due to off-label prescribing.

In fact, drug company AstraZeneca paid US$520 million in 2010 to resolve allegations the company illegally marketed Seroquel for uses not approved by the US Food and Drug Administration (FDA).

Antipsychotic drugs

All antipsychotic drugs – both first generation, which were developed in the 1950s, and second generation, developed since the 1950s – exert their effect mainly by blocking dopamine transmission in various parts of the brain. They block dopamine D2 receptors, which alleviates symptoms of psychosis such as hallucinations, delusions and thought disorder.

Other receptors may also be blocked. However, these blockages may cause serious side effects.

Quetiapine is sold under the brand name Seroquel. Credit: hopeless128/Flickr, CC BY-NC-ND

Quetiapine is a second-generation antipsychotic drug that also blocks histamine H1 and serotonin type 2A receptors. This is thought to account for its sedative properties, which is why it’s used off-label for insomnia.

Antipsychotic drugs, especially first-generation antipsychotics such as haloperidol, fluphenazine and trifluoperazine, can be associated with some serious side effects, such as the neurological disorder tardive dyskinesia. This involves involuntary movements of the face, tongue and mouth and, less commonly, the limbs, head, neck and trunk. In some cases, tardive dyskinesia may be irreversible.

All antipsychotic drugs can also cause neuroleptic malignant syndrome, a neurological disorder which can progress rapidly over 24 to 72 hours. Neuroleptic malignant syndrome can cause instability, altered consciousness, muscle rigidity and even death. The incidence is greatest in young men.

Both first- and second-generation antipsychotics have been reported to contribute to heart arrhythmia, where the electrical impluses co-ordinating your heartbeats malfunction. In a recent large cohort study, researchers reported that antipsychotic drugs, including quetiapine, almost doubled the risk of sudden death from a heart attack.

Quetiapine has fewer side effects than first-generation antipsychotics. But recent research and clinical trials have reported considerable risk of metabolic side effects. These include weight gain, elevation of cholesterol and triglycerides, and diabetes, even when prescribed at recommended doses.

Quetiapine as a sleeping drug

Studies on the use of quetiapine for sedation have produced conflicting results.

A very small randomised placebo-controlled study, funded by AstraZeneca (manufacturer of quetiapine) and involving 14 healthy subjects, reported that, compared to placebo, both 25mg and 100mg quetiapine administered at night increased the sleep quality and the amount of sleep.

Another independent study conducted in Thailand did not support these findings. Researchers tested the drug in a randomised two-week controlled trial (where one group received the drug and another received a placebo). They found 25mg quetiapine at night for primary insomnia did not improve sleep.

Quetiapine can cause significant weight gain, even when used in small to moderate doses for sleep. It has also been associated with increased blood glucose (sugar) and dyslipidaemia (an imbalance of fats circulating in the blood). These increase the risk of developing type 2 diabetes and heart disease.

In a retrospective study in the United Kingdom, 43 psychiatric patients aged 19 to 65 years were prescribed low-dose quetiapine for insomnia, usually 100mg at bedtime. Over the 11-month study period, their weight increased by an average of 2.22kg.

Despite the safety concerns associated with using quetiapine as an antipsychotic, the risks may be acceptable when treating patients with serious mental illness, given there are few alternatives.

But the evidence so far suggests prescribing quetiapine off-label for people who have problems sleeping places them at unnecessary risk of harm.

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Unusual combo reduces health risk from atypical antipsychotic Provided by The Conversation

This article was originally published on The Conversation. Read the original article.

Citation: What is Seroquel and should you take it for insomnia? (2017, August 29) retrieved 2 February 2020 from https://medicalxpress.com/news/2017-08-seroquel-insomnia.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.

Seroquel, Atypical Antipsychotics for Insomnia, Dementia?

Being overweight is a serious health problem long-term. It can lead to all sorts of additional health concerns and puts you at greater risk for more diseases other than just diabetes. Efforts to add another medication to Seroquel to help with the weight gain (such as metformin) don’t help much. And while type 2 diabetes could be reversed in some people, it’s not something you want to be facing just to get a good night’s sleep.

Seroquel: Just Use Common Sense

Too many doctors prescribe way too many drugs for off-label uses. That’s their prerogative. But as an empowered patient, it’s important that you understand when you’re being prescribed a medication that’s not been formally approved for that use. That usually means there’s a set of reasons — scientific, money, marketing — that it’s not been approved for that use that should be taken into consideration when deciding whether to take it, or to instead ask your doctor for some other options.

Seroquel, like Prozac before it, is not a cure-all. It cannot solve all the behavioral, sleep, or memory problems physicians think it can. Doctors should become far more skeptical of such off-label uses, and remember that just because a single small study comes out showing it could be used for other condition doesn’t usually mean it should be (at least not without careful consideration and monitoring). Small studies rarely demonstrate real clinical efficacy until replicated, and are usually silent about the severity of adverse side effects in a larger, diverse population.

In short, doctors and their patients need to start using common sense when it comes to prescription medications like Seroquel. It’s not a sleep medication, and should generally not be prescribed just for insomnia or dementia.

Read the original article: Popular drug Seroquel, first meant for schizophrenia, reveals ‘off-label’ issues

Seroquel, Atypical Antipsychotics for Insomnia, Dementia?

24-Year-Old Man Died Suddenly From Taking Painkiller With Anxiety Medicine, Father Says

One of those doctors was Richard DeWorsop, a now-retired psychiatrist in Toms River, New Jersey. In a phone interview, he couldn’t recall any AstraZeneca representatives mentioning the risk of possible death from Seroquel interacting with methadone.

DeWorsop wrote 107 new Seroquel XR prescriptions in that period and received 488 samples, according to the lawsuit.

“They didn’t caution us about that,” DeWorsop said. “I don’t remember the rep ever talking to me about anything related to methadone.”

“AstraZeneca’s policy is to promote its medicines in accordance with FDA-approved labeling and FDA regulations—our employees are required to follow our compliance policies,” said Bozarth, the company spokeswoman.

Seroquel first carried a warning label about drug interactions in the U.K. in 1997. Six years later, regulators in the European Union required similar labeling. In June 2011, the FDA told AstraZeneca to enhance the U.S. warning by advising doctors that use of Seroquel with drugs like methadone should be avoided.

The combination with methadone remains a concern among doctors, particularly because the heart risk isn’t well known, according to physicians who treat patients with addiction issues.

Detox facilities found Seroquel helped treat withdrawal symptoms in patients who had abused opioids. But people addicted to opioids also sometimes take the drug for its euphoric feelings.

“The problem is that some patients have learned that if they use more Seroquel than is prescribed, it can sedate them, it can numb their emotions,” said Stephen Delisi, a psychiatrist at Hazelden. He said he wouldn’t prescribe the drug unless all other alternatives failed.

The Kings County Medical Examiner listed acute combined methadone and quetiapine intoxication as the primary cause of Bradley Nebinger’s death, concluding it was an “accident.” A review commissioned by the family found that the doses he was prescribed were within a reasonable range and that there appeared to be no signs of intentional overdose.

The 269-pound Bradley suffered from knee pain for several years, and had searched for doctors who would prescribe him medications, his father said, a practice known as “doctor shopping.”

“He was a charmer. He could talk people into things,” said his father.

John Nebinger said his son’s life had brightened before he died. He hadn’t had a drink in two months and was about to graduate from community college. “Things were looking up.”

“Unfortunately, he always thought a pill was the answer,” Nebinger said.

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Quetiapine

Side effects

Not everyone will experience side effects with quetiapine, and most of the common side effects of this medication will go away or get better within a couple of weeks. If you think you have a side effect that has lasted longer than this, see your doctor to discuss possible alternatives to quetiapine.

Don’t stop taking quetiapine without consulting your doctor, as this can lead to withdrawal symptoms.

Very common side effects of quetiapine (affecting more than one in ten people) include:

  • dizziness, which may lead to falls
  • dry mouth
  • feeling sleepy
  • weight gain
  • unusual muscle movements

Common side effects of quetiapine (affecting up to one in ten people) include:

  • feeling like your heart is pounding, racing or skipping beats
  • indigestion or constipation (having difficulty pooing)
  • feeling weak
  • swelling of the arms or legs
  • high blood sugar
  • blurred vision
  • unusual dreams or nightmares
  • increased appetite
  • disturbances in speech or language
  • thoughts of suicide or worsening of your depression
  • shortness of breath
  • being sick (mainly in older people)

Young people are more likely than adults to get the following side effects:

  • having thoughts about hurting themselves or taking their own lives
  • increased appetite
  • higher blood pressure
  • movement disorders
  • higher levels of the hormone prolactin in the blood
  • feeling irritable

Body

Some studies have shown a risk of developing diabetes among young people taking quetiapine who have a family history of diabetes. This could be linked to putting on weight, which can also be a side effect of taking quetiapine.

Watch out for any early signs of diabetes. These include:

  • wanting to drink a lot
  • going for a wee a lot
  • feeling weak

If you are a young person who already has diabetes, taking quetiapine may affect your blood sugar levels.

Talk to your doctor and check your blood glucose levels regularly.

You may have to increase the dosage of the medication you use for your diabetes.

A side effect of quetiapine can be either weight loss or weight gain. Weight gain is more common than weight loss.

It is very difficult to know how it will affect each person who takes it, but if you start to have problems with your weight while taking quetiapine, talk to your doctor or pharmacist about this.

If you put on weight while taking this medication, and this bothers you, talk to your doctor about other similar medicines you could try. You could also discuss managing your weight through diet and exercise.

Sleep

In the first few days of taking quetiapine, you may feel extremely sleepy.

Taking quetiapine with alcohol or some other medicines could make this even worse.

If you have been taking quetiapine for a few weeks, and you feel very sleepy, you should go back to your doctor to see if there is something else that you can try.

Quetiapine can also cause sleep-talking, sleep-walking, and some people have done other activities while they were asleep, like eating.

You might also have strange dreams or nightmares.

Talk to your doctor if any of this worries you.

Sex and fertility

Sex

Quetiapine can have side effects that might affect your sex life. These should pass within a couple of weeks. If not, go back and see your doctor as there are other medications you can try.

Sexual side effects can include:

  • not feeling like you want to have sex
  • swelling of the breasts and (very rarely) some milk flow, regardless of gender
  • changes to your period
  • getting a painful erection that could last a long time (priapism). If this happens to you, seek medical advice immediately as it can be dangerous

Fertility
There is nothing to suggest that quetiapine affects fertility.

Pregnancy, post-natal and breastfeeding

Pregnancy

When deciding whether to take quetiapine during pregnancy it is important to weigh up how necessary quetiapine is to your health against the possible risks to you or your baby, some of which will depend on how many weeks pregnant you are.

Quetiapine is not seen as high risk and has a low rate of transfer across the placenta into a baby.

There does not appear to be an increased risk of malformations, miscarriages or having a baby born early.

From month four of a pregnancy onwards, an increase in dose of quetiapine may be required to keep body levels the same.
Quetiapine may slightly increase your chance of getting high blood pressure linked to pregnancy (pre-eclampsia), putting on extra weight and gestational (pregnancy-linked) diabetes.

To reduce the chance of a blood clot in your leg you may be advised to have a course of blood-thinning injections. Your doctor can advise you about this.

Post-natal

If you take quetiapine close to delivery your baby may have some side effects or discontinuation symptoms, like being irritable, crying or problems feeding and sleeping. These are usually mild and go away within a few days without treatment.

Breastfeeding

Quetiapine is passed in small amounts to the baby through breast milk. Breastfeeding may help with any discontinuation symptoms.

You should discuss the risks and benefits of breastfeeding with your midwife or doctor.

Remember that it is important for you to remain well while you are bonding with and looking after your baby. For this reason, it may be best to take medicine for your mental health when breastfeeding.

Make sure that your doctor, nurse, or health visitor checks your baby for any side effects.

If your baby was premature or has health problems, then you will need to be extra careful about taking medicines while breastfeeding. It may be best not to breastfeed if this is the case, but you should discuss this with your doctor or midwife.

Driving and transport

Taking quetiapine may make you feel tired or dizzy, and may affect your eyesight when you start taking it.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you.

Do not worry – most people drive as normal while taking quetiapine.

You must tell The DVLA (Driver and Vehicle Licensing Agency) if you have bipolar disorder, schizophrenia, schizoaffective disorder or other mental health conditions that could affect your driving.

You can be fined up to £1,000 if you do not tell DVLA about a medical condition that affects your driving.

You may be prosecuted if you are involved in an accident as a result.

School and exams

Try not to take quetiapine for the first time just before your exams.
You might feel very sleepy, have blurred vision or not feel as alert as usual.

You should talk to your doctor about any future exams if you are starting quetiapine.

You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start quetiapine to improve your motivation to study.

Do not worry – most people take exams as normal while taking quetiapine.

Friends and family

You may want to let your family and friends know you are taking quetiapine so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Sport

Quetiapine is not a banned substance in sport.

It can, however, produce a false positive test for methadone or tricyclic antidepressants on a urine drug screen.

You could also feel very sleepy, have blurred vision, or feel less alert when you start taking it. This might affect your performance in sports where you need a lot of focus.

You should not participate in sports where you need to focus until you know how quetiapine affects you.

Do not worry – most people play sports as normal while taking quetiapine.

Alcohol and street drugs

Alcohol

You can continue to drink alcohol while taking quetiapine, but having the two together might make you very sleepy.

During the first few days, it might be best to stop drinking alcohol until you see how the medicine affects you.

If you want to drink alcohol, remember that you might be sleepy and make sure you can get home safely.

Street drugs

Some street drugs can increase levels of dopamine in the brain (e.g. cocaine, cannabis, ecstasy). As antipsychotics block the effects of dopamine, the ‘high’ from street drugs may not be as ‘high’ as before. You may therefore be tempted to increase the dose of your street drug to make up for it, but this could be dangerous.

Cannabis and other drugs may have their own side effects on your mental health, like anxiety or psychosis. For more information, have a look at our drugs and alcohol page.

Some street drugs can make you feel sleepy and this could be made worse with quetiapine.

Quetiapine can enhance the effects of some street drugs and has itself been abused for this purpose. Do not share your quetiapine with anyone else.

Prescription medicines

Quetiapine does not mix well with some other medicines and drugs.
Always talk to the doctor if you are taking other medicines. Tell the pharmacist you are taking quetiapine if you buy medicines (including things you put on your skin) for common illnesses.

Other interactions

Do not drink grapefruit juice while you are taking quetiapine, as it can increase the amount of drug absorbed from the gut.

References and further reading

For more helpful links and information, have a look at our references and further reading page.

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