[RealNurseWitch]

Last night I cared for a woman whose diagnosis was chest pain (I am, for the time being, STILL in Med-Surge ). She was a new admit, so I was getting all of her home meds clarified and in order, and... this woman takes 900 mg's of Seroquel at bedtime every night! And, according to my drug book and our pharmacist, the DAILY maximum is 800 mg's! So, I called her attending MD and told him about the dosage and asked him if he had ever known anyone to be on this high of a dose and he was like, "No... is she SURE that's how much she takes?" But yes, she was, and that's what the label on her bottle said also. Apparently she had been on 600mg's for a little while but after some stressful events which threw her into a tailspin and made her moods unbearably labile... her psychiatrist and psyche NP upper her dosage to 900mg.

The attending MD did end up OK'ing the dosage. He seemed rather reluctant to.

I asked her if her psyche MD had been monitoring her pretty carefully... having her blood drawn every visit... she said yes.

But... how dangerous is this? As long as she is having regular checks of liver and kidney function, checks for EPS's... is this okay? Wouldn't the doc look for other alternative meds, seeing as how she was already getting a RATHER high dose of Seroquel before (600 mg's) and it wasn't working?? Have any of you ever seen anything like this?

:gandalf:

[lovinghands]

I've seen a few pts on 900 mg of Seroquel. The highest dose that I've seen is 1500 mg which the pt was slowly tapered off of after admission. Many of our docs believe Seroquel is mislabeled as an antipsychotic - seems to work better on mood, impulsivity and sleep.

[LoriAlabamaRN]

Wow... I have never heard of a dose that high either. I think that the most I have given is 450mg.

[StuPer]

Seroquel if I remember rightly is another of the newer antipsychotics that the manufacturer has been pointing out the 'advantages' increased off-range doses. In my mind it seems the newer antipsychotics have been promoted as having a big reduction in side-effect profile compared to the older antipsychotics, and in fact this is true. However what the drug companies have been slow to acknowledge is that the newer antispychotics come with their own set of serious side-effects, which can be equally as debilitating as the older ones.
Both Seroquel and Risperdal have been subtley promoted as being suitable to go off-range in certain circumstances (I have attended drug rep presentations where they showed research to this effect).
Personally I have seen little evidence of good efficacy in Seroquel, however it does appear to work well as a sedating agent and I have seen psychiatrists prescribe it the same way as they would prescribe Largactil, and yes I too have seen it up around the 900mg mark.
regards StuPer

[Orca]

That dose sounds a little high to me.

[KR]

Hello to all u psych nurses. I am a 6 yr veteran to ICU. However, I am rapid cycling bipolar as well. At one point, I was on 1200mg of seroquel. Now I am on 900 mg of seroquel. Along with that I take, 12 mg ambien, 200mg of lamictal, 25mg of doxepin, and 100mg of zoloft. I have to take all of these at once before bed time or I won't sleep at all. Sad part is that I have been on many more drugs and such. I am on my third psych doc and I have no faith in any of them. But that is discussion for another thread. Just chiming in that I have seen doses higher than that.

[blugreeneyez]

That is not that unfamiliar in the psychiatric setting. We give 1000 mg at times. If we could only get it in a form of an injection which they are currently working on to giv IM for patients that are out of control and unable to be redirected. I think this is a giant step in the psychiatric community. Seroquel is also been studied and proven to reduce cravings in an addict as well as stabilization of moods with bipolar disorder. The trick is getting the patients to stay on thier meds once they are released from the hospital.


blugreen

[nursekathi]

I have given 1200mg to teens in my residential facility as a hs dose, with smaller doses throughout the day.

[Meerkat]

Yes, and don't forget, antipsychotic can cause changes in the heart!

[MadRedneckRN]

I have a patient who takes 1500 Seroquel, 30 Ambien, 2 Klonopin and 1 Ativan every night. He is still able to walk around an hour later!!!! Ya gotta wonder how much meth, crack and heroine he was doing on the streets