Question about Seroquel

[BoogiePop]

Is it true that the less mg you recieve of seroquel, the more drowsy you get? I remember a psychiatrist once telling this to a patient but I couldn't find any objective data on the internet or in the PDR.

[nightmare, RN]

You can be very drowsy on low dose of seroquel to start with but then most patients develop a tolerance to it and the drowsiness goes away.Also the dose usually has to be increased because of the tolerance.

[BoogiePop]

I understand this, but what I need to know is if a low dose of seroquel, is more potent for sleeping that a high dose.

[nightmare, RN]

Seroquel is not a sleeping pill! It is used for episodes of mania and schizophrenia.

[BoogiePop]

yes. I also understand is not an hipnotic nor an ansiolitic. The thing that this patient was complaining that the seroquel 400mg that he was receiving was making him sleepy, and ask the psychiatrist to lower the dose. that was when the psychiatrist told the patient that lower doses of Seroquel were more likely to cause him drowsiness than higher doses.

[nightmare, RN]

Well one of it's side effects is drowsiness,I've never heard of that but have seen plenty of patients drowsy when commenced on it.They are usually started out on a lower dose and I have seen it reduced because of excessive drowsiness but this is in the elderly when absorption can be problematic.

Have looked in the BNF and do not see that in cautions etc.

[BoogiePop]

I think she is wrong. Can't ask her today cause she's not in here today. However I wanted to make sure nobody else had heard anything. Thanks anyway, and if someone else knows anything else it will be appreciated.

Who knows maybe she just want it to get her off her back.

[nightmare, RN]

Hope you find your answer.

[Blackcat99]

My 86 year old mother has alzheimer's and use to be awake all night "just wanting to talk" not needing anything. The doctor started her on Seroquel and finally she started sleeping at night. The doctor had to keep increasing her dose to get good results. She is now on 250mg every night. If it wasn't for seroquel my mom would have ended up in a nursing home. I am so very grateful that her doctor finally found something that worked for her.

[medpsychRN]

A lower dose of seroquel is not going to increase sedation. I don't know why the MD would say this.

[PsychNurseWannaBe, BSN, RN]

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!