[PsychNurseWannaBe]

Ya know...I think I actually heard of this. But it was a long time ago. I can't remember it totally though. Something like a small dose will cause sedation without other high dose side effects... which are agitation, anxiety and restlessness.

I'm trying to rack my brain with this.

[IMustBeCrazy]

I suppose this would be best to back up with objective trial results, but I don't feel like googling atm.

I can say that in practice, *generally speaking and not accounting for age variables*, initially Seroquel tends to make people drowsy on low doses. Like another mentioned, after a few days the body often begins to develop a tolerance and the dose can be titrated up.

At higher doses, I often get comments from pts about how they feel "hung over" in the morning. Our MD's often do use a higher dose, usually anywhere from 100-600 (rarely) mg at bedtime. When asked they specifically state it's for "sleep". So, it is being used off-label for sleep at night in some places. Usually I see it used this way for patients that are 1) already on Seroquel during the day, 2) are polysub abusers or 3) extremely psychotic. Urinary retention can be a problem as well at these high doses.

Interestingly enough, I learned just recently that Seroquel is the #1 prescribed drug in any class in the U.S. So, it's probably good to have this discussion!

[elkpark]

Unfortunately, the docs (psychiatists) at the facility where I work very commonly rx Seroquel (purely) for sleep -- you'd think they could find something a little more benign to give as a sleeper ... There's no way on earth I would ever agree to take an antipsychotic to help me sleep (but, of course, most of our clients don't know any better and are happy to take any and as many drugs as they can get ...)

[New2ER]

For some reason, I'm wondering if the psychiatrist wasn't telling the patient this to try and discourage them from taking a lower dose of the med. Not necessarily ethical, but just a thought.

[drmorton2b]

50 mg of Seroquel at bed time-rational sleep, I see it everyday. This use is mostly used for the more agitated clients. Everyone else usually gets Trazodone, or benadryl for sleep.

[MedicalLPN]

Actually Seroquel is being used more and more for things other than mania, schitzophrenia, and psychosis, we're seeing it used for patients with nocturnal anxiety at a low dosage 25-50mg. Also between 200-400mg Seroquel can work really well for depression episodes in Bipolar Disorder.

[Wren54]

Dear friends,

This is my first post, excuse me if it's a bit wordy.

Anti-psychotic meds are used for their effects on the dopamine system, but they also have strong anticholinergic side effects. Along with dry mouth and constipation, they can cause quite a lot of drowsiness.

Now, dopamine is usually activating, so there is a tug of war with these meds between activating effects and sedating effects. When a med like Seroquel is given in low doses, the anticholinergic effects win. In higher doses, the dopimanergic effects win.

Seroquel is frequently used off label in low doses as a sleeping agent, so not every patient who takes this med for sleep has psychotic problems. A person can develop tolerance to the drowsiness, just like tolerance to Benadryl when it's used for insomnia. However, many take this medicine for long periods and find it very helpful for sleep.

And now, I'm going to catch some zzz's myself!

[edisonnurse]

I work as a psych nurse in an adolescent facility and I distinctly remember our medical director, who has been a psychiatrist for over 29 years, telling a patients family that very same thing...the lower the dose the more drowsiness the patient experiences. I myself also looked for the data on this and came up empty. Makes no sense logically, but it might just be true. I'll keep searching and if I come up with something I'll let you know.

[BoogiePop]

Found it! apparently Wren 54 was right, its because of the Histamine receptor. you can find the link here;

http://www.medscape.com/viewarticle/484929_8

or try http://en.wikipedia.org/wiki/Seroquel
and look on reference 15 at the end of the page


pretty interesting, wouldn't have thought it myself. Thanks for your replies.

[angel4gramma]

I take 600 mg of seroquel at bedtime. MD started it when I told them I hadnt slept in 3 days. I am bipolar and have depression. The dose started low and increased until I could fall asleep shortly after taking it. I kept stopping it cause I was too sleepy for work. Finally I was told I need to stick it out for 3 weeks. Now I can fall asleep but I am not sleepy in the morning.