Seroquel

[Spirit]

Hi all, Zooie, I used to take Propranalol for high blood pressure.
Guy, I'm sorry you're feeling so down. Finding the right meds is difficult at best. Please keep on keeping on to get the right "cocktail" for you so that you can feel better. Hope you've seen you're psychdoc by the time you read this post. We're all rooting for you. Please keep posting.
Luna, I get restless feet sometimes, and what helps me is to put them up on a footstool and that calmss them down somewhat. I haven't been able to tell what causes it. It's intermittent.

[guy]

Hi well a follow up to my appointment.... the doc agreed that if i had gone to hospital they probably would of tranquilised me and sent me into a coma.... great hey

I think i am going to have to try and see someone weekly for awhile though the 45 buck fee out of my 150 a week is a bit crippling.
whinge whinge.
felt like we talked over a few issues though.
and my mood is slowly starting to improve- thanks to all for the support

[Luna]

all i am is a costly maintenance exercise with no value

Guy, this is so totally not true and is definitely the BP talking. (Uhh, and I recognise it all too well from every one of my own depressions!) Like Zooie says we ALL have our value, our role. Never forget you are unique, just like everyone else! (had to throw that in; it's funny but it is also very profound.)

Zooie (and whoever else is interested) I asked "Cybershrink" about the akathisia. Cybershrink is a retired psychiatrist who has been employed by health24.com to answer readers' psychiatric questions, specifically in South Africa. He is a great person and has the wisdom of someone who has lived through so much. He gives great advice and is very re-assuring. Here is the exchange:

My question:
Subject: Akathisia or restless legs syndrome

"Dear CS
A birdie told me you’ve been at a conference, hope it was interesting!

Seroquel has worked remarkably well for my (horribly treatment-resistant) bipolar depression, so much so that I feel ready to tackle life outside my front door again -yay! I’ m also on Lamictin, Wellbutrin and tapering off from EfexorXR 300mg, now at 75mg.

I think there is problem with the Seroquel, though. I’ve never understood the difference between restless legs syndrome and akathisia, (can you give me any idea?) but I have one of them. It comes on every night about 90mins after I have taken my dose, 400mg, and is gone by morning. It’s really bad I bolt out of bed, there is no way I can lie still, I have to pace, I get anxious, bordering on panicky and feel as if I have to get out of my body to get away from it. The muscles in my legs particularly, feel as if I have to cut them open to release the tension inside. No matter how tired I am, I am way too restless and anxious to do anything but pace. And of course I cannot lie down to go to sleep. It’ s truly ghastly.

It’s been about a week, at first fairly mildly, but the last two nights unbearably so. I researched a bit and read that anti-histamines can be used for this. I scouted around and found some cinnarizine and took 2 – which mercifully made it go away. The following day I tried to get diphenhydramine from the pharmacy (which is what is really recommended in what I read) but it isn’t made in SA, so I was given Allergex. But this made no difference, and it still raged after 4 tabs. Then I added one cinnarizine and after a while it remitted and I finally fell asleep.

I feel hesitant to disturb my pdoc over the weekend, (and silly that I didn’t phone last week, but it wasn’t this bad.) Do you think it is safe to keep taking cinnarizine until I can speak to him on Monday? Or can I reduce or stop the Seroquel? Or is it reasonable to try and get hold of him today? I’ve read that the early appearance of akathisia is associated with earlier onset of tardive dyskinesia (yeah, I know, a little bit of knowledge is a dangerous thing!) and that and the prospect of a repeat performance tonight and every night, is really scaring me. I’m afraid to take tonight’s dose. This feeling has to be the MOST awful side-effect there is! In the past it has always has been a deal-breaker, the med gets the boot, but Seroquel works SO WELL I’m in a bind. Is this dangerous? – should I be stopping immediately?

And I guess I am also asking if this is serious enough to disturb my pdoc today?"

And his answer:

"Yep, (conference was) interesting and useful other than atrocious catering at the Southern Suns Grayston.

Pleased to hear that the revised medications, including Seroquel, are proving more effective.

Restless Legs syndrome arises on its own, without you needing to take any meds at all to achieve that status (and there's a recently released med that may help relieve it). Akathisia is a drug side-effect, and doesn't only affect legs, and may include an irritating sense of restlessness apart from any muscle movements.

From your description, the symptom may be related to peak blood levels of the drug, and maybe your doc can work out a plan for smaller doses taken more than once a day, maintaining a slightly lower average level, without the main peak that may cause the discomfort.
Diphenhydramine , originally sold as Benadryl, is on sale over the counter, sometimes as a sleep aid, in a number of countries. In South Africa it was I hear sold as Betasleep, and as a Schedule 2 med. I haven't heard of it being unavailable. It was produced by Restan laboratories. And if the cinnarizine rids you of the symptom, couldn't your doc provide a prescription for that ? Allergex contains chlorpheniramine.

As for TD, well, many instances of TD may start with Akathisia among other symptoms, but most cases of Akathisia do not progress to TD. Cinnarizine through till Tuesday may not be a problem. But this is one of those annoying situations, where only your doc can be sure whether you should call him, and only after calling and bothering him, might you be certain there was no need to do so.

If Seroquel is helping so much, let's rather find a way to minimize the symptom by dosage re-arangements, and to get rid of the symptom with a med that relieves it. "

[Zooie]

Dear Luna,
Wow, that was informative! Thank you for posting it. The only problem personally is that I'm allergic to antihistamines! They cause real bad heart palpitations and I was told not to take them.

Anyway, I wish you well in dealing with your RLS/akathesia. Mine was very minimal last night, I have lowered my Seroquel to 150 on my days off (my work day dose). Thanks again for posting your results, will be anxious to hear what your pdoc does.

[guy]

G'day all, well I think i have overcome the seroquel, od now i have to adjust to the overall lack of antyspcyhotic meds after more than seven years on them, my brain is struggeling.

i wrote to the local public hospital to try and get some information about what types of services they can offer me as in or outpatient. as i am feeling like death one moment and then possbible glimpses of things i can do,

it looks like my law degree will go down the drain though:-( as once again another semester of study is stuffed up by meds.

beam me up scottie, im ready for the next life

[Luna]

... The only problem personally is that I'm allergic to antihistamines! ...

There are other drugs. As Spirit mentioned propanalol (Inderal) can be used (also used as a hypertension med). I was just scouting for something I had in the house that night as it was already late, and I found the anti-histamines!

Thanks again for posting your results, will be anxious to hear what your pdoc does.

Okay. He said to try going down to 300mg in the evening and see how that works out. Then he said another option would be to try 50mg mornings, 50mg lunchtime and then either 200 or 150mg in the evening.

300mg is not going to work if taken all in one dose. I tried it today, taking it around 14:30 as I just can't handle the dreadful restlessness in the evening. Just 4 or so hours of it this afternoon convinced me of that. But the 200mg has been fine. So it remains to be seen how awake I can stay on 50mg morning and lunch and then the 200mg in the evening.

Does anyone know if it's okay to split the plain Seroquel tablets (not the XR)? I have 200mg tabs, so I cut them in half with a pair of scissors. But they have a thin coating on them, so I wondered. Tomorrow I'll try the 3 x day dosing. I really struggle with remembering to take midday meds and forget the Wellbutrin SR 150mg dose too often. It's easier to remember when I'm home, but how do any of you manage to remember lunch meds if you're out and about?

[Zooie]

Luna,
You wrote: "but how do any of you manage to remember lunch meds if you're out and about?"
I used to use one of those little pill holders, they're great if you have to take meds when you're not at home.

That's interesting what your pdoc said. I sure hope it works for you. About cutting the pills. I am in no way an expert about what happens if you cut a pill that is coated, but I do it. Mine are 300mg, which is too high, so I use a pill cutter and take half. My regular doc did tell me tho that meds lose their "potency" if cut up and left too long (not taken right after you cut them I guess), so I only cut mine every other night. There are probably people reading this that are appalled at this, but I can't afford to have one RX for 200mg, one for 300mg, and one for 50mg or 100mg. You might ask your pdoc for samples in those doses (if they come in them, I don't know, I only have 100mgs and 300mgs on hand, and I cut both). Seems like I remember that pills that are coated are because it protects the stomach? Don't remember.

Thanks for posting what he said, and good luck on getting a dosage program that works!

P.S. I LOVED your other post about mania! (BIG LOL)

[Muddler]

Luna, I'm a great pill cutter - I'm always tuning my doses. One can actually get little pill cutters at the pharmacy. I'm on my second. I haven't noticed anything negative from it. Really don't know how you cut the Seroquel with scissors!

[Luna]

Luna,
You wrote: "but how do any of you manage to remember lunch meds if you're out and about?"
I used to use one of those little pill holders, they're great if you have to take meds when you're not at home.

Um... I do have one of those. There is one 'box' for each day, and each box has 4 compartments, for morning, noon, supper and bed times. It's easy to take that day's compartment with me, but... um... What I'm asking is, if you have your mind on work or whatever, how do you actually remember getting them from the pill holder into your mouth...?

Really don't know how you cut the Seroquel with scissors!

I assure you it isn't a very accurate science... but it's been all I have had. I asked at the pharmacy for a pill cutter once, but they didn't sell them. Perhaps a little pharmacy phone-around on Monday is in order.

I also googled 'splitting seroquel' and it seems it's quite common for people to split their Immediate Release. Not the XR version.

(Even the 200mg last night gave me akathisia, so today I've taken 50mg morning, 100g lunch and will take 150mg tonight. Maybe this'll also reduce the morning hangover a bit (?) Let's not even discuss the headaches from hell. )

[Zooie]

I'm so glad the smaller doses throughout the day is working to stop the akathesia, Luna. I'm so afraid to try that, 'cause Seroquel knocks me out so bad, but admit I've never tried it. May experiment on my days off. I could cut my 100mg to 50mg for the morning, then take only 100 at night. That would be heaven to stop the RLS AND the coma-like state I get into sometimes. I'm always so sleepy in the mornings tho. We'll see. But good luck to you!

When you get the pill cutter, if you have a big Seroquel pill to cut, sometimes the razor thingy comes out, just push it back in the slot. I've had mine for a while now and it's hanging in there!

As far as actually remembering to take the dose...hmmm, well, over the years I've just applied a rigorous approach to knowing I can't live without meds and I just take the darn things, whenever and wherever! Hope that helps some?

Have a nice day.

[Luna]

I got a pill cutter! It looks as though it would be really accurate, with the little blade an' all, but It's actually less accurate than I thought it would be. Ye olde scissor-technique wasn't so bad after all! - I'm getting about the same accuracy with both. Zooie, the trick is to make sure that the blade part of the scissors is carefully positioned dead in the middle and that you cut quickly. But I like my new toy and sit happily and cut Seroquel 200mgs in half and then again into quarters. Then I sit and happily sort and partition them and all the other drugs into my 4-a-day, 7 days-a-week (28 compartments!) pill organiser. I really need to get a life. As soon as I've had a sleep.

This Seroquel dosing is damn difficult. I have to take 300mg per day. 50-50-200 works during the day, but even the 200mg gives me RLS at night, so that I have to get out of bed and pace until I am so groggy I fall over. That's much later than my usual bedtime, so there goes that routine. I have to stay vigilant and keep moving with the RLS or I get into a panic. I've tried 75-75-150 which was much better as far as the RLS was concerned, but I was so groggy all day. I'm in a catch-22.

Ideally I would like to take all 300mg at night, but I'd be in nightly panics. UNLESS he adds a Rx for the RLS. I'm so way beyond thinking it untenable to take another med just for the SEs of the first; as long as I'm stable, just bring it on. Of course I would then go back to waking with a Seroquel hangover... You can't win.

[Zooie]

Hey Luna, glad you got the pill cutter! But don't cut too many in advance. Like my regular doc says, pills lose their potency if cut and left too long (don't know what "too long" is tho). Anyhoo. I might try the scissor method on the 300mg horse pills, mine always get stuck up in the pill cutter.

Also, I think you know about propanolol (think it's a blood pressure pill) helping with the RLS/akathesia. You might check with zaniac (Jeff) about that, he's on Seroquel and propanolol. (He posts under Personal Stories, almost 1 year clean). I meant to ask him if he takes that for akathesia.

Anyway, good luck with the dosage!

[Luna]

Zooie - thanks for the advice I remember you writing about the loss of potency of cut pills somewhere else, so I only do about 2 days' worth at a time. But then I have to remember that I still need to add the Seroquel before I take my meds on the following days. All too often I just think I've done them all, empty the compartment, swallow and go. Hey, there's always some problem to moan about.

I had forgotten about the propanolol. Great idea. I'm going to ask about that, next appt. Then perhaps I can take the whole 300mg at night. Last night's 150mg cost me about 2 hrs sleep, having to get out of bed to handle the RLS. I'm OVER this.

[Zooie]

First, I'm half asleep, so hope I get all this posted correctly (typing from notes). I forgot to get the complete web site but it's probably easy to find. Anyway, I thought the following was VERY interesting:

The United States patent for Seroquel doesn't expire until 2011. However, it has already expired in Canada (generic name is quetiapine fumarate). I found a web site in Canada (Northwest Pharmacy.com) that sells (for example) 100 pills of 100mg Seroquel (generic) for $19.99!!! Their phone number is 1-866-539-5330. Worth checking out!

[Luna]

Zooie, don't you have problems with those at Customs? Or is it just in South Africa that they're so vigilant? They catch all the books and DVDs that I have ordered from outside the country, and make me pay tax.

Does anyone else have difficulty swallowing, a blocked nose, and headaches on Seroquel? I'm not complaining, I'm just saying...