Tips for tapering off Seroquel (quetiapine)

[Bluewisp]

I just tried the suspension in liquid. 25mg in 25ml and followed the video. I waited 4 hours for it to "dissolve" even if it's not really disolving. But there is a lot of particles dropped at the bottom, even by shaking, it's like if a lot of it is heavier than water. The water is still white so I probably got medecine from it, but I don't know if my 6.25ml contains really 6.25mg, even 6mg. It's kind of worrying. I should know the result pretty fast since insomnia strikes somewhere under 6mg. Usually, I know at 3am when my sleep is totally disabled and that I will not sleep at all of the night. Since we are in the week-end, it should not have too much consequences, but I can't do this more than 2 nights. I will have to sleep at least to work for monday. So in case of total failure, I will have to take 6.25 in solid form again before to find another way. I will just stay positive for now and hope for the best. I've also a worry that I may never be able to sleep again without seroquel, but well, in August when I tried cold-turkey from 50mg xr, the third night I was able to get one to two hours or sleep even if it tooks until 6am...So it was showing some kind of progress I guess, letting think it will not stay forever. But without 3 nights of sleep I was too broken to continue. I felt those 3 days like 3 weeks and I've decided to not screw my holidays anymore and wait later for another solution. At least I knew against what I was fighting. You know, I got not a trace of insomnia before, from 400 to 12.5. I got some at 6.25 "sometimes" because the cut cannot be straight and accurate, probably, so I must have maybe 4-5mg one day, 7 the other and 6 when I'm lucky... I think there is a trigger somewhere under 6.25 that disable sleep. I thought that if I was able to find it, for example at 5mg, I could wait above at 5.5mg some days, wait for it to vanish, and then go to 5, wait again, and finally get rid of this until 0. But seeing all those suspended particles, I'm worried for now.

[brassmonkey]

Seroquel has a solubility rate of 3.3mg/mL of water. So there should be  no problem with all the active ingredient dissolving into the water. The particles you are seeing are bits of filler material that no longer matter.

[Bluewisp]

41 minutes ago, brassmonkey said:

Seroquel has a solubility rate of 3.3mg/mL of water. So there should be  no problem with all the active ingredient dissolving into the water. The particles you are seeing are bits of filler material that no longer matter.

Reading this do me a lot of good. Thank you. I really hope it will work.

[Bluewisp]

I got a confirmation from a pharmacist that a liquid solution will likely to degrade in efficiency with days, that we don't know much also about efficiency in water. I'm at 1mg so efficiency is very important for stability. So the found solution is to prepare a new solution every day to be sure to have the same amount/efficiency of med each time (again suggested by the pharmacist). So I report it if it may help someone at tiny doses like me. Also, do we know if the 4h are really necessary for let the pill in water? I use 25mg, it spread very fast and I don't really have the time each day to prepare this 4h before taking it. 2h for example, would be easier, but I don't want to screw up the total suspension process. Do we know if it works under 4h for 25mg? Thanks.

[Emma86]

Tapering quetiapine, advice as taking XR.. how to taper in small amounts on XR? Switch to instant?

 

I’m on quetiapine 112.5 

I take 2 50mg Extended release and a quarter of the 50mg for the 12.5 which makes it instant. 
 

I need to taper down more, my Phyc has said to switch completely over to instant, I have always taken the XR and came from taking 400mg ! 
 

needing to do a slow taper and cut pills. 
some People say take one 50mg XR and the rest 25mgs instant and cut them. So it’s half and half … 

 

I take this at night.

any advice welcomed ! 
xx

 

Edited January 6, 2022 by ChessieCat
added topic title before merging with existing topic

[ChessieCat]

@Emma86

 

Have you read post #1 of this topic?

[Go2zero]

22 hours ago, Emma86 said:

I need to taper down more, my Phyc has said to switch completely over to instant, I have always taken the XR and came from taking 400mg ! 
 

You are used to XR release. In my opinion not a good idea to switch to instant release. Since you are not stable yet and since you are taking also the Lorazepam and Mirtazapine, I would not change any form of a drug you are taking. Keep everything as stable as it is. There is not one good reason to change from XR to instant release.

 

You can easily combine XR (50 mg pills) and add the extra needed dosage in instant release. In that way most of the dosage taken will remain XR. Keep things as most as possible stable during tapering.

[Bluewisp]

I've read somewhere in this thread that it can be a big hit to go from XR to standard. And I tested it myself. After the minimal XR pill, I switched to standard and got sudden muscle fatigue and pain in all articulations, so much that nothing could explain this otherwise. I was even not able to carry a backpack above 10min when normally, I was doing it often during all summer and for hours. It happened during the first week, and it was brutal. So tapering from XR itself is a kind of parallel taper it seems.

[ChessieCat]

I have moved posts about Emma's questions with the responses to Emma86's Introduction topic which you can find here:

 

 

[snowdog]

Somebody has ever tapering the XR version by dry cutting and using a scale? I'm going to taper 50 mg of quetiapine XR and see many places saying that it is not possible to cut these. I'm afraid of switch to IR and have more side effects because in the past I took 100mg IR and had blood pressure issues after take the dose. In the case of taking 25mg at night and 25mg in the morning, it can make more sleepy than with the XR during the day? Can I made something like  37.5mg at night and 12.5 in the morning and see if it works?

[snowdog]

I'm sharing a post I did in my presentations topic:

 

I found a simulator comparing XR vs IR blood concentration during the day in a scientific paper. I must say I didn't have the patience to read the article and just downloaded the code and made some adaptations for my dosage and adjusted the times to make the concentrations as close as possible. The X axis shows the time since the first dose you set in the simulator. Y axis show the concentration, based on a monte carlo simulation with the equations derived from real data collected from patients. The best curve for me is the curve where I divide IR in 4 doses, not in equal intervals. Source: https://www.mdpi.com/1999-4923/12/4/297

 

[Emma86]

@snowdog I’m very interested in what you’ve written here v been looking for more research in how to taper from XR when you are at 100mg or 50mg XR as like you say people say don’t cut it.. I have heard a couple of reports people cutting it and being ok but Iv also heard people not being ok. 
 

I’m on 100mg XR I’m incredible sensitive and damaged from a prior benzo withdrawal and now on 3 drugs any move I make I feel it. 
 

when I taper the XR I am thinking what is the best way? I was thinking to change to 1 XR 50 and the other 50 in instant IR and see how that lands for me and my body. I take it all at night… so then I thought to spread the IR maybe slightly earlier in the evening and the rest when I sleep. Like you say taking it in the day could make me sleepy .. Iv never taken it it in the day. 
 

I was thinking to just cut the XR as I am so sensitive to any changes and the IR pills are from a different brand, I have been sensitive to brand change before… so I’m cutting the XR pill it becomes instant abs I am then using the same pill I have done for my whole time on the drug.. 

 

so it’s such a tough decision… did you change from XR to IR? If so how was it? Have you tried cutting the XR … thank you 🙏🏻♥️
 

 

[snowdog]

Hi, @Emma86.

 

I still holding my quetiapine, since I still recovering from other drugs withdrawal. Since you are on 100mg, maybe you could change gradually, as you said. 50IR + 50XR, and hold. The full IR. But I think the best way is to divide the dose of the IR version during the day, according to my research.

 

I'm even considering to use a liquid version from a compound pharmacy, so I can make a microtaper.

[Emma86]

@snowdoghey sorry to hear your in withdrawal from others I know what that’s like! Yeah I’m thinking to do that one XR one IR. I take it all at night. You think I need to take it the next day? Like 50 at night and 50 in the day.. 

 

hard to know, as dosing in the day may make me very tierd… 

 

 

[snowdog]

@Emma86it's a trial and error method. Maybe you could use only 25mg of the IR version during the day. I really don't know, it will be a adventure for me too.

[Emma86]

@snowdog good luck! 
 

im going to try to take the IR parts a little earlier before I go to bed.. as so far Iv been taking all of this at night.. see how that feels 🙏🏻 if it’s not working I’m going to take in the morning a bit. I will be cutting my XR pill as I’m so sensitive a brand change of an IR pill could really swing me off track. So far if I try change the brands it destabilises me, as my brand doesn’t come in IR of course! They don’t make it easy! To get off this horrid stuff! 
 

il let you know how it goes! 
Emma  

[RobertZ]

I've come across something that may be helpful for us inadvertent Seroquel addicts:

 

"(...) For drugs with short half-lives or “fast off” characteristics, like clozapine or quetiapine (supplementary table S12),¹⁰⁵ with reputations for quicker onset of psychosis following withdrawal, more caution may be required and it may be necessary to reduce doses by 2.5–5 percentage points of D₂ (or cholinergic or histaminergic) occupancy every 6–12 weeks, depending on individual responses (see supplementary material)."

 

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266572/

 

Seems like monthly 10% reductions could still be too steep for some of us.

 

[Emma86]

Hey guys so I thought I’d add here that I cut the quetiapine 50mg XR it’s been 5 days I’m ok … I spread it over the evening as I take 100mg XR all at once at bedtime. 
 

so I cut one 50 XR took a bit at 10.30

11.30

12.30 

 

I have not experienced much appart from a blocked nose and bit of a headache on the first night xx 

 

im on mirtazipine also 25mg and 0.125mg benzo. 
 

but it appears cutting a 50mg XR is not bad.. and saves you changing your pill totally to a different pill or different brand which for some is not ok! 
 

 

 

[Cheeky]

Hey everyone, 

Does anybody know the Sert of Seroquel?

[JohnBrodie]

hey all

 

How's it going with your tapering off seroquel?

 

I'm down to 25mg from 100mg in December last year and now considering a water taper from here.

 

Its been great reading all the information in these 5 pages!

[RobertZ]

On 11/14/2014 at 5:25 AM, CosmicMinds said:

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

 

It has minimal D2 blockade at the very low doses. While this doesn't make it an effective antipsychotic, it might still be relevant for avoiding supersensitivity psychosis or TD because of the short half life.

Quetiapine dose (mg)	D2 occupancy (%)
1200	38.0
1000	36.3
800	34.1
600	30.9
400	26.1
200	17.8
100	10.9
50	6.1
25	3.3
0	0

Table S8a Commonly used doses of quetiapine and their D2 occupancy. Based on an Emax equation derived from data in Lako et al(2013)(5).

 

The table is from https://academic.oup.com/schizophreniabulletin/article/47/4/1116/6178746?login=false (supplementary table S1)

 

On 11/14/2014 at 5:25 AM, CosmicMinds said:

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

 

I take it once every 24 hrs too and haven't noticed interdose withdrawal.

 

 

[Blackm0zart]

Okay, I’ve been prescribed three 25mg tablets so I can begin taking one 25mg tablet whole and suspend the second in liquid, making 5% reductions to my dose. My dosage is currently 50mg at night. What should be my exit dose? How long should I hold, 4-8 weeks? What is the safest way to measure the doses and are there any problems regarding the generic form of seroquel? Thankfully at 50mg it is no longer an antipsychotic or mood regulator and only acts as an antihistamine. If I tried to stop taking seroquel today I wouldn’t be able to sleep, like most people attempting to stop. I feel very relieved knowing I’ve made it this far, I’d like to quit taking this pill for good. 

Research explaining why Seroquel acts as a different drug at different doses:

 

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

 

https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp-rj.2022.180207

[Vancouver1986]

Hi all,

 

I have a few questions that I asked in my thread about my 50mg I.R. Seroquel Taper.

 

#1: I read on this forum that going from pills --> all liquid may be rough as your nervous system is used to pill form/liquid form may mess with the potency. And the rate of absorption, which can have very serious implicafions to your nervous system and the taper itself. So, to use as many pills as possible. Ex: start with one 25mg pill, three 3/4 pills (6.25mg each), & the rest liquid. (& then remove a 1/4 as time goes by when it's needed).

 

Did I read this correctly? Easpecially with Seroquel I.R., since the half-life is only 6 hrs. My Pristiq's 1/2-life is a touch better at 11hrs. And it has an extended-release hard coating.

 

#2: I read on this forum that as you go further and further into your taper the % drop from the last dosage in mg/mL needs to be smaller and smaller. The only issue is that I plan to do an extremely slow taper over like 4.5 yrs. I have pictures in my thread of how little of a reduction in mg/mL I want to start off with. There's a reason for this and for not doing -5% (or even -2.5% or -1%) of the two 25mg pills or liquid bottle.

 

My past 11 attempts of tapering off 50mg Seroquel I.R. since July 2021 were: histamine overload (now I know), serotonin muckery (limbic system distress), and almost Psychosis 3 of those 11 times. Various of medical professionals didn't once mention a liquid taper and only had me try a taper by removing 1/4 of one of the two small pills. I now know that's a -12.5% reduction. I also tried this many times at home due to not knowing about a liquid taper. All of those missed shifts ($), wasting fuel and wear/tear on my car driving to the walk-in clinic or admitting myself to the hospital due to withdrawal symptoms, etc.