From the Guidelines
Quetiapine (Seroquel) should be gradually tapered rather than abruptly discontinued to minimize withdrawal symptoms and potential relapse of the underlying condition. The recommended procedure typically involves reducing the dose by 25-50% per week under medical supervision, as suggested by general clinical guidelines for discontinuing psychotropic medications 1. For example, if someone is taking 300mg daily, they might reduce to 200mg daily for one week, then 100mg daily for another week, then 50mg daily before stopping completely. The exact tapering schedule should be individualized based on the current dose, duration of treatment, and patient response. During the tapering process, patients should monitor for withdrawal symptoms such as insomnia, nausea, headache, dizziness, irritability, or return of original symptoms. Some patients, particularly those on higher doses or with longer treatment duration, may require an even more gradual taper extending over several months. This gradual approach is necessary because abrupt discontinuation can cause rebound effects due to neurochemical adjustments that occurred during treatment, particularly involving dopamine and serotonin receptors. Patients should maintain regular contact with their healthcare provider throughout the discontinuation process and report any concerning symptoms promptly. Key considerations in the tapering process include the patient's history of treatment, the presence of any comorbid conditions, and the potential for withdrawal symptoms or relapse of the underlying condition, as noted in guidelines for managing psychiatric medications 1. It's also important to consider that some patients may require a more gradual taper due to individual factors, such as age, medical history, or concomitant medication use. In all cases, the goal of the tapering process is to minimize the risk of withdrawal symptoms and relapse, while also ensuring the patient's safety and well-being. Regular monitoring and follow-up with a healthcare provider are essential to achieve a successful discontinuation of quetiapine.
From the Research
Discontinuing Seroquel (Quetiapine)
Discontinuing Seroquel, also known as quetiapine, requires careful consideration and a gradual tapering approach to minimize the risk of withdrawal symptoms and relapse.
- The process of stopping antipsychotics, including quetiapine, may be causally related to relapse, potentially linked to neuroadaptations that persist after cessation, including dopaminergic hypersensitivity 2.
- Gradual tapering of antipsychotic medication is recommended to reduce the risk of relapse and withdrawal symptoms 2, 3.
- A study on quetiapine withdrawal syndrome suggests that tapering the dose can provoke severe withdrawal symptoms, including nausea and vomiting, but pretreatment with domperidone may help prevent these symptoms 4.
- The recommended tapering method involves reducing the dose gradually over months or years, with reductions becoming smaller and smaller in size as the total dose decreases, at intervals of 3-6 months, titrated to individual tolerance 2.
- Some patients may prefer to taper at 10% or less of their most recent dose each month, and final doses before complete cessation may need to be as small as 1/40th of a therapeutic dose to prevent a large decrease in D2 blockade when stopped 2.
- Withdrawal methods, such as gradual tapering, can affect outcomes, and people who withdraw gradually across more than one month may be more likely to stop and avoid relapse during withdrawal 3.